What Are Mental Compulsions?
In Obsessive-Compulsive Disorder (OCD), compulsions are repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession or according to rigid rules. These compulsions aim to reduce anxiety or prevent some dreaded event, even though they are often not logically connected to the feared outcome or are clearly excessive.
Since this is such a pervasive issue, I’ve made two comprehensive and self-guided worksheets on this topic. There are certain response patterns to anxiety or intrusive thoughts (aka obsessions) that can actually make the problem worse. The way one responds to an intrusive thought is called a “mental compulsion”.
For example, if someone with health anxiety had an intrusive thought about whether or not a new freckle they see is cancerous (such as “Hmmm, I notice this new spot on my arm is darker than the rest, what if that is a sign of skin cancer?”) they might respond to that with a physical (called “overt”) compulsion, like checking the internet for articles on how to tell if something is skin cancer, but they also will respond with mental compulsions.
Mental compulsions sound like endless reasoning, rationalizing, or analyzing something that you are anxious about. This occurs more often than physical compulsions (because your thoughts are always present and we can’t escape them), but often gets overlooked in treatment because it’s harder to spot the pattern, or they often get confused with an obsession.
Mental compulsions are how you respond to an obsession. With the earlier example, you think to yourself, “Well, that can’t be skin cancer, because I went to my dermatologist just the other month and he said everything was fine”.
OCD and anxiety is too smart for this rationalizing and it will throw you in an endless loop when OCD responds with “But what if your dermatologist missed this spot? But what if in the past month you have formed skin cancer? How long does skin cancer even take to form? What if I had it before but now there’s physical signs?” and you will try to quiet those thoughts with more reasoning and rationalizing, only to get thrown further into the cycle of rumination. This is a mental compulsion. There are a few helpful ways to respond to anxiety or an intrusive thought and one way is a practice called “non-engagement responses” (see worksheet under OCD resources for examples).
If you offer logic or rationalizing in response to OCD or anxiety, it will double down on you. It will ask “but how do you know that isn’t skin cancer” and the only truth is, we don’t know in that moment. Sure, you could visit your dermatologist every month to check, but that also would be fueling a compulsive behavior.
The only answer to compulsions whether they are physical or mental is to embrace uncertainty. This might sound simple, but when OCD or anxiety makes something feel like life or death (like the thought of having cancer), this is a skill that takes time and practice. Being okay with saying to your anxiety “I don’t know if that is cancer or not, I’ll just have to wait and see at my next scheduled appointment,” (as anyone would) might feel very challenging.
Going up against OCD without giving it the response it demands is also challenging. However, you don’t have to be stuck in endless rumination and mental compulsions forever, that is the good news!
