Research suggests that people with OCD can show stronger brain responses during error processing, alongside differences in the systems involved in inhibitory control. In plain English, the brain may be especially sensitive to signals that something is wrong, while having a harder time stopping a response.
I find this interesting because it may help us understand an experience that can be hard to explain: doing everything OCD tells you to do and still feeling like something is off.
It’s sort of like feeling as if there is a bug on your arm and trying to brush it off, except you know there’s no bug there anymore. Your brain is still telling you to pay attention and get it off, even though you know there’s nothing there. At least, that’s my experience of it.
This is part of why OCD is so frustrating. You can know you already checked a million times, did the thing over and over, and actually remember unplugging the hair straightener that OCD is telling you will set the house on fire and kill your cat. And heck, you can even recognize in the moment, this is my OCD. But knowing doesn’t necessarily make you feel like you can stop doing the thing it wants you to do.
If you don’t experience OCD, it makes sense that you might think logic or fact checking would help. “The straightener has an automatic shutoff, nothing will happen!” Except often, you already have the information. What you’re waiting for is the feeling of certainty you thought would come with it. And that feeling might not arrive, no matter how many times you check.
The cruel part is that the compulsion often does make you feel better. Maybe only briefly, but you get a little relief. And your brain remembers that feeling, and then learns that checking, reviewing, asking, or washing is what helps next time you feel anxious or unsure. The more you get relief from it, the harder the habit can become to break.
This gets especially complicated when the compulsion is happening entirely in your head. You might analyze a conversation, review a memory, compare one feeling to another, test how you feel, reason with yourself, search your memory for evidence, or keep turning the same question around and around looking for certainty.
You keep thinking not necessarily because there is more information to uncover or a conclusion to reach, but because you are waiting for the thought that will finally make the uncertainty disappear. Maybe if I look at it from this angle. Maybe I forgot this detail. Maybe this changes things. Maybe I should go through the conversation again and pay closer attention to what I said. The problem is that there is always another angle, another possible error, another loophole you had not considered.
This is one of the particularly painful things about mental compulsions, at least in my experience of living with them. OCD tells you that if you can just figure it out, you will finally feel certain. So you think and think and think and think, trying to reach the end of something that keeps producing another question. It can make your own mind feel like a torture chamber, because the thing you are using to try to escape the uncertainty is also the thing keeping you inside it.
Exposure and response prevention, or ERP, is one of the main psychological treatments for OCD. With support from a therapist, you gradually practice experiencing the thoughts, situations, or sensations that bring up distress without doing the compulsion you would usually turn to for relief. That includes the rituals happening in your head. More about ERP
The work is learning to have that unfinished, uncertain feeling without having to solve it. Which is really fricken hard when you’ve learned, over and over, that solving it is what brings relief. You’re practicing leaving a question unanswered, even while your brain is telling you to go back and figure it out. Gradually, repeatedly, you get to learn: I can feel uncertain and still go on with my day. I don’t have to figure this out right now.
This article is for education and reflection. It is not a substitute for therapy, medical care, or individualized mental health advice.