Understanding the Obsessive-Compulsive Disorder (OCD) Cycle
Imagine a typical evening where you’re preparing dinner. As you set the table, a nagging thought surfaces: Did you turn off the stove? Despite remembering doing so, doubt takes root. Visions of a potential fire and its consequences plague your mind. This discomfort compels you to repeatedly verify the stove’s status. Such episodes, where doubt leads to action, exemplify the OCD cycle.
Obsessive-Compulsive Disorder (OCD) is a mental health disorder defined by an enduring pattern of obsessions and compulsions1.
- Obsessions: These are persistent, unwelcome thoughts or images that induce significant distress. Unlike everyday worries, obsessions are often irrational and disproportional2. For instance, after locking your front door, you might still be consumed by the notion that it’s unlocked, leading to the fear of potential theft or intrusion.
- Compulsions: These are repetitive behaviours or mental acts an individual feels driven to perform in response to an obsession. While these actions might seem excessive to outsiders, for the person with OCD, they provide temporary relief from the distress. Using the previous example, compulsively checking the door lock multiple times—even in the middle of the night—would be a compulsion.
The continuous loop of this cycle can dominate an individual’s daily life, often leading to a significant amount of time being spent on these behaviours and thoughts.
The Four Stages of Cycle of OCD
- Obsessions: Wide-ranging in nature, obsessions can focus on cleanliness, safety, order, or even more abstract fears like offending someone. What’s common is their intrusive nature. They can be challenging, especially when they clash with your beliefs or self-image. For instance, a devout person might be tormented by blasphemous thoughts, even though they deeply respect their faith.
- Anxiety: Resulting from the intrusive obsessions, this anxiety isn’t just everyday worry. It’s an escalating, overpowering feeling. It convinces the individual that the obsessive thought has a high chance of becoming reality. This is known as thought-action fusion and you can read about it here.
- Compulsions: These are the coping mechanisms developed to counter the anxiety. They might seem logical initially, like double-checking a stove. But as OCD intensifies, these actions can become more ritualistic and less connected to the original fear, such as avoiding certain numbers or colours believed to be “unlucky” or “dangerous.”
- Temporary Relief: The compulsions bring about a short-lived respite from the anxiety. But this calm is fleeting, as newer obsessions soon emerge, and the cycle begins anew.
I’m going to give a couple of examples from my clinical practice to help bring the cycle of OCD to life.
Case Study: Tom
Background: Tom, a 35-year-old teacher, has always been a cautious person. Recently, he’s been having troubling thoughts about germs and getting sick, which have started to take over his daily life.
Obsession: Every time Tom touched a doorknob, tap, or any public object, he’d worry he was picking up harmful germs. He would vividly imagine getting severely ill, even if he just touched a clean surface.
Anxiety: These thoughts made Tom anxious. He’d get a sinking feeling in his stomach, picturing himself bedridden or in a hospital. This fear was constant and started to affect his mood and energy.
Compulsion: To calm his fears, Tom began washing his hands excessively. He’d scrub them for several minutes, multiple times an hour, ensuring he used a lot of soap. Sometimes, he’d wash them until they were red and raw.
Temporary Relief: After washing, Tom would feel a bit better, thinking he’d gotten rid of the germs. But this relief was short-lived. The next time he touched something, the cycle of fear and hand-washing would start all over again.
Impact on Life: Tom started avoiding public places to minimize touching things. He declined invites from friends, stopped going to the gym, and even took days off work. His hands were often sore from overwashing, and he felt trapped in a cycle of fear and ritualistic hand-washing.
Seeking Help: Seeing the impact on his life, Tom decided to get help. He started therapy where he learned about OCD and how it was causing his fears and behaviors. With guidance, he was gradually exposed to touching objects without immediately washing his hands, teaching him to manage his fears. Over time, Tom began to regain control over his life, reducing his hand-washing and facing his fears head-on.
Breaking Tom’s story into the components of the OCD cycle:
- Every time Tom touched a doorknob, tap, or any public object, he worried he was picking up harmful germs, leading him to visualise getting severely ill.
- These thoughts produced significant anxiety in Tom, a sinking feeling that he might become seriously sick from the germs.
- To alleviate this anxiety, Tom began washing his hands excessively, scrubbing them for extended periods multiple times an hour.
- Temporary Relief:
- After washing his hands, Tom would feel a temporary relief from his anxiety, thinking he’d gotten rid of the germs.
