We all have thoughts, such as, “I’m going to lose my keys and get locked out of my house” or “I touched something that is dirty and I’m going to get sick.” Although such thoughts are common, when we persevere on them, they turn into obsessions.
Obsessions belong to the same class of perseverative cognition as worry and rumination. However, obsessions are different in that we perceive them as intrusive, that is, we do not want to have them. When we freak out about the possibility of losing our keys or getting sick, it does not feel right: we tense up, our breathing gets shallower, and we start to sweat. It becomes difficult to focus on anything else. Our minds become plagued with racing thoughts.
So, it makes perfect sense that we go to great lengths to try to get rid of our obsessions. The problem, however, is that more often that not, we end up resorting to techniques that paradoxically increase the frequency and intensity of these thoughts. For example, one common way of dealing with obsessive thoughts is by trying to not think about them. However, the more we try to not have a thought, the more it comes back, thus perpetuating a vicious cycle of feeling out of control and having more intrusive thoughts (see review by Wenzlaff & Wegner, 2000). One classic way of illustrating this phenomenon is by asking you to think of anything but a white bear. Wait a few seconds. Now, what are you thinking about?
Most people will answer” a white bear” or “a bear” or perhaps even “something white.” This is because the more we tell ourselves “don’t think of a white bear,” the more we are activating the notion of a white bear in our minds. You can see how this applies to our obsessions: the more we tell ourselves “don’t worry about the keys,” the more we obsess about the keys.

By jessicafm – Jessica Merz
A second way of dealing with obsessions entails engaging in compulsions. In this way, when we experience obsessive thoughts about losing our keys, we might develop a ritual of reaching into our pockets and touching the keys three times with each of our fingers. Or when we obsess about germs and getting sick, we might wash our hands so frequently that our skin gets dry and begins to peel off. In addition to taking up time and mental and physical energy, these compulsions further exacerbate the vicious cycle of obsessive thinking. When we engage in a compulsive ritual and it doesn’t work (which is oftentimes the case, since they have little connection with the events we are trying to prevent), we feel anxious and out of control. We then tell ourselves that if we could only come up with a better ritual (“with the perfect ritual”), we would be able to gain control over our thoughts. And thus compulsions become exponentially more convoluted and time-consuming. And obsessions become more frequent and intense.
You might wonder, then, what is the best way of dealing with obsessions (and the ensuing compulsions). The answer is quite simple: just let these thoughts be. Intrusive thoughts, just like emotions, can be quite brief. But we usually perpetuate them by trying to suppress them or by engaging in compulsions. But, if you just watch them come and go, you will have power over them. By letting go of your need to control these thoughts, you will paradoxically be more in control of them. Of course, letting go is a very difficult thing. But, as I frequently say, it’s all about practice!!!
Now, I should also mention that when obsessions and compulsions get out of control, they turn into obsessive compulsive disorder (OCD). OCD is more than just being a bit obsessive or having some quirks. OCD is a debilitating mental disorder that affects 2-3 millions of Americans. If you’re interested in catching a glimpse at a patient’s perspective, I recommend that you check out the HBO TV show Girls (spoiler alert; skip to next paragraph). In the last two episodes of the second season (the show has just wrapped up its third season) the main character, Hannah (played by show creator Lena Dunham), is under so much stress that she re-experiences the OCD symptoms that she had as a child. She begins to count and to do most things in series of 8s. At one point, she is shown in front of the mirror compulsively cleaning her ear with a q-tip. She does so with such fury that the q-tip gets stuck and she has to go to the emergency room to get it removed. When the doctor pulls it out, it’s bloody. She’s embarrassed. When she gets home, she resumes cleaning her ears. She can’t stop.
Despite its severity, OCD is a very treatable condition. The first line of psychosocial treatment entails exposure and response prevention (ERP), which is an evidence-based form of cognitive behavioral therapy. In a nutshell, ERP entails 1) exposing patients to their obsessions (think of losing the keys, touch something dirty) and 2) preventing them from engaging in the associated compulsions (checking pockets, washing hands). By being able to stay with that anxiety, patients experience habituation, that is, a reduction in their anxiety. Once the anxiety is lower, the obsessions become less frequent and the drive to engage in compulsions, less intense. In addition, some people benefit from psychotropic medications, primarily certain antidepressants.
As a final note, if you think that you or a close one might be suffering from OCD, here are some additional resources:
Anxiety & Depression Association of America (ADAA)
International OCD Foundation
National Alliance on Mental Illness (NAMI)
National Institute of Mental Health (NIMH)
(feel free to let me know of additional resources; Twitter @DrAmeliaAldao