Types of Obsessions Explained

What is an Obsession?

An obsession is a thought, idea, mental image, feeling or impulse that is persistent, intrusive and unwanted. Obsessions are usually repetitive, meaning the individual may have the same or similar obsession over and over again, and are always unwelcome. The individual experiencing obsessions may feel they cannot control them and they may interfere with their ability to function normally in their everyday life. Obsessions can cause significant anxiety and distress and impact the person’s mental health.

Obsessions can be extremely distressing and in people with obsessive compulsive disorder (OCD), obsessions can lead to compulsions. While obsessions are the distressing thoughts and feelings, compulsions are the behaviours that are connected to these thoughts. Most people who experience obsessive or intrusive thoughts know that their thoughts are irrational, however, they feel so real that the only way they feel they can deal with the thoughts and reduce their anxiety is through compulsive behaviours.

Compulsions are behaviours that are typically ritualistic that the individual performs to help counteract the obsession. They usually involve action related to washing, checking, counting and ordering, for example, turning a light on and off 10 times before leaving the room, washing their hands to the point where they become painful and chapped or reciting repetitively are all examples of compulsions.

Compulsive behaviours are, either consciously or unconsciously, performed to help the individual manage their anxiety or prevent the perceived harm (to themselves or others) associated with the obsessive thought. Although compulsions can provide short-term relief from the obsessions, this doesn’t usually last long before the obsession starts again. Compulsions are often extremely time-consuming and can take over a person’s life.

Although many people have heard of compulsions and will recognise many of the signs or stereotypes associated with compulsions, they are often not aware of the unwanted and distressing thoughts that trigger the compulsions. It is possible for a person with OCD to experience only obsessions or obsessions and compulsions. Sometimes, an obsession and a compulsion are clearly linked, for example, a fear of contamination can result in a handwashing compulsion. In other cases, it can be difficult for other people to identify the connection between the obsession and the compulsion and the compulsion may seem random, but the connection still exists for the person experiencing the obsession.

Anyone can experience obsessions and they are not always harmful. Harmful, obsessive or intrusive thoughts can also occur because of a stressful life event and will end when the stressor is gone. Occasional obsessions or intrusive thoughts are usually nothing to be concerned about. However, if an obsession is unwanted, worrying or distressing, begins to take over your thoughts in any way or you feel unable to control the obsession, this indicates the obsession is harmful.

True obsessions are also not usually fleeting (this would be a worry rather than an obsession), instead, obsessions can last hours, days or weeks and can be recurring. It can be difficult for the person experiencing obsessions to differentiate between the obsessive or intrusive thought and reality. This can further add to their distress or negatively affect their mental health.

Obsessions are typically associated with obsessive compulsive disorder (OCD). However, anyone can have obsessive thoughts, ideas or impulses, not just people with OCD. The difference between an obsession for a person with OCD is the effect it has on them. A person with OCD is more likely to experience significant distress, shame and other negative emotions when they experience an obsession and the obsession may be more likely to interfere with their daily life and take over their thoughts. Obsessions can start at any age, although the onset is most common during adolescence or early adulthood.

Types of Obsessions

Because obsessive and intrusive thoughts are completely individualised, there are a huge number of obsessions a person can experience. Obsessions can be centred around people, places, objects, feelings, situations, thoughts, religion or contaminants. One person’s obsessions are usually centred around the same theme, for example, obsessions relating to germs.

Although obsessions are individualised and no two people experience obsessions in the same way, obsessive and intrusive thoughts typically (but not always) fall into one of five categories:

Perfectionism

Obsessions can manifest as perfectionism, with the individual obsessed with the fear of not being perfect. They may fear making mistakes, saying or doing something wrong, not looking perfect or being judged negatively by others. Perfectionism can include obsessions with everything being neat, tidy, clean and in the right place, obsessions with organisation and order, obsessions with looking and acting ‘perfect’ and the fear of making a mistake.

For example, for someone with perfectionist obsessions, the idea of scoring 9 out of 10 on a test would be devastating and cause extreme distress. Perfectionist obsession can also include moral perfectionism, where the person feels they must act a certain way and strictly observe rules, whether self-imposed, societal, religious or moral.