This sequence of Obsession → Anxiety → Compulsion → Temporary Relief constitutes the OCD cycle. For Tom, the cycle restarts every time he touches something he perceives as potentially germ-infested.
Case Study: Sheila
Background: Sheila, a 26-year-old journalist, is passionate about her work. Recently, however, she’s been struggling with a particular concern that has been disrupting her daily routine.
Obsession: Every time she sends an email or submits an article, she becomes consumed by the thought that she might have written something offensive or made a terrible mistake, even if she had proofread her work multiple times.
Anxiety: These thoughts induce significant stress in Sheila. She starts to feel nervous, imagining her colleagues laughing at her mistakes or her boss reprimanding her for an oversight. This anxiety becomes a dark cloud overshadowing her confidence in her work.
Compulsion: To counter her fears, Sheila develops a routine. She re-reads her emails and articles multiple times before sending or submitting them. Sometimes, she would even delete and rewrite entire sections, just to be “extra sure” there weren’t any errors. Even after sending, she’d continuously check her sent folder, rereading her emails to confirm she hadn’t made any mistakes.
Temporary Relief: After her meticulous checks, she feels a brief moment of calm, thinking she’s ensured her work is error-free. However, this peace is momentary. The next piece of work she has to send brings the whole cycle of doubt and checking back into play.
Impact on Life: Sheila’s productivity at work starts to decline. Projects that used to take her a few hours now stretch over days due to her constant checking. She becomes hesitant to share her ideas in meetings, fearing they might be flawed. Her sleep suffers, as she often lies in bed, replaying her day’s work, wondering if she missed any errors.
Seeking Help: Sheila’s close friend, noticing her stress and changed behaviour, suggests she see a therapist. In therapy, she learns about the OCD cycle and realises her checking behaviour is a compulsion resulting from her obsessive fears. With her therapist’s guidance, she works on strategies to manage her obsessions without resorting to her compulsive checking. Over time, with effort and support, she starts to rebuild her confidence and find balance in her work again.
The components of the OCD cycle:
- Sheila becomes consumed by the thought that she might have written something offensive or made a mistake in her emails or articles.
- These thoughts induce significant stress , making her imagine worst-case scenarios like colleagues laughing at her mistakes or her boss reprimanding her.
- To counter her fears, shere-reads her emails and articles multiple times before sending. She checks her sent folder repeatedly to confirm she hasn’t made any errors.
- Temporary Relief:
- After her meticulous checks, she feels a brief moment of calm, thinking she’s ensured her work is error-free.
This sequence of Obsession → Anxiety → Compulsion → Temporary Relief forms the OCD cycle. In Sheila’s case, the cycle repeats every time she has to send an email or submit an article.
Breaking Free from the Cycle
The root of the OCD cycle is a mix of heightened anxiety and the compelling need to alleviate it.
- Acceptance: One of the initial steps towards recovery is recognizing and accepting the thoughts without succumbing to the compulsions. The Exposure and Response Prevention (ERP) therapy adopts this approach. Here, individuals are safely and progressively exposed to their triggers, teaching them to manage their reactions. Read more on ERP.
- Embrace Uncertainty: Life is inherently uncertain. For someone with OCD, this uncertainty can be a trigger. Instead of seeking absolute certainty (like checking twenty times if the window is closed), it’s therapeutic to embrace the possibility of not being entirely sure.
- Avoid Reassurance-Seeking: Continuously seeking validation, like asking someone repeatedly if everything’s okay, only strengthens the cycle. It’s essential to cultivate self-trust.
- Mindfulness Meditation: Regular mindfulness sessions help individuals stay rooted in the present, reducing the grip of past obsessions or anxiety about potential future ones.
- Medication: Some individuals benefit from medications that regulate neurotransmitters implicated in OCD. Consulting a psychiatrist can provide clarity on this front. You can read more about medications on MayoClinic.
The key to breaking free from OCD is the understand the OCD cycle. Once you see how the things you do to ease your anxiety, i.e. compulsions are in fact responsible for keeping it going, you can start to recover. How? Therapy teaching you how to confront your obsessions, without giving in to the urge to perform a ritual (compulsion.)
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA ↩︎
- Ruscio, A. M., Stein, D. J., Chiu, W. T., & Kessler, R. C. (2010). The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Molecular Psychiatry, 15(1), 53-63 ↩︎