Why Compulsions Aren’t Always Visible (and Why That Matters)
OCD Is More Than What You Can See
“Are you sure you have OCD? You don’t even wash your hands all the time.”
“You seem totally fine — I’d never guess you’re struggling.”
If you’ve ever heard something like this, you’re not alone. One of the most persistent myths about obsessive-compulsive disorder (OCD) is that compulsions are always visible behaviors — things like cleaning, checking, or arranging objects over and over.
And while those behaviors can be part of OCD, they’re not the whole story. Many people with OCD engage in mental compulsions — internal rituals that are just as powerful, distressing, and time-consuming as physical ones. Because these compulsions are invisible, they’re often dismissed or misdiagnosed, leaving people feeling misunderstood and unsupported.
What Compulsions Actually Are
To understand why this matters, let’s back up.
OCD is made up of two main parts:
Obsessions: intrusive, unwanted thoughts, images, or urges that cause intense anxiety or discomfort.
Compulsions: repetitive actions — physical or mental — meant to reduce that anxiety or neutralize the fear.
Compulsions are the brain’s attempt to “solve” the anxiety caused by intrusive thoughts. The problem? They only make the cycle stronger.
The Hidden World of Mental Compulsions
Mental compulsions happen entirely in your mind, which means they’re easy to miss — even for the person experiencing them. Some common examples include:
Mental checking: replaying events in your head to “make sure” you didn’t do something wrong.
Reassurance-seeking through thinking: repeatedly analyzing whether you’re a good person, whether a thought “means” something, or whether something bad will happen.
Neutralizing thoughts: trying to “cancel out” a scary thought by thinking a specific phrase, prayer, or image.
Counting or repeating silently: performing mental rituals a certain number of times to feel safe.
Compulsive rumination: endlessly trying to “figure out” the meaning or cause of an intrusive thought.
These internal behaviors serve the same function as washing your hands or checking a lock — they’re attempts to manage anxiety and gain certainty. But because no one can see them, they’re often mistaken for “just overthinking” or “being too worried.”
Why Misunderstanding This Is a Big Problem
When we limit our understanding of OCD to visible compulsions, a lot of people fall through the cracks. Someone struggling with mental rituals might be dismissed as anxious, indecisive, or overly cautious — when in reality, they’re caught in the same painful loop as anyone else with OCD.
This misunderstanding can lead to:
Delayed diagnosis: People may go years without realizing they have OCD because they don’t “fit the stereotype.”
Shame and self-blame: Hidden compulsions can make people feel like their suffering isn’t valid or “serious enough.”
Ineffective treatment: Approaches that don’t address mental compulsions won’t break the OCD cycle.
Recognizing that compulsions can be internal is key to getting the right help — and to validating the very real struggle people face.
How to Start Breaking the Cycle
The good news is that mental compulsions respond to the same evidence-based treatment as visible ones. Exposure and Response Prevention (ERP) — the gold standard for OCD — focuses on helping you face your intrusive thoughts without performing the compulsions (mental or physical) that keep them going.
Some steps that help:
Name what’s happening. Label mental rituals for what they are: compulsions, not problem-solving.
Practice awareness. Notice when you’re slipping into mental checking or rumination, even if it feels automatic.
Resist the urge to “figure it out.” Accept uncertainty as part of the process — and a sign of progress.
Work with a therapist trained in ERP. Having support can make it much easier to recognize and interrupt the cycle.
Your Struggle Is Real — Even If No One Can See It
Just because your compulsions aren’t visible doesn’t mean they’re not valid. OCD is not defined by how it looks from the outside — it’s defined by the internal cycle of obsession and compulsion that takes over your mind.
If you’ve ever felt like your pain “doesn’t count” because it’s invisible, know this: it counts. And you deserve help.
You Don’t Have to Fight OCD Alone
At Found Mental Health, we understand the full spectrum of OCD — including the invisible battles that happen entirely inside your head. Our therapists use evidence-based approaches like ERP to help you break free from compulsions, build tolerance for uncertainty, and start living beyond OCD.
If this sounds familiar, reach out to us — you’re not alone, and healing is possible.
Offices located in Provo, UT | Online help available across Utah
