Although the content of obsessions and compulsions can vary from person to person, there is a common cycle that most people with OCD experience. The cycle consists of four parts: An obsessive thought, an increase in distress, usually in the form of anxiety, engaging in compulsive behavior to decrease this distress, and temporary relief.
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What Is the OCD Cycle?
For those with OCD, obsessions and compulsions generally occur in a cyclical pattern. An obsession can cause distress, and a compulsion is performed in response. Over time, an individual with OCD associates the temporary relief from compulsion as the only way their anxiety decreases. This causes the pattern of compulsions to become reinforced over time and, therefore, continue the cycle because of the anxiety relief that follows compulsive behaviors.1
Once this OCD cycle is established, it can be hard to break out of. The longer someone is in this cycle, the more reinforcing it becomes and the harder it is to break. The frequency of experiencing these cycles varies depending on the person, their specific symptoms and the severity of their OCD symptoms.
Stages of the OCD Cycle
The OCD cycle has four parts that occur usually after experiencing an OCD trigger. It is often called a vicious cycle or feeling stuck in an OCD thought loop of “wrongness.”2 Researchers have found by examining brain scans that, even when people with OCD recognize the need to stop these behaviors, this loop prevents them from being able to do so.2
The four stages of the OCD cycle are:
1. Obsession
Obsessions are unwanted, recurring, and cause a feeling of distress. They may take the form of thoughts, images, or impulses. An obsession sometimes occurs in response to a trigger, which could be external, like something in the environment, or internal, such as a body sensation. The content of these obsessions varies depending on the type of OCD.
Common types of obsessions include:
- Contamination obsessions: Contamination OCD obsessions focus on the fear of germs or contracting and spreading illness. There are two main groups of contamination obsessions: Disgust-based, which fears discomfort of feeling unclean or dirty, and harm-based fears, which focus on fear of being contaminated by something.3
- Harm obsessions: Obsessions in harm OCD consist of fear of harming yourself or others you care about. Intrusive, violent images may occur with this type of OCD.
- Symmetry obsessions: In this subtype, obsessions focus on the need for sameness, to order things, or to be even.
- Forbidden thoughts obsessions: Multiple themes fall within this subtype, such as pedophilia OCD and scrupulosity OCD. At its root, obsessions of this type are focused on thoughts considered taboo, such as intrusive, unwanted sexual thoughts or thoughts about morality and religion.
- Checking obsessions: These obsessions focus on the fear of being responsible for something bad happening, forgetting or losing important things, or making a mistake.
2. Anxiety
Although the content of obsessions varies from person to person, a high level of distress is associated with obsessions across all persons with OCD. Once an obsession arises, a high amount of anxiety occurs as the next step in the cycle of OCD. Rather than riding out this wave of anxiety, those with OCD turn to the next step in the cycle: compulsions.
3. Compulsion
While in the cycle of OCD, compulsions are then utilized to decrease the high anxiety an individual experiences. Compulsions may take the form of observable behaviors or mental rituals. Over time, someone with OCD starts associating these compulsions with the ability to calm their anxiety, reinforcing the drive to engage in compulsive behaviors even more.
Common types of compulsions include:
- Contamination compulsions: Compulsions in contamination OCD involve taking measures to avoid disease or contaminants. Some examples include excessive hand washing, ritualized or excessive showering, or repetitive and excessive disinfecting and sterilizing of items in the home.
- Harm compulsions: With harm OCD, the compulsions focus on preventing or ensuring harm does not occur. Examples would be staying away from sharp objects, checking that you did not run someone over while driving, or asking for reassurance from others that you didn’t cause harm.
- Symmetry compulsions: Symmetry OCD involves compulsions that focus on ordering things a specific way, such as lining items up, repeatedly fixing objects until they are even or symmetrical, or positioning items with even spacing.
- Forbidden thoughts compulsions: The compulsions for this type can vary based on the specific theme of forbidden thoughts. Some examples include avoiding being around children, avoiding any media that discusses sex, and seeking reassurance from outside sources.
- Checking compulsions: Examples of checking compulsions would include checking to see if the door is locked repeatedly, checking the stove/oven, and repeatedly reviewing to see if you did or did not do a task.
4. Temporary Relief
After a compulsion is performed, a sense of relief from anxiety is achieved. Because relief often comes after a compulsion, these behaviors become reinforced as the main way to achieve this sense of relief. However, this relief is temporary until the next obsession occurs again. At this point, the OCD cycle starts over again.
Treatment For OCD
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What Triggers the OCD Cycle?
OCD cycles are triggered by different things for different people. Some triggers may be external, something in the environment that causes an obsession. Other triggers may be internal, such as a memory, thought, or body sensation. Because each person may have unique triggers, it is important to observe what triggers set off your OCD cycle to improve awareness.
How to Break the OCD Cycle
Although it may feel impossible to break out of the OCD cycle once it’s established, there are ways to do so. The two most researched ways to seek help for OCD and break this cycle are through therapy and medications. Other strategies can help support breaking OCD thought loops, such as practicing mindfulness, seeking support from others, and becoming more comfortable with uncertainty.
Here are some strategies for how to break the OCD cycle:
Therapy for OCD
Therapy is considered a first-line treatment for OCD and can be highly beneficial in breaking the OCD cycle. At the start of therapy, your therapist will obtain a history of your symptoms and your goals for treatment. They will assess your specific symptoms of OCD and explore how the cycle of OCD plays out for you.
Therapeutic options for OCD include:
- Exposure and response prevention (ERP): ERP for OCD has been identified as the gold standard treatment for OCD due to its effectiveness.4 ERP helps break the cycle of OCD by participating in exposure exercises to provoke the feared obsession while not engaging in compulsive behaviors. This helps break the association between compulsions being viewed as the only way to achieve relief from obsessions.
- Cognitive behavioral therapy (CBT): CBT helps explore the connection between thoughts, feelings, and behaviors. CBT for OCD specifically attempts to break the link between obsessive thoughts and compulsive behaviors that are used to reduce distressing feelings, therefore breaking the cycle of OCD.
- Acceptance and Commitment Therapy (ACT): This approach emphasizes enhancing psychological flexibility to help break the OCD cycle. ACT encourages an individual to find alternative ways to respond to the distress caused by obsessive thoughts other than engaging in compulsions.
- EMDR: In EMDR for OCD, the main focus is lessening present-day distress that occurs with the obsessions. This approach traces back the root of this distress to desensitize and reprocess past events contributing to present OCD symptoms.
What is the best therapy for OCD?
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Medication for OCD
Medication may sometimes be recommended for OCD, depending on the severity of symptoms. The kind of medications often prescribed for OCD are known as selective serotonin reuptake inhibitors (SSRIs). Medications for OCD can help reduce the distress associated with the cycle of OCD, making it easier to break. If anxiety is lower, this can help an individual resist engaging in a compulsion to reduce distress.
Commonly prescribed medications for OCD include:5
- Escitalopram
- Fluvoxamine
- Fluoxetine
- Paroxetine
- Sertraline
- Clomipramine
Practice Mindfulness & Meditation
Implementing mindfulness regularly has been shown to have a positive impact on OCD, particularly when in combination with meditation for OCD and other therapeutic approaches.6 Mindfulness emphasizes awareness of the present moment and letting thoughts, emotions, and body sensations pass without judgment. By taking this approach to obsessions that occur, it can help reduce the distress associated with them.
Seek Out Social Support
Being stuck in the OCD cycle can be isolating like you’re going through this alone. Reaching out to social support can be beneficial to help this. Sharing with your support system how your OCD cycle impacts you can help you feel less alone. Joining a support group of other individuals with OCD can also help build your support system.
Learn to Accept Uncertainty
Many obsessions are rooted in a sense of uncertainty, which can cause discomfort and a feeling of unease. Another way to help break the cycle of OCD is to become more comfortable with the feeling of uncertainty and any related emotions that come up with it. As uncertainty-related distress decreases, so will the drive to perform compulsions.
Grounding Skills
Obsessions can be future-focused and bring up fear of what possible outcomes could occur in the future, often negative. Learning and using grounding techniques can bring you back into the present moment rather than fixating on the future. Grounding skills can also help you cope with the anxiety that occurs with obsessions.
When to Seek Professional Support for OCD
Professional support can help you break the OCD cycle, making it a crucial first step in treating OCD. This is particularly important if you have noticed your symptoms becoming more unmanageable, feeling stuck in this cycle more often, or if it has started affecting you in important areas of your life. Using an online therapist directory and searching for a therapist specializing in OCD can be a beneficial place to start. If you prefer to seek treatment at home, consider the NOCD app for online therapy or searching for OCD treatment through an online therapy platform is another option. Online OCD resources can be another great place to start when considering your support options.
In My Experience
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