What if I don't do any compulsions?

The single most common reaction of my clients to my initial diagnosis of OCD is “But I don’t do any compulsions!”  

Many individuals, including mental health practitioners, have a very limited definition of what qualifies as a compulsion.  

Most are able to identify obsessive thought but then many mischaracterize or simply miss the ritualistic behavior that aims to short-term neutralize the obsessive fear.  

This fundamental misunderstanding of compulsions led to a pop psychology concept of “Pure O” where therapists elevated the concept of only obsessive OCD.  

Nonetheless, if the diagnosis is truly OCD, then the compulsions must exist.  “Pure O” is an empty and meaningless term.  

One compulsion that routinely gets missed is avoidance.  The difference between compulsive avoidance and simply letting something slide is the tremendous amount of mental effort that goes into the task that we are avoiding.  

Choosing not to fly somewhere because of OCD fears may involve hours of rumination on plane crashes, guilt over not visiting one’s family across the country, and even rituals of buying tickets and then canceling them when the OCD gets overpowering.  

Avoidance rarely puts something out of our minds, but rather elevates the obsessive thinking.  We expend effort to avoid.  

Compulsions are also misunderstood to be primarily physical (like tapping, hand washing, checking locks) while most OCD individuals experience mental rituals.  Even something like checking a lock can actually be a ritual that is fully performed in one’s head.  Scanning a memory and reminding oneself of an action can be a compulsion.  Or even picturing the locked door in our minds! 

Compulsions are varied and complex, and are the single most misunderstood concept in OCD.  

If you struggle with OCD, please consider working with a therapist specially trained in OCD Treatment.