Relationism

Relational perfectionism occurs when a person has obsessive and intrusive worries about their relationships. Although most common in romantic relationships, it can also occur in familial or professional relationships or friendships. This can manifest as:

• Obsessive focus on their partner’s perceived flaws.
• Comparing the person unfavourably to others.
• Questioning their feelings towards the individual or the individual’s feelings towards them.
• Worrying that their partner is going to cheat on them, hurt them in some way or abandon them.
• Constantly questioning whether your partner is the right person for you.
• Fixating on what you would do if your relationship ended.

Although these thoughts can be common in relationships and everyone can have them from time to time, people with relationship OCD experience these feelings constantly and may have the same intrusive thoughts and fears every day, even if their relationship is actually very strong.

Relational obsessions can affect a person’s behaviour. For example, they may constantly seek reassurance or validation, may compare themselves and their partner to others or may begin to behave in an unhealthy way in the relationship, such as checking their partner’s phone.

Contamination

Contamination is the most well-known type of obsession and is what many people think of when they think of obsessions. It involves an excessive fear of physical contamination, from dirt, bacteria, chemicals, viruses, illnesses, bodily fluids, faeces and other things they think could cause them harm. People with contamination obsession may perform compulsions to help relieve their distress or may engage in obsessive or ritualistic behaviour to protect themselves from the perceived harm of contaminants. For example, they may:

• Wash their hands excessively, to the point where their skin is red, irritated or bleeding.
• Wash themselves ritualistically.
• Refuse to touch things unless they are wearing gloves.
• Throw things away after only one use or if they are touched by another person or animal.
• Shower and change their clothes several times a day.
• Excessively clean and disinfect things.
• Refuse to go to certain places.

Fear of harm and causing harm

Obsessive thoughts and impulses can relate to causing harm to yourself or other people. In many cases, the person has obsessions that their behaviour is going to hurt themselves or other people. For example, they may obsessively check that the oven is off because they are scared that they are going to start a fire, may refuse to hold a baby out of fear of hurting it or dropping it or may refuse to drive a car because they think they are going to crash.

Although it is normal to have thoughts of causing harm occasionally, for a person with obsessions, they experience an everyday fear that their actions are going to cause harm, even with no evidence to support this. They may begin avoiding people they love out of fear of harming them or refuse to go to certain places, go near certain objects or may even refuse to leave their home.

It is common for people with obsessive thoughts about causing harm to perform mental rituals, which are a type of compulsion. This could include obsessively chanting good thoughts to seek reassurance from themselves that they are a good person, excessive prayer (e.g., praying they won’t crash the entire time they are in a car), trying to replace bad thoughts with good thoughts or playing out scary scenarios in their head.

Intrusive thoughts

Intrusive thoughts are thoughts that people typically perceive negatively that they can’t stop thinking about. The thoughts are usually related to something the person considers taboo, repulsive, immoral, dangerous, inappropriate or evil. For example, they may think about sexual, violent or disturbing images without wanting to or may have aggressive impulses towards other people or animals (e.g., picturing yourself killing someone who is being mean to you).

Intrusive thoughts are extremely common and are a normal thing to experience. However, intrusive thought obsessions are persistent and the individual may be unable to stop or control them. For someone with obsessive, intrusive thoughts, these thoughts can be extremely distressing and affect their everyday life. An individual may feel disgusted, ashamed or worried that the thoughts mean they are a bad person and are going to act on them, which is not true. An obsessive thought, even if it is about something the person considers abhorrent, is very different from a desire to act on this thought.

Causes of Obsessions

There is no one specific cause of obsessions or OCD, instead, there are multiple risk factors that could contribute to someone having obsessions, including:

• Genetics – Like many mental health conditions, OCD could have a genetic component. Although no specific gene has been identified, OCD often runs in families and someone who has a close family member, such as a parent or sibling, with OCD may be more likely to develop it themselves.
• Traumatic experience – A traumatic experience or stressful life event, such as being a victim of abuse, a loved one dying or being bullied, can increase the likelihood of someone having obsessive thoughts and impulses. Your body and brain’s reaction to the trauma can cause intrusive thoughts, obsessions and compulsions as a way of coping with the trauma.
• Learned behaviour/ environmental impact – Having a close family member or friend with OCD, obsessions, anxiety or other mental health difficulties, particularly during childhood or adolescence, can increase the likelihood of a person developing obsessions themselves.
• Other mental health difficulties – Many people who have OCD or experience obsessions have at least one other mental health difficulty, such as anxiety, depression, post-traumatic stress disorder (PTSD) or schizophrenia.
• Neural differences – Differences in the brain can cause obsessive thoughts. Some people with OCD have abnormally high activity in some areas of their brain or produce less serotonin than other people.
• Personality differences – Personality can be a factor in OCD. People who are typically more anxious, have a Type A personality or are more obsessive or meticulous in general, may be more likely to develop OCD.

What is an Obsessive Disorder?

An obsessive disorder is a long-lasting and often debilitating mental health condition that is characterised by obsessive, intrusive and recurrent thoughts and behaviours that are unwanted and affect a person’s everyday life. The most well-known obsessive disorder is obsessive compulsive disorder (OCD).

Being obsessive and having obsessive disorder are not the same thing. Many people are obsessed with things that do not harm them and don’t affect their everyday life. For example, they may become fixated on a song and listen to it every day or be obsessed with a certain food. However, this is likely not a symptom of obsessive disorder. Even when obsessive thoughts cause harm, for example, being stressed and constantly thinking about an issue at work, this is also often not indicative of an obsessive disorder and is just a response to a life event that will stop when the stressor is over.

However, if an obsession is accompanied by compulsive behaviour or is significantly impacting a person’s mental health, wellbeing or everyday life, it could be an obsessive disorder. The easiest way to tell if you have an obsessive disorder is to consider whether the obsession is impacting your day-to-day functioning. If it is, then it is likely an obsessive disorder.

Another difference between normal obsessions and obsessive compulsive disorder is how the person deals with the obsessive or intrusive thought. While many people may have the thought and move on from it, a person with obsessive disorder may have the thought and immediately begin to panic, become distressed or take the thought too seriously. For example, if someone annoys them and they picture themselves hurting them, they may immediately think they are evil or dangerous.

Obsessive disorders have three main components:

1. Obsessions: The persistent, intrusive and unwanted thought, idea, mental image, feeling or impulse.
2. Emotions: The feelings of anxiety, distress, fear and shame caused by the obsession.
3. Compulsions: The ritualistic behaviours that a person with an obsessive disorder performs in response to their obsessions.

Obsessive disorder can vary in severity, with some people having fairly mild symptoms and others having obsessions that are debilitating. The severity of a person’s obsessions can also vary over time. For example, obsessions may get worse if they are experiencing stress in other areas of their life.

Obsessive disorder can have a significant negative impact on a person’s life, particularly when coupled with compulsions. Someone with OCD may also experience:

• Mental health difficulties, such as anxiety and depression.
• Difficulties maintaining relationships.
• Difficulties engaging in everyday tasks because of how time-consuming compulsions are.
• Increased risk of substance-use disorder.

How to Manage Obsessions

Managing obsessions is completely individualised and what works for one person may not work for another. Some people have to try multiple things before they are able to successfully manage their obsessions.

Effective management strategies include:

• Acknowledge the thought – Even if your natural instinct is to ignore the thought or quickly try and replace it with something else, it can actually be more beneficial to acknowledge it. Acknowledging the intrusive or obsessive thought, rather than viewing it as threatening or worrying, can help you to accept the thought in a non-judgmental way, calm yourself down and regulate your thoughts and emotions and move on from the thought. Acknowledging the thought can also help to stop you reacting to the thought, which, in turn, can decrease compulsions.
• Identify any patterns – Identifying any patterns in your harmful thoughts can help you to understand any triggers and prevent the trigger from affecting you in the future. Having more knowledge about your obsessions and any patterns that occur can help reduce the occurrence of intrusive thoughts.
• Challenge your thinking – Most intrusive thoughts have no basis in reality, but they still feel very real. One way to help manage intrusive thoughts is to challenge them, particularly when they are related to negative thoughts about yourself (e.g., “I look so ugly”, “Everyone hates me” or “I’m going to fail the test”) or things that are unlikely to happen (e.g., “If someone sneezes near me, I’m going to catch Covid and die”). Question your thoughts by asking yourself what evidence exists to support it and challenge your thoughts by reminding yourself of all the evidence that DOESN’T support the thought (e.g., “Everyone doesn’t hate me, I have close friends who care about me, my parents love me a lot and my neighbours always say hello to me”).
• Distract yourself – Distracting yourself from the intrusive thoughts is an effective way of making sure you are not fixating on them and can make you less anxious. You can distract yourself by going for a walk or exercising, talking to someone you feel comfortable with, getting involved in a hobby, listening to music or watching TV.
• Join a support group – Support groups can help you connect with other people with OCD who have similar experiences to you and understand what you are going through. Support groups also offer information and resources to help you understand your obsessions and compulsions better and develop coping strategies. Support groups can be in-person or online. Popular support groups in the UK include:
  • OCD Action
  • OCD UK

Lifestyle changes

There are several lifestyle factors that can worsen obsessions, such as:

• Sleep habits: Not getting enough sleep, whether due to a sleep condition such as insomnia or poor sleep habits, can significantly worsen obsessions and intrusive thoughts and worsen the negative impact obsessions have on your mental health and day-to-day life. Focusing on improving your sleep habits and, if necessary, speaking to your GP to get support with your sleep can reduce the impact of obsessions.
  • Exercise: Exercise can help improve mental wellbeing, distract you from intrusive thoughts and help improve your sleep, all of which can improve the symptoms of OCD.
  • Avoiding drugs and alcohol: Drugs and alcohol can exacerbate the symptoms of OCD. Although drugs and alcohol may offer temporary relief, once the effects have worn off, intrusive thoughts can feel much worse and the distress and anxiety associated with them can worsen. Additionally, research has shown that people with OCD are at higher risk of developing a substance-abuse disorder, as they may use alcohol and drugs as a way of quieting their thoughts or minimising their anxiety. It is recommended to avoid taking drugs or drinking excessive alcohol.
  • Meditation and mindfulness: Meditation and mindfulness can help improve the connection between your mind and body and can help you manage intrusive thoughts. When practising meditation, mindfulness or yoga, you will learn deep breathing techniques and how to manage your thoughts.
• Managing stress – Regular or intense stress can trigger or worsen obsessions. Stress can trigger intrusive thoughts or make them much worse, so focusing on managing stress is an effective way of also reducing obsessions.

If your obsessions are affecting your mental health or your day-to-day life in any way, you may need additional support and tailored treatment. Having obsessive or intrusive thoughts could be a sign that you are experiencing OCD or another diagnosable medical condition and there may be possible treatment plans that can help you manage your obsessions. Visiting your GP could give you access to the support you need.

Your GP will ask you questions about any obsessions or compulsions you are experiencing, how they affect your life and your overall mental health. If your symptoms are consistent with OCD, your doctor will make a diagnosis and may refer you for treatment. The treatment plan could include medication, such as SSRIs (selective serotonin reuptake inhibitors) and therapy, such as cognitive behavioural therapy (CBT).

Symptoms of Obsessive Thoughts

Obsessive disorders are commonly misdiagnosed, as they often share symptoms with other disorders, such as anxiety. One person’s obsessions typically stay within the same category. For example, someone with OCD who experiences contamination obsessions may have different obsessive thoughts and compulsions surrounding contamination fears.

Although different people may have different obsessive thoughts, some of the most common obsessions include:

• Fear of contamination from dirt, bacteria, chemicals, viruses, illnesses, bodily fluids, faeces and other things.
• Fear of harming yourself or others, either purposely or accidentally.
• Intrusive thoughts about things you consider taboo, immoral, repulsive or illegal, such as thoughts of a violent or inappropriately sexual nature.
• Fear of hurting inanimate things.
• Constant fear of something happening to someone you care about.
• Fear of not looking and acting perfect or of failing in some way.
• Fear of doing something inappropriate or embarrassing (e.g., of shouting swearwords in a church).
• Fear of things being out of order or not organised to your liking.
• Trying to suppress the thoughts, which can make them worse or cause more distress.
• Staying away from places or situations that might trigger obsessions or compulsions (e.g., refusing to touch other people).
• Avoiding things to prevent something bad from happening. For example, avoid touching dangerous objects, such as knives, in case you hurt yourself or others.

Although anyone can experience these thoughts, not just someone with OCD, most people are able to quickly move on from the thought and go about their day. However, for people with OCD, the thought can be extremely distressing and cause severe anxiety. People with OCD tend to overvalue how important and meaningful their thoughts are. They may think having a negative thought makes them a terrible person, that they are dangerous to others or that having the thought means that thing is now going to happen. This can cause significant distress.