Almost everyone occasionally double-checks whether the door is locked or the stove is switched off. With obsessive-compulsive disorder, however, thoughts, doubts or rituals take up so much space that they can significantly impair everyday life. Those affected often know themselves that their fears or actions seem exaggerated. Nevertheless, the internal pressure cannot simply be turned off by willpower.

What are obsessions and compulsions?

Intrusive thoughts are recurring thoughts, images or impulses that force themselves upon a person unintentionally and are experienced as distressing. For example, they can relate to contamination, responsibility, mistakes, order, sexuality, religion or the fear of harming oneself or others.

Compulsions are repeated actions or mental rituals intended to reduce anxiety, uncertainty or a feared event. These include, among other things, frequent checking, washing, counting, ordering, repeating, mental neutralising or repeatedly seeking reassurance.

Compulsions can also be invisible

Not all compulsions are visible from the outside. Some people mainly perform mental rituals. They check memories, repeat certain phrases in their minds, analyse their feelings or try to neutralise a distressing thought with another thought. Constantly asking others for reassurance can also be part of the OCD cycle.

Because many sufferers are ashamed of the content of their thoughts, symptoms are sometimes concealed for a long time. An appreciative and non-judgmental conversational framework is therefore particularly important for diagnosis and therapy.

How does the compulsion cycle develop?

Compulsive behaviours do not stem from unreasonableness. Initially, they fulfil a comprehensible function: they are intended to reduce anxiety or uncertainty. However, it is precisely this short-term relief that can stabilise the cycle.

Over time, more and more situations can become incorporated into this routine. What initially takes up a few minutes can increasingly dominate the daily schedule. Relatives sometimes unnoticeably become part of the system when they take over monitoring, offer reassurance again and again, or adapt their own routines to fit the compulsion.

Do intrusive thoughts mean an actual intention?

Distressing intrusive thoughts are often experienced as so frightening precisely because their content contradicts personal values. A thought is not automatically a wish, an intention or an action. For a professional assessment, however, it is important to carefully distinguish between thoughts, impulses, actual intentions and potential risks.

The attempt to forcibly suppress a thought or to gain complete certainty about its meaning can focus attention further upon it. Repeatedly checking whether one feels secure enough can also become a ritual. In therapy, a different way of dealing with uncertainty and internal reactions can be developed.

Are compulsion and addiction the same thing?

Obsessive-compulsive disorders and addictive disorders are clinically distinct conditions. Nevertheless, individual mechanisms can be similar. In both, intense inner pressure, repetitive behaviour, a sense of limited control and short-term relief can play a role.

In the case of compulsions, the behaviour often serves to neutralise anxiety or prevent a feared consequence. In an addiction, depending on the type, the foreground is characterised by factors such as craving, reward, habituation, or the avoidance of withdrawal and unpleasant feelings. In individual cases, the boundaries cannot be drawn solely on the basis of a single behaviour.

Compulsions and addictions can also occur together. Some people try to regulate tension or distressing thoughts with alcohol, medication, nicotine or other behaviours. Therefore, a detailed medical history takes into account not only the obsessive-compulsive symptoms, but also substance use, medication, other psychological stress and physical illnesses.

What can provide psychotherapeutic support?

At the beginning, the focus is on understanding the personal symptoms in detail. Which thoughts, situations and feelings trigger the compulsion? Which visible or mental rituals follow? What is avoided? To what extent are daily life, relationships and work affected? Previous coping attempts, resources and personal goals are also part of the anamnesis.

Cognitive behavioural therapy and exposure

Cognitive behavioural therapy with exposure and response prevention is particularly well-researched scientifically. This involves a carefully prepared approach to feared situations or thoughts. The usual compulsive action or neutralisation is either not carried out or is reduced step by step. This allows the experience to emerge that tension can subside even without a ritual and that uncertainty can be tolerated.

Exposure does not mean confronting those affected unprepared with maximum anxiety. Planning, transparency, a viable therapeutic relationship and individual resilience are essential. Mental rituals and reassurance behaviours must also be recognised so that one visible action is not merely replaced by another safety mechanism.

Further aspects of the treatment

Depending on the severity, relatives can be involved and comorbid conditions treated alongside. Medical treatment may also be an option and should be managed by a doctor. If distressing experiences or internal images are significantly contributing to the current symptoms, EMDR can also be considered as a supplementary measure after careful evaluation. However, EMDR does not automatically replace the disorder-specific procedures recommended for obsessive-compulsive disorders.

In my private practice in Bad Schwalbach, I offer psychotherapeutic appointments either in person or online. Which approach is professionally appropriate in any individual case will be clarified together after a detailed case history.