All the anxiety disorders, including OCD, function similarly. An obsession is any thought or action that causes anxiety to increase. A compulsion is any thought or action that causes anxiety to suddenly decrease. When an obsession is triggered, anxiety or another negative emotion increases and the person engages in a ritual to alleviate the anxiety. Rituals do reduce anxiety in the short-term. We are biologically wired to alleviate discomfort. Rituals are therefore used over and over to alleviate anxiety. Behaviors used in rituals are not inherently right or wrong. However, the repetitive use of behaviors to avoid an emotional experience is maladaptive. For example, hand washing is not inherently bad. Many hours of repetitive hand washing done for the purpose of avoiding anxiety and providing reassurance about a feared consequence is maladaptive. Similarly, distraction from and reassurance regarding negative thoughts are not maladaptive. Consistent and repetitive distraction and reassurance seeking in connection with re-occurring thoughts are maladaptive. The person who relies upon these strategies usually knows that they are not fixing the problem.
The reliance upon rituals (e.g., avoidance, distraction, reassurance seeking, washing) to avoid negative emotion contrasts with how normal human thoughts and emotions are handled. When we permit thoughts and emotions to come and go on their own, the thoughts and emotions remain at normal and manageable levels. In contrast, when rituals are relied upon to escape the experience of anxiety two things happen: Anxiety increases over time and the overall number of areas affected by OCD increases. This is despite the fact that the severity of OCD waxes and wanes over the course of a person’s life and specific fears change in nature over the course of a person’s life.