Reference
Guide | Reference

26  Obsessions, Compulsions, and Stuckness

26.1 Summary

  • Intrusive thoughts, images, or urges paired with repetitive behaviors or mental rituals that feel hard to resist.

26.2 Patient-Language Phrases

  • “I can’t stop thinking about it.”
  • “I have to check or repeat things to feel okay.”
  • “I get stuck on certain thoughts.”
  • “I do it even though I know it doesn’t make sense.”

26.3 Core Features

  • Intrusive thoughts or urges that feel unwanted.
  • Compulsions, checking, reassurance seeking, or mental rituals.
  • Sense of relief followed by return of doubt or distress.

26.4 Boundary Markers

  • What it is: repetitive thoughts or behaviors driven by distress or uncertainty.
  • What it is not: goal-directed habits or preferences without distress.

26.5 Variants / Spectrum

  • Checking and reassurance loops.
  • Contamination or harm-focused fears.
  • Symmetry or “just right” compulsions.
  • Body-focused repetitive behaviors (skin, hair).
  • Health or illness-focused rumination.

26.6 Severity Anchors (0-4)

  • 0: No significant intrusive thoughts or rituals.
  • 1: Mild, occasional, manageable.
  • 2: Moderate, recurring, impacts focus or time use.
  • 3: Severe, frequent, time-consuming or impairing.
  • 4: Extreme, disabling or unsafe.

26.7 Time-Course Patterns

  • Chronic with fluctuating intensity.
  • Trigger-linked spikes.

26.8 Functional Impact

  • Work/school: reduced focus, time lost to rituals.
  • Relationships: reassurance seeking or conflict.
  • Self-care: delays or avoidance.

26.9 Common Mimics / Differential

  • Anxiety threat responses without rituals.
  • Trauma intrusions without compulsions.
  • Psychosis with fixed delusional beliefs.

26.10 Medical / Substance Rule-Outs

  • Stimulant effects or withdrawal.
  • Neurologic contributors to repetitive behavior.

26.11 Developmental Expression

  • Childhood: rituals or checking that intensify under stress.
  • Adolescence: increased rumination and reassurance.
  • Late life: health anxiety or checking related to safety.

26.12 Cultural / Context Notes

  • Some rituals are culturally normative; assess distress and impairment.

26.13 Measurement Prompts

  • Brief obsession/compulsion measure.
  • Time spent on rituals or reassurance.

26.15 Documentation Snippet (1-2 lines)

  • “Intrusive doubts with checking rituals and reassurance seeking; Compulsivity 3; chronic course.”