When someone is dealing with obsessive-compulsive thought patterns, they are not necessarily struggling with obsessive-compulsive disorder (OCD). Someone may prefer that things are in a certain order or double-check that the door is locked before leaving the house. These behaviors can be considered healthy under most circumstances.

But when these obsessive-compulsive thought patterns evolve into full-fledged mental rituals that diminish quality of life, OCD might be the issue. If you or someone you care about may be struggling with OCD, below is everything you need to know about how OCD mental rituals work and the role they play in recovery.

What Is an OCD Ritual?

An OCD ritual—also called a compulsion—is any safety strategy used in response to the feared consequence produced by an obsession. Obsessions are best understood as incorrect predictions that eventually morph into a focal point of the individual’s daily life.

Of course, nobody wants to feel fear or anxiety about a possible negative event. In many instances, people avoid these thoughts, but people diagnosed with OCD try to reduce or eliminate their obsessions by performing rituals. Rituals and compulsions can be either mental or physical, but they generally follow prescribed rules and are repeatable.

Types of OCD Mental Rituals and Physical Rituals

Rituals can be physical, mental, or both, but most fall under one of four categories:

1. Repeating actions
2. Decontamination rituals
3. Ordering and arranging actions
4. Reassurance-seeking and checking rituals

OCD Mental Rituals vs. Physical Rituals

Mental rituals work similarly to physical rituals. With physical compulsions, the individual diagnosed with OCD takes actions like washing their hands or checking locks to decrease the anxiety produced by their obsession.

Similarly, mental rituals involve an individual taking repeated mental action to decrease the anxiety produced by their obsession. For example, they might analyze the meaning of a thought, repeat a special word, or review their behavior over and over.

Mental rituals are much harder to spot than physical rituals because they involve cyclical thought patterns rather than observable behavior. When someone diagnosed with OCD follows a physical ritual, the people around them are able to witness that maladaptive behavior and respond accordingly.

With mental rituals, nobody except for the individual engaging in them knows that they are being used to reduce the anxiety produced by an obsession.

Are you trying to determine if you or someone you care about might be engaging in OCD rituals? OCD Symptoms

Common Examples of OCD Mental Compulsions

Some common examples of OCD mental rituals include:

• A mental review of lists
• Evaluating the meaning of a thought
• Trying to suppress or stop unwanted thoughts
• Thinking special words, sayings, images, or phrases
• Trying to change a “bad” thought into a “good” thought
• Saying prayers over and over or in accordance with specific rules
• Spending excessive time trying to analyze or resolve obsessional doubt
• Reviewing conversations or activities over and over to remove doubt or until the review is completed “perfectly”

Understanding the Different Types of OCD and Rituals

An OCD diagnosis can take many forms, and the specific subtype of OCD an individual has been diagnosed with plays a pivotal part in how ritual behaviors manifest in daily life. The nine primary subtypes of OCD are:

1. Contamination OCD

With Contamination OCD, the individual’s obsession involves a focus on being “contaminated” with the fear of contracting a disease or spreading germs.

Common ritual behaviors include:

• Using strong chemicals to clean themselves
• Separating “contaminated” and “non-contaminated” items
• Excessive and repetitive hand washing, showering, or cleaning

2. Responsibility OCD

When someone is diagnosed with Responsibility OCD, they feel an inflated responsibility for ensuring the safety of others and engage in rituals to protect others from perceived threats. 

Common rituals include:

• Compulsive prayers
• Mentally reviewing memories over and over for reassurance
• Checking behaviors like making sure the oven is off a certain number of times before leaving the house

3. “Just Right” OCD

“Just right” OCD, also called Perfectionism OCD, is often stereotyped in popular culture. It involves intrusive thoughts and physical rituals that revolve around making things perfect. If something isn’t “just right,” these individuals believe something bad will happen, and their ritual behavior will prevent that from happening.

Common rituals include:

• Adjusting the volume dial to a preferred number
• Rearranging object to ensure the symmetry or balance
• Only stepping on an even number of cracks when walking outside

Note that engaging in these behaviors is not necessarily indicative of an OCD diagnosis. Instead, these types of mental preferences are natural for many and may simply indicate a strong attention to detail or preferences. It is when these preferences become so strong that they must be acted upon or some negative outcome becomes inevitable in the mind of the individual.

