What makes obsessive thoughts compulsive

Obsessive-compulsive and obsessive-compulsive disorder

When the tendency to control things or the tendency to be clean develop into an obsessive-compulsive disorder

11/11/2011 From Dr. Christine Amrhein

After driving a car, Thomas B. has the thought: “It could be that I ran into a child on the way without noticing it.” He then drives the same distance five more times and climbs up wherever there are often children stop, and check that there is no injured child on the ground. That happens to him more and more often. His wife recently separated from him.

The 46-year-old suffers from an obsessive-compulsive disorder like around two percent of the population. This disorder begins in most cases in adolescence or early adulthood before the age of 30. Symptoms tend to increase over time and severely affect life. Without therapy, the disorder becomes chronic in two-thirds of those affected.
A characteristic feature of obsessive-compulsive disorder are tormenting thoughts and impulses that are always the same, or actions that the person concerned has to carry out in a similar way.

Typical of obsessive-compulsive disorder is that the person is aware that it is their own thoughts or impulses and that they are basically absurd. In contrast to schizophrenia, for example, he does not experience it as something that has been input from outside.

Different forms of obsessive-compulsive illness

Compulsive behavior

Is the stove off? Is there still a candle burning somewhere? Everyone knows these thoughts. But it only becomes stressful or even pathological when someone adjusts his entire daily routine to check over and over again whether something is not in the desired order or the planned sequence.

Every person is subject to certain everyday constraints, every person develops routines in order to better organize his life. Even if the individual design can vary and these everyday routines can already take on compulsive features in one or the other, this is not yet a diagnosis of obsessive-compulsive disorder. To be able to diagnose obsessive-compulsive disorder, these symptoms must be very distressing and severe enough to significantly interfere with normal, everyday activities.

Obsessive thoughts

Obsessive thoughts are thoughts, pictorial ideas or impulses for action that impose themselves and repeat themselves again and again in a similar form. The content of obsessive-compulsive thoughts is very individual and has to do with the respective biographical background. Exactly what is not supposed to happen is thought of. In this respect, it is understandable why those affected suffer so much from it.

Like most of those affected, Thomas B. cannot simply push away his stressful thoughts, which is why he develops compulsive actions that help him to reduce anxiety and tension, at least for a short time. But this neutralization, as it is called in technical jargon, does not last long. On the contrary, these compulsive acts contribute to the fact that the person concerned is more and more dominated by the obsessive thoughts, because he cannot experience that the feared does not occur at all.

Those affected often suffer from strong feelings of shame and guilt. The obsessive thoughts are accordingly mostly of a very threatening nature and have violence and aggression, dirt and contamination, sexuality, religion or magic and, above all, order as their content.

Compulsory impulse

In the case of compulsive impulses, the person affected suffers from impulses to do something forbidden or immoral without wanting to do so, for example to injure a child or to kill people. Even if those affected suffer greatly from being able to follow the impulse, they usually don't.


Those affected often develop a kind of ritual in order to alleviate the tormenting character of obsessive thoughts and impulses or to prevent them for a short time. These are mostly repeated control or cleaning actions. For example, Thomas B. drives all the streets once again every evening to check that he really hasn't hit a child. Depending on the degree of his tension, he even repeats these control actions several times in one evening.

Compulsion to control

One of the most common compulsive acts is the compulsion to control. People who suffer from it spend a lot of time checking whether the stove is off, the candles are out or doors are closed, for example. They develop very time-consuming control rituals which in the long run prevent them from participating in life and from coping with their everyday tasks.

Compulsive Personality Disorder

In people who suffer from obsessive-compulsive personality disorder, there is no historical trigger for the disorder, but unlike obsessive-compulsive disorder, all areas of life are affected.

Living or working with them can be very stressful for others. Because people with an obsessive-compulsive personality disorder set their own moral concepts absolutely and often control other people in their actions without being instructed to do so.

It is difficult for them to overlook apparent flaws and not focus on the big picture. Focusing on details often prevents them from completing their own tasks on time.

Obsessive-compulsive disorder therapy

Therapy, which usually consists of a combination of psychotherapy and medication, can in most cases have a beneficial effect on the course of the obsessive-compulsive disorder.
Cognitive behavior therapy is considered the most effective therapy method for obsessive-compulsive disorder.

Other therapeutic approaches such as psychoanalysis and depth psychological methods are useful as a supplement or after successful treatment of the obsessive-compulsive symptoms. Involving the family is particularly useful when children or young people are treated with compulsions or when family conflicts play a role in the development or worsening of the obsessive-compulsive symptoms.

Various studies have shown that a combination of a drug and psychotherapy is the most effective therapy method. Some antidepressants, most of which are used to treat depression, have also been shown to be effective for obsessive-compulsive disorders.