Obsessions are unwanted, intrusive, and persistent thoughts/urges/sensations that create significant distress, anxiety, and doubt. Obsessions trigger such painful emotions because they are ego-dystonic. That is, they contradict your beliefs and how you see yourself.

While everyone experiences unwanted thoughts, they only become obsessions when you’re unable to let go of them. Whereas people without OCD perceive their intrusive thoughts as insignificant, OCD sufferers appraise them as dangerous and worthy of attention. It’s this consistent evaluation of intrusive thoughts as meaningful that increases their occurrence, causing them to become stuck on a loop.

Obsessions typically show up in the form of “what-if” questions, such as “What if I lose control and harm someone?” or “What if my partner isn’t the “right” person for me?” Because these types of thoughts create overwhelming doubt and despair, people with OCD feel driven to perform rituals, so that they can gain control over them and prevent a feared outcome.

The content of someone’s obsessions typically centers around one or many themes, commonly referred to as the subtype(s). Common OCD subtypes are harm (to self or others), contamination, relationship, “just right”, pedophilia, sexuality, symmetry, scrupulosity, existential, real event, and sensorimotor.

Regardless of your OCD subtype(s), a high degree of painful emotions will invariably follow your obsessions. If you have OCD, you may think that your unwanted thoughts or anxiety is the problem. However, it’s your negative judgment of your thoughts along with your urgent need to eliminate uncomfortable emotions that fuels your OCD.

If you struggle with OCD, you also likely believe that your negative feelings signal something bad may, in fact, happen. This thinking error fuels your belief that your intrusive thoughts are important and merit an exploration. In your quest to prove to yourself that your fears won’t come true, you resort to engaging in compulsions.

Compulsions are repetitive mental or physical behaviors that you feel compelled to do to reduce the anxiety and uncertainty created by your obsessions. Most people with OCD can acknowledge that their compulsions are irrational. However, despite this awareness, they are unable to resist engaging in rituals, only intensifying their distress, and contributing to feelings of shame and depression.

Some notable examples of mental rituals are ruminating (i.e., analyzing, figuring out, worrying), neutralizing, suppressing intrusive thoughts and self-criticism. Some examples of physical compulsions include checking, doing things in multiples, washing, cleaning, and arranging things until it “feels right.” In addition to mental and physical rituals, asking others for reassurance and avoiding places, people, or things are also compulsions.

After performing compulsions, you feel temporary relief and an increased sense of certainty regarding the theme(s) of your obsessions. This results in people with OCD associating rituals with alleviation of pain, in turn strengthening their perceived need to perform compulsions. Because your improved mood and increased sense of control is always short-lived, you must now take on more and more rituals to achieve the same level of relief and sense of certainty.

The more that you rely on compulsions to feel better, the more that you reinforce the obsessions and the subsequent painful emotions, and the more powerful the OCD cycle becomes. As a result, OCD sufferers spend considerable time performing rituals. This leads them to neglect critical areas in their life, such as relationships, work, school, and personal care.