OCD Mental Compulsions: When OCD Is Hidden
By: Growth Era Counseling & Wellness
Obsessive-compulsive disorder (OCD) is often portrayed in media as an illness driven by visible behaviors—excessive handwashing, checking locks, or lining up objects just right. But there’s a lesser-known, more hidden aspect of OCD that many people don’t see—or even recognize in themselves: mental compulsions.
This OCD Awareness Week, we’re shedding light on mental compulsions, the silent mental rituals that can be just as distressing—and disruptive—as physical ones.
What Are Mental Compulsions?
Mental compulsions are repetitive thoughts or mental acts that a person with OCD performs in response to obsessive fears. These actions happen entirely in the mind, making them invisible to others. They often aim to reduce anxiety, neutralize disturbing thoughts, or prevent something “bad” from happening.
Unlike physical compulsions, which can be seen—like repeatedly washing your hands—mental compulsions may include:
Replaying past events to check if something went wrong
Mentally reviewing conversations to ensure nothing inappropriate was said
Silently repeating phrases, prayers, or numbers to feel “safe”
Trying to mentally “cancel out” or “undo” a bad thought
These acts can become automatic, feel necessary, and take up hours of mental energy—yet go completely unnoticed by friends, family, or even therapists unfamiliar with the nuances of OCD.
Common Types of Mental Compulsions
Mental compulsions can take many forms. Here are some common examples:
Mental reviewing – Replaying events, conversations, or decisions over and over to make sure nothing was done “wrong.”
Counting – Mentally counting steps, tiles, or beats to achieve a sense of safety or control.
Compulsive prayer – Repeating prayers mentally in a specific way, or starting over if they’re not said “perfectly.”
Self-reassurance – Mentally telling yourself “It’s okay” or “That won’t happen” in response to intrusive thoughts.
Thought suppression – Trying to push away or replace intrusive thoughts with more “acceptable” ones.
Rumination – Getting stuck in long mental loops trying to figure something out or gain certainty.
These mental rituals are often linked directly to OCD themes like harm, contamination, religious morality, existential fears, or relationship doubts.
The Myth of “Pure O” OCD
Some people experience OCD primarily through mental compulsions, which has led to the term “Pure O” (short for “purely obsessional” OCD). However, the idea that someone can have OCD without compulsions is misleading.
In reality, mental compulsions are compulsions. The compulsive part of OCD doesn’t always look like handwashing or door-checking—it can look like spending hours in your head trying to feel certain, safe, or morally clean.
That’s why many clinicians now consider “Pure O” a misnomer: compulsions are still present—they're just mental instead of physical.
How Mental Compulsions Show Up Across OCD Themes
Here are examples of how mental compulsions appear in different OCD subtypes:
Contamination OCD
Obsession: “What if I spread germs?”
Mental Compulsion: Mentally reviewing what you touched and if it was clean.
Harm OCD
Obsession: “What if I hurt someone accidentally?”
Mental Compulsion: Replaying your actions to confirm you didn’t cause harm.
Religious OCD (Scrupulosity)
Obsession: “What if I offended God?”
Mental Compulsion: Repeating prayers perfectly or mentally confessing.
Existential OCD
Obsession: “What if life has no meaning?”
Mental Compulsion: Trying to figure out philosophical or existential questions.
Can You Have OCD Without Compulsions?
No—compulsions are a required part of an OCD diagnosis. But they aren’t always obvious. People often miss mental compulsions because they feel like natural problem-solving, introspection, or worry.
If you spend significant time mentally checking, reviewing, or seeking reassurance in your mind, it may not just be “overthinking”—it might be OCD.
How Are Mental Compulsions Treated?
The gold standard for treating OCD, including mental compulsions, is Exposure and Response Prevention (ERP)—a type of cognitive-behavioral therapy specifically designed for OCD.
In ERP, you work with a trained therapist to:
Face your obsessions without avoiding or distracting from them.
Resist compulsions, including mental rituals like rumination or reassurance.
Build tolerance to anxiety and uncertainty—without relying on mental rituals to feel “safe.”
For example, someone with harm OCD might be exposed to a triggering thought like “What if I snap and hurt someone?” Instead of mentally reassuring themselves with “I’d never do that,” they would learn to sit with the discomfort and allow the thought to exist without neutralizing it.
Over time, ERP helps retrain the brain to no longer respond to obsessions with compulsions—and breaks the OCD cycle at its core.
You’re Not Alone—And There Is Help
Mental compulsions can make you feel like you’re “just overthinking,” “going crazy,” or “too in your head.” But they’re a real and valid part of OCD, and most importantly: they’re treatable.
If you recognize yourself in this post, know that you don’t have to suffer silently. With the right support and treatment, you can break free from the hidden rituals that OCD uses to keep you stuck.
If you or a loved one is struggling with OCD—whether it’s visible rituals or hidden mental compulsions—please don’t hesitate to reach out.