Everyone gets fixated on fears or worries from time to time. But people with obsessive-compulsive disorder, or OCD, frequently experience upsetting thoughts that make them extremely anxious. And then they develop rituals to cope with their anxiety.

What is an obsession?

People with OCD have intense fears or worries that focus on a specific topic, known as an obsession. When you have an obsession, you can’t stop thinking about it, no matter how hard you try — and when it keeps popping into your head, these are called intrusive thoughts.

Some common obsessions include:

• Fear of contamination: You’re always worried about things like germs, getting sick, or keeping things clean.

• Safety: You constantly think about all the ways that you or a loved one could get hurt.

• Fear of causing harm: You’re always sure that you’ve upset or harmed other people, even when they assure you that you haven’t. Or you’re afraid that you might hurt someone any minute, even though you’re desperate not to.

• Religious or moral guilt: You worry a lot about doing the wrong thing in a moral sense. This might mean breaking religious rules and offending God. Or it could mean doing things that go against your values and being a so-called “bad person.”

• Relationship obsessions: You obsess over every detail of your close relationships, especially romantic relationships. You’re constantly afraid that you don’t love your partner enough, or that they’re about to break up with you.

• Sexual obsessions: You have extreme worries about sex. Maybe you worry about having taboo sexual thoughts, like incest, even though you’ve never experienced these kinds of desires — you’re just scared that you might experience them. Or you might worry that you could commit sexual violence, even though you don’t want to at all.

• Obsessions focused on suicide: You don’t want to die, but you constantly think about suicide and get scared that you might hurt yourself without wanting to.

Many people with OCD have more than one obsession. Obsessions can also shift and change over a person’s lifetime.

What is a compulsion?

People with OCD develop specific rituals or repeated behaviors to cope with the anxiety caused by their obsessions. These behaviors are called compulsions. You feel like you have to do them, even when you don’t want to, because it seems like the only way to make the anxiety go away.

Some common compulsions include:

• Checking things over and over, like needing to review your homework five times or always running home to make sure you didn’t leave the stove on.

• Cleaning way more than is necessary. For example, you can’t leave for school until your bed is perfectly made with no wrinkles, or you’re afraid to eat without making sure that your silverware is spotless.

• Repeating actions, like reading a paragraph over and over or walking in and out of a room.

• Counting, either things around you or just to a certain number in your head.

• Arranging things in specific ways, like lining your books up perfectly or ordering your sock drawer in a pattern.

• Saving or hoarding things that you don’t need. This is different from collecting things that matter to you. Instead, you might hang onto every gum wrapper, receipt, or piece of junk mail.

• Seeking reassurance from other people. You’re always asking friends or family to tell you that you don’t need to worry: “Are you sure that she’s okay? Is he mad at me? Will we get there safely?”

  
  

A lot of people with compulsions describe a feeling of doing them until they feel “just right” —and how they can’t stop before that feeling comes.

Doing a compulsive behavior can make you feel better for a minute, but then the anxiety comes back, and you need to do it again. For example, you might feel calm when your friend tells you that they’re not mad at you. But if that feeling goes away, even a few minutes later you might have an urge to ask them again.

Invisible compulsions

It’s important to know that not all compulsions are visible. Some people with OCD cope with anxiety through mental compulsions like replaying memories or conversations in their heads, silently repeating words or lists, or reassuring themselves over and over that things are okay.

This kind of OCD is sometimes called “pure O,” but that label is misleading because these mental rituals are still compulsions — they’re just not the kind that other people can see.

People who have OCD with mental compulsions might look like they’re withdrawn or distracted, because their attention is focused on their compulsive thoughts.

OCD can be confusing and upsetting, but there are effective treatments for it. A doctor or mental health professional can help you find the right combination of support for you.