Checking Compulsions: Part One

A few months ago I became strangely concerned about the cat getting locked in my closet. It’s one of those walk-in closets and as I’m getting ready for work every day, it’s not unusual for the cat to pay me a visit. I’ve never been much of a checker, so I found it especially irritating when I would walk away from the closet, make it halfway down the hall, and then be overwhelmed by an urge to walk back and carefully examine all of the potential hiding spots where a cat might be. I just hated the idea of the poor, dumb animal crying all day while I’m at work, peeing on my floor, scratching at the door. So for weeks, I became a checker. I’d do a quick glance at my surroundings in the closet, leave, then walk back in and do a more thorough investigation. Occasionally this pattern of behavior would happen two or three times. Finally, I decided this was a symptom I was not going to allow, so I stopped doing it. I gave a quick, cursory glance around the space, left the closet, shut the door, went on with my life. I did it every day and some days I would get the free reassurance of encountering the cat outside of the closet and some days I wouldn’t because he was under a bed or in another room. One night when I arrived home from work my wife told me she found the cat in my closet. It had been there for at least 8 hours. But here’s the interesting part. My checking urges didn’t get worse. They actually reduced.

There’s a reason why this makes sense and it has nothing to do with me being less concerned about the wellbeing of my pets. First, let’s explore what compulsive checking really is. In obsessive-compulsive disorder (OCD) there is always an obsession (intrusive thought, image or urge) and a compulsion or series of compulsions (efforts to resolve the distress of an obsession). Common portrayals of OCD suffering usually involve excessive washing or repeated checking of things like the stove or light switches. Checking compulsions are certainly common in those with obsessions involving catastrophic outcomes of irresponsibility. For example:

• Fear of being responsible for fire or flood
• Fear of wasting resources by leaving something on or dripping
• Fear of losing things by leaving them open or unlocked
• Fear of sending inappropriate materials through the mail/email
• Fear of forgetting things
• Fear of not fully understanding things
• Fear of causing harm to a person or pet by leaving them in a potentially dangerous or unpleasant situation (as with my cat)

Checking compulsions can also be prevalent in a variety of other obsessive themes as well. For example, a person afraid that they may have hit someone with their car might return to the “scene” to check for victims or may check the conditions of the car for evidence of impact. Obsessions related to health, sexual orientation, violent thoughts, morality and others can also include checking behaviors. Most checking compulsions involve literally directing one’s attention to a physical object in an attempt to be reassured. So, for example, when there is obsessive doubt about whether the door of your home has been locked, you may go to the door to obtain a reassuring visual confirmation. Or if you fear sending something inappropriate in an email, you may repeatedly check your sent folder to make sure you haven’t done so. Checking to get certainty that a stove or other appliance has been turned off is also very common.  

Checking compulsions may present as mental rituals, wherein the “objects” being checked are in the body or the mind. For example:

• Checking how the body feels inside for any signs of illness
• Checking for signs of arousal related to sexual or violent obsessions
• Checking for urges to engage in an inappropriate, embarrassing act
• Checking if feelings are appropriate/correct (as in relationship obsessions)
• Checking to see if something is still bothersome or noticeable (as in sensorimotor/hyperawareