Obsessions: Overview, Types, Treatment

Obsessions are persistent and often intrusive thoughts, ideas, or impulses. Most people know that their obsessions are excessive but feel unable to control them. 

Because they are unwanted and disturbing, obsessions usually cause anxiety. To relieve that anxiety, people with obsessive-compulsive disorder (OCD) are driven to perform compulsions. 

Compulsions are rituals or behaviors that temporarily “neutralize” someone’s distress about an unwanted obsession. Most people with OCD experience both obsessions and compulsions. 

This article will discuss obsessions, including types, causes, coping methods, and treatment options.

Types of Obsession

Obsessions typically fall along certain anxiety-inducing themes—such as fears of harm, sickness, and bad luck, as well as things that are inappropriate or wrong. 

The five most common types of obsessions can be categorized as perfectionism, relational, contamination, causing harm, and intrusive thoughts. All obsessions can cause significant emotional distress, lower your self-esteem, and interfere with your ability to function normally in relationships, work, or school.

How Common Is OCD?

Obsessive-compulsive disorder is a relatively common mental health condition. Over the course of their lives, about 2.3% of U.S. adults will meet the criteria for OCD.

Perfectionism

People with perfectionistic obsessions are overwhelmed by a fear of making mistakes, doing something wrong, or leaving things out of place. Perfectionistic OCD may involve obsessions with:

• Order, symmetry, and organization
• Neatness
• Following specific rules, directions, and routines
• Feeling that things are “in their place” or “just right”
• Completing tasks at work or school “perfectly”

Contrary to popular belief, perfectionistic obsessions aren’t always about organization, neatness, or arranging household items. Some people with OCD also exhibit scrupulosity, a type of moral perfectionism. Scrupulosity often involves rigidly adhering to strict religious, ethical, and/or moral beliefs.

Relational

Relationship-focused obsessions involve overwhelming doubts and worries about the “rightness” of a romantic relationship or partner. Some researchers refer to this kind of obsession as relationship obsessive-compulsive disorder (ROCD).

People with ROCD may experience symptoms such as:

• Constantly questioning their own feelings or their partner’s feelings
• Wondering if their partner is their soulmate or “the one”
• Frequently comparing their current partner to previous partners
• Preoccupation with their partner’s perceived moral, emotional, or physical flaws
• Worrying that their partner will cheat or leave the relationship

Many people with relationship-focused obsessions attempt to relieve their anxiety by asking constantly for reassurance of their partner’s love or loyalty. They may also fantasize excessively about finding their “ideal” soulmate or developing the perfect relationship in order to manage their distress.

Contamination

Contamination obsessions may involve fears of physical contamination (such as with dirt, bacteria, germs, chemicals, or illness) or moral contamination (such as with a person, place, or idea that is perceived as “bad” or distasteful).

When confronted with the possibility (or even sometimes the thought) of contamination, people with contamination obsessions often feel overwhelmed. 

To feel “pure” or “clean” again, people with contamination-related obsessions may:

• Wash their hands, body, or personal items excessively
• Clean household surfaces frequently
• Stick to a rigid, inflexible diet 
• Avoid social situations, especially crowds
• Go out of their way to avoid certain places or people
• Engage in compulsive rituals such as counting, repeating phrases, or praying

Causing Harm

Some people with OCD experience obsessions related to causing harm to themselves or others. Common examples of obsessive fears related to causing harm include: 

• Forgetting to turn off household appliances
• Getting into a car accident 
• Getting someone sick
• Accidentally dropping a baby 

Many people with OCD feel an “over-responsibility for harm,” meaning that they feel their everyday actions can cause bad things to happen even when it’s unlikely or impossible. 

For example, someone with OCD might feel an intense impulse to perform mental rituals to prevent their loved one from getting sick, even if they know those things are unrelated. Others may excessively check the oven to make sure it’s turned off.

Intrusive Thoughts

Intrusive thoughts are typically related to something frightening, dangerous, inappropriate, or repulsive, such as: 

• Unwanted sexual imagery
• Unwanted violent imagery 
• Aggressive impulses
• Religious blasphemy 

About 80%–90% of the general population experiences intrusive thoughts. However, for some people—such as those with OCD—those obsessive thoughts are persistent and anxiety-inducing enough to interfere with daily functioning. It’s important to remember that having intrusive thoughts doesn’t mean you’ll act on them.

Causes

Obsessions typically don’t have any single root cause. Instead, they are most likely due to a combination of genetic and environmental factors. 

Researchers have identified many possible causes of obsessive-compulsive disorder, including: 

• Genetics: According to twin studies, about 45%–65% of OCD symptoms can be attributed to genetic factors.
• Trauma: Experiencing trauma, such as abuse or betrayal, is a significant risk factor for OCD. Additionally, many people with OCD also have post-traumatic stress disorder (PTSD).
• Upbringing: There is some correlation between having had an overprotective parent and the development of OCD. Parents who are anxious and/or have obsessions themselves may pass them on to their children, partly through genetics and partly through the home environment and learned behavior.
• Stress: Studies suggest that stressful life events, especially during childhood, often play an important role in the development of obsessions. 
• Brain abnormalities: Imaging studies conducted on people with OCD have revealed hyperactivity in areas of the brain that are involved in impulse control, emotional regulation, and decision-making.
• Other conditions: An estimated 69% of people with OCD have one or more comorbid (coexisting) conditions. These include mental health conditions, such as generalized anxiety disorder (GAD) and major depressive disorder (MDD), as well as tic disorders like Tourette’s syndrome (TS).

Obsessive-compulsive disorder is the most common mental health condition that involves obsessions. However, some obsessive symptoms may also be present in other mental health conditions, such as:

• Schizophrenia: A mental illness that causes disturbances in thinking, behavior, and perception
• Obsessive-compulsive personality disorder (OCPD): A condition that involves a long-lasting, overwhelming preoccupation with orderliness, perfectionism, and control

How to Manage Obsession

Obsessions may feel like they’re out of your control, but there are many ways to feel more empowered. Here are some ways to cope with obsessive thoughts:

• Find support: Participating in peer support groups for people with OCD or intrusive thoughts can help you feel less alone and connect you to valuable resources. 
• Avoid drugs and alcohol: Many people with OCD also have a substance use disorder (SUD). In turn, excessive alcohol use worsens OCD symptoms. If you have OCD, it may be best to limit your intake of drugs and alcohol as much as possible.
• Practice good sleep habits: Insomnia often exacerbates intrusive thoughts. To improve your sleep quality, practice healthy sleep habits like going to bed at the same time every night and turning off your phone an hour before bedtime. 
• Exercise regularly: Staying physically active may help you burn off excess energy and keep your mind off of your obsessions. Research suggests that vigorous exercise can even reduce the severity of OCD symptoms.
• Use a self-help program: From workbooks and online exercises to smartphone apps, there are plenty of self-help tools you can use to monitor your obsessive thought patterns and learn to stop them in their tracks. 
• Practice mindfulness: Obsessions may make you feel like you’re not in the driver’s seat when it comes to your thoughts. Mindfulness and mind-body techniques, such as yoga and meditation, can help you stay grounded and present.
• Manage stress: Chronic stress can trigger obsessive thoughts or make them worse. If you are prone to obsessive thinking, it’s important to optimize your stress and try to relax when necessary.

Getting Help

Some people with OCD feel too guilty or embarrassed about their obsessions to seek help. But your obsessions aren’t really “you.” Treatment can help to reduce your anxiety and improve your quality of life. Talk to a healthcare provider about your options. 

Treatment for OCD typically involves: 

• Exposure and response prevention therapy: Exposure and response prevention therapy (ERP) is a type of cognitive behavioral therapy (CBT) that involves confronting your obsessions and resisting the urge to perform compulsive behaviors in response in a clinically supervised setting. Around 50%–60% of people who undergo ERP experience significant and long-term improvements in their OCD symptoms.
• Medication: Alongside psychotherapy, medication is sometimes prescribed to treat symptoms of OCD. Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), have been found to be especially effective.

Summary

Obsessions are persistent thoughts, ideas, images, or impulses that a person feels unable to control. Typically, obsessions are time-consuming, disturbing, and unwanted. They often cause anxiety and distress and impair functioning.

There are five main types of obsessions: perfectionism (often related to symmetry, organization, or rules), relational (doubts or worries about a relationship, typically a significant other), contamination, causing harm, and unwanted intrusive thoughts (often with sexual or violent themes).

Many people with obsessions have obsessive-compulsive disorder (OCD). There are many factors that increase the likelihood of developing OCD, including genetics, trauma, stress, parenting style, brain abnormalities, and comorbid medical conditions. OCD is typically treated with psychotherapy—especially exposure and response prevention (ERP) therapy—and/or medication.

A Word From Verywell

Many people with obsessions feel ashamed of their intrusive thoughts. But you don’t have to feel alone. Obsessive-compulsive disorder is treatable and common. Don’t be afraid to reach out to your healthcare provider for help.

Frequently Asked Questions

• People who have obsessive thoughts or worries about a particular romantic partner often have an intense fear of abandonment. Many people with relationship-focused obsessions experienced childhood trauma or rejection, leading them to develop an insecure attachment style. Others may have experienced betrayal, such as cheating, in a past relationship.

• Obsessions and their accompanying compulsions are typically time-consuming and overwhelming. People with obsessions usually feel extreme distress or anxiety about their intrusive thoughts.

  They may seek to relieve their inner tension by performing a certain action compulsively, such as washing their hands, “checking” (doors, locks, ovens, etc.), counting, or asking repetitive questions.

• Most people experience some degree of obsessive symptoms, such as intrusive thoughts, at some point in their life. Recurring, unwanted thoughts are especially common during times of stress. However, most people who have occasional intrusive thoughts don’t develop full-blown obsessions or OCD.