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Obsessions and Compulsions
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Obsessions are recurrent and persistent thoughts that are viewed as intrusive (that is, coming up unexpectedly), unwanted, and inappropriate. These thoughts also bring up considerable amounts of anxiety and distress. In fact, obsessions can be so distressing that they even bring on panic attacks (Steketee and Barlow 2002). In addition to thoughts, obsessions can also take the form of impulses (intense desires or urges to engage in some kind of behavior) and images that unexpectedly come into a person’s mind (APA 2000). In exercise 9.1, we provide some common obsessions (Baer 2000; Steketee and Barlow 2002). Obsessions can really be about anything, so this is not an exhaustive list, but it might give you some idea of the different types of obsessions that can develop. Check off any that you experience. You can also provide some of your own if they are not on the list. In completing this list, keep in mind the definition of obsessions that we provided previously. As we will discuss, it is actually quite common to have some of these thoughts from time to time. Focus instead on thoughts that are persistent, distressing, and intense and that interfere with your life.
Exercise 9.1 What Are Your Obsessions About?
Mark all that apply.
| Fears about being exposed to germs or dirt | |
| Concerns about being exposed to bodily fluids that may transmit certain illnesses (for example, HIV, hepatitis C) | |
| Concerns about having or developing a particular disease (for example, cancer) | |
| Concerns about eating food that could be contaminated, leading to illness or an allergic reaction | |
| Concerns about being exposed to environmental toxins (for example, radiation, lead) | |
| Fears that you might accidentally or impulsively physically harm yourself in some way | |
| Concerns that you will do something to either accidentally or impulsively hurt someone else | |
| Fears that you might be unable to control your behavior in front of others (for example, shouting out swear words, writing rude comments in an e-mail) | |
| Blasphemous thoughts (for example, lewd or angry thoughts toward some religious figure) | |
| Fears of being possessed by some evil force | |
| Thoughts about sexual acts that are illegal, looked down on, or considered lewd (may include concerns about acting on these thoughts) | |
| Concerns about sexual orientation even though you have no reason to doubt your sexual orientation | |
| Fears of death or dying, or of doing something to bring on another person’s death | |
| Desires for symmetry and order (this may include things in your environment and how you appear to others) | |
| Concerns about not being perfect in your speech or writing (for example, having to say or write things the “right” way) | |
| Anxiety about throwing away or losing something of value | |
| Fears of losing another person, such as your child | |
| Doubting your actions (for example, doubting that you turned the iron off even when you remember having done so) | |
| Extreme difficulties in making a decision for fear of making the wrong choice | |
| Fears related to superstitions (for example, breaking a mirror, crossing the path of a black cat, needing to knock on wood) | |
| Believing that certain objects, colors, numbers, or images convey significant information about something that will or could happen | |
| Do you have other obsessions? List them. | |
| 1. 2. 3. 4. 5. 6. 7. 8. |
“Compulsions” can refer to behaviors or mental activities that occur in response to an obsession. People often feel that they have no choice when it comes to compulsions. They may feel driven to engage in some kind of compulsion. Compulsions may be viewed as rules that have to be followed to avoid severe consequences (APA 2000). Compulsions are intimately tied to obsessions. They are a way of neutralizing obsessions or relieving anxiety stemming from an obsession. For example, a person who has an obsessive thought that they might accidentally throw away or lose something of sentimental value may not throw away anything. This may include things that the person logically knows don’t have sentimental value, such as newspapers, grocery bags, and food containers. This type of compulsive behavior (hoarding) helps alleviate any anxiety stemming from the possibility that something of sentimental value might be accidentally thrown away.
In exercise 9.2, we provide a list of compulsions that people can experience (Baer 2000; Steketee and Barlow 2002). As with obsessions, we want you to focus on those compulsions that result in considerable distress and interfere with your life. Don’t include compulsions that occur infrequently or are easy to resist.
Exercise 9.2 What Kind of Compulsions Do You Experience?
Mark all that apply.
| Excessive hand washing, bathing, showering, or frooming | |
| Excessive cleaning of your house or other valued objects (for example, your car) | |
| Behaviors focused on preventing contamination (for example, wearing gloves, not touching doorknobs or mail, refusing to use public restrooms) | |
| Frequent and persistent checking of locks, appliances, alarm systems, and so on | |
| Checking your body or someone else’s to make sure you did not harm it | |
| Frequent checking to make sure you did not make a mistake on something, such as homework or bills | |
| Repetition of basic activities, such as turning a light switch on and off and over again | |
| Needing to do things in a certain order or a certain number of times (for example, having to touch a door five times before opening or closing it) | |
| The need to repeatedly go through an entry, such as walking through a doorway or entering a building over and over again | |
| Extreme organizing behavior to make sure everything is perfectly aligned or in perfect order | |
| Counting (for example, counting floor tiles or other objects in your environment) | |
| Having to do certain behaviors in a certain order, such as when getting dressed in the morning, preparing a meal, or eating a meal | |
| Excessive religious activities, such as praying | |
| Repetition of certain phrases or words when talking or reading | |
| Seeking constant reassurrance | |
| Saving items that you do not really need (such as newspapers and mail) | |
| Collecting items that you find or come across, such as pieces of glass that you find on the street | |
| Having to do something over and over again until you feel that you’ve done it “just right” | |
| Needing to touch certain objects | |
| Repeated behaviors stemming from superstitions (such as knocking on wood) | |
| Needing to bring up certain thoughts or engage in other mental activities to counter bad thoughts (for example, mentally reciting a poem or stating some phrase) | |
| Do you have other compulsions? List them. | |
| 1. 2. 3. 4. 5. 6. 7. 8. |
Now that you have a better understanding of the types of obsessions and compulsions you experience, let’s briefly talk about the anxiety disorder that these symptoms are a part of.