Why Do Obsessions and Compulsions Develop?

Just like some of the other symptoms of anxiety that we discussed, such as worry, obsessions and compulsions (as strange as they might seem) do serve some kind of purpose. In actuality, the world can be a dangerous place, and to some degree, we are always at risk of some kind of harm. For some people, the uncontrollability and unpredictability of life and all of its unknown dangers is very difficult to tolerate. This may be particularly true for someone who has experienced a traumatic or very stressful life event, a situation that often increases fears of uncontrollability and unpredictability. In fact, there is some evidence that OCD may develop after such events (Cromer, Schmidt, and Murphy 2007). Obsessions and compulsions develop in an attempt to establish some sense of controllability, predictability, certainty, and safety.

For example, let’s say that a mother frequently involuntarily imagines her child dying from drinking some household cleanser. Obviously, this image will be quite distressing, and even if the probability of its happening is very low, the mother, of course, will be motivated to make sure it doesn’t happen because, even with the very low chance that it could happen, she doesn’t want to risk it. Therefore, she engages in some compulsive behavior to make sure her child is safe. She may constantly check the caps of cleansers to make sure they are secure. She may organize cleansers in a certain way so that the more harmful ones are out of her child’s reach. She may also frequently check on her child to make sure he is okay and has not ingested anything. All of these actions provide a feeling of control and predictability, reducing her anxiety. The problem is that these feelings of reassurance are fleeting. The image will probably keep popping into her head, increasing her need to engage in certain compulsions.

Before we move on to specific DBT skills for obsessions and compulsions, it is important to understand how your obsessions and compulsions work together. In exercise 9.3, we would like you to write down some obsessions that you have. Look back to exercise 9.1 if you need help identifying some. Then, identify the behavior or mental act that occurs in response to the obsession. Use exercise 9.2 if you need some help identifying specific compulsions. Being more aware of how your obsessions and compulsions work together will help you identify ways in which you can break that connection and come up with healthier and more effective ways of managing the anxiety that comes from your obsessions.

Exercise 9.3 What Compulsions Follow Your Obsessions?