4. Harm/Aggression OCD

Harm OCD is diagnosed when an individual experiences intrusive thoughts that involve acts of violence. In order to ensure they do not engage in these acts of violence, the individual follows rituals like:

• Asking other people if they might be capable of hurting others
• Spending excessive time researching violent crimes and criminals
• Hiding dangerous objects so they are not tempted to harm someone

5. Sexual Orientation or Gender Identity OCD

Sexual Orientation OCD is identified by the presence of intrusive thoughts around confusion about an individual’s sexual orientation. To decrease their anxiety, individuals may engage in rituals like:

• Mental reviews of memories, sensations, and thoughts
• Compulsively dating in order to “prove” their sexual orientation
• Repeating “I’m not gay” a certain number of times when an intrusive thought arises

6. Pedophilic OCD

An individual diagnosed with Pedophilic OCD experiences intrusive sexual thoughts about children. A person diagnosed with Pedophilic OCD is not necessarily a pedophile, and they do not necessarily feel any sexual attraction toward children, but they feel excessive anxiety that they might be a predator.

To avoid these thoughts, they may engage in rituals such as:

• Staring at children to check that they are not aroused
• Searching the internet for information to ensure they are not a pedophile
• Washing hands after touching children to ensure they are not “contaminated”

7. Relationship OCD

Relationship OCD is defined by intrusive thoughts around the uncertainty of a relationship. For example, someone may worry if their spouse really loves them or that they might have made the wrong decision by choosing their partner.

In response, some rituals they might engage in include:

• Testing their feelings by flirting with other people
• Comparing their partner to other people to test their attraction
• Having compulsive sex to ensure they are still attracted to their partner

8. Scrupulosity OCD

Scrupulosity OCD revolves around religious or moral obsessions. Examples of common rituals are:

• Excessive visits to confession
• Acts of self-sacrifice or self-harm as penance
• Repeating acts of scripture or prayer a specific number of times

9. Hyperawareness OCD

When someone is diagnosed with Hyperawareness OCD, their obsessions revolve around an acute awareness of physical sensations like blinking, breathing, or hearing with the anxiety being that they will never be able to stop noticing or thinking about them.

Ritual behaviors may include:

• Checking behaviors to ensure a sensation feels “normal”
• Asking other if it is normal to be aware of their bodily sensations
• Blinking a specific number of times to safely stop thinking about the sensation

How To Stop Mental Compulsions From OCD

Following an OCD diagnosis, many people immediately assume the goal should be to find a way to put a stop to the physical or mental compulsions. They may ask questions about how to stop OCD thoughts or if OCD can go away. However, these compulsions are only symptoms of underlying anxieties and trauma. A more effective treatment goal, at least initially, is not to stop the mental compulsions but to understand the underlying causes of OCD.

The best way to put a stop to mental compulsions with OCD is not by trying to eliminate them or make them go away. Instead, you have to treat the root causes. At the same time, you have to understand that when treating the root causes, ritual behaviors do not disappear overnight. Individuals diagnosed with OCD develop these rituals over the course of months to years, and it can take the same amount of time to work through and resolve them. 

The Cost of OCD Mental Rituals

Ultimately, it does not matter what type of OCD someone is diagnosed with. All OCD mental rituals come at a cost. They limit the individual’s behavioral choices and interfere with the ability to live a meaningful life.

Fortunately, recovery is possible, and the team at PCH has witnessed it firsthand. We once worked with an individual diagnosed with Contamination OCD whose ritual involved taking eight-hour showers to feel “decontaminated.” Even in extreme cases of OCD like this, there is hope for individuals to live a life of well-being and purpose. 

We Want To Know What Happened to You

At PCH, we want to know what happened to you—not what is “wrong” with you. We approach every OCD diagnosis the same way. If you or someone you care about may be struggling with OCD rituals, learn more about our approach to OCD treatment and when you are ready, find out if PCH is right for you.