The OCD Cycle: What It Is & How to Break It

What Is the OCD Cycle?

The OCD cycle consists of four stages: obsessions, anxiety, compulsions, and temporary relief. Often called a vicious cycle or feeling stuck in an OCD thought loop of “wrongness,” once the OCD cycle is established, it can be hard to break out of. The individual with OCD associates the temporary relief from compulsion as the only way their anxiety decreases. The next time a person’s intrusive thoughts are triggered, they are more likely to perform a compulsion to get rid of their distress.^{1, 2}

Here are the four stages of the OCD cycle:

Stage 1: The Cycle Begins With an Obsession

OCD obsessions are unwanted, recurring, intrusive thoughts that cause a lot of distress. OCD obsessions are triggered by different things for different people. Some triggers may be external, such as 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 obsessions, it is important to observe what triggers set off your OCD cycle to improve awareness.

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: For the symmetry OCD 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: Checking OCD obsessions focus on the fear of being responsible for something bad happening, forgetting or losing important things, or making a mistake.

Stage 2: The Obsession Causes Anxiety

Although the content of obsessions varies from person to person, all obsessions are based on uncertainty, such as “What if I catch a virus from touching the doorknob?” or “What if I cannot stop thinking about my heartbeat?”. The uncertainty causes immense anxiety and distress.

Additionally, many individuals with OCD have obsessions that are immoral or highly taboo. For example, incest obsessions or postpartum obsessions. Because these obsessions do not align with the person’s moral compass, their anxiety is further heightened.

Stage 3: The Anxiety Leads to Compulsions

While in the cycle of OCD, a person with OCD turns to their compulsions as an attempt to cope with the high levels of anxiety they are experiencing. Compulsions can be behavioral, such as checking the doorknob, but compulsions can also be mental, such as mentally reviewing a scenario over and over again in your head.

Common mental compulsions include:

• Mental reviewing: Going over past events, conversations, or actions in one’s mind to check for mistakes and proof that one’s worries are not true.
• Seeking reassurance from oneself: Obsessively reassuring oneself that the obsession is false and that everything is okay or that a feared event will not happen.
• Counting: Repeatedly counting certain numbers, objects, or actions.
• Praying: Repeating specific religious phrases or prayers.

Common behavioral 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 obsessively seeking reassurance from friends, family, and mental health professionals.
• 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.

Stage 4: The Compulsions Provide Temporary Relief

After a compulsion is performed, a sense of relief from anxiety is achieved. However, the relief a person feels is always temporary until the next obsession occurs. At this point, the OCD cycle starts over again.

Feeling relief after performing a compulsion is the key reason a person becomes stuck in the OCD cycle. The more a person performs a compulsion, the more they reinforce their brain into thinking that the only way they can feel better is by performing their compulsion. Therefore, the next time an obsessive thought triggers anxiety, the more likely the person will be to engage in compulsive behaviors.

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 break 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:

Seek Professional Treatment

The best way to break the OCD cycle is to begin OCD treatment. Exposure and response prevention (ERP) is considered a first-line treatment for OCD because research has repeatedly shown it to be the most effective way to stop compulsions.⁴ Medications for OCD may also sometimes be recommended, along with other types of behavioral therapies. Remember, every individual is unique, and it is important to find a treatment plan that works for you.

Treatment 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.
• Medication: SSRIs are the most commonly prescribed medication because they can help reduce the anxiety that obsessions cause.⁵ If a person’s anxiety is lower, they are more able to resist their compulsive urges and break the OCD cycle.
• 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): Many obsessions are rooted in a sense of uncertainty (i.e., “What if I harm my child?” or “What if I am a pedophile?’ which can cause a feeling of unease. ACT for OCD can help someone to accept 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.
• Eye movement desensitization and reprocessing (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.

Practice Mindfulness & Meditation

Mindfulness can help break the OCD cycle by encouraging individuals to observe their thoughts and feelings without judgment. This approach allows people with OCD to experience intrusive thoughts without feeling ashamed or guilty. This will reduce the anxiety they feel and make them less likely to perform compulsive rituals.

Additionally, mindfulness exercises like meditations for OCD and breathing exercises for anxiety can regulate the nervous system. This can help someone to reduce the anxiety they feel when their obsessions are triggered and make them less likely to use compulsions to cope. Mindfulness also encourages a person to stay in the present moment, as opposed to ruminating about the past or worrying about the future. This awareness combats many OCD mental compulsions.

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 and asking for help in your OCD recovery process is as important as professional support. If you are struggling to find support in your personal life, there are many different support groups for individuals with OCD that can act as a source of comfort and camaraderie.

How to Find Professional Support

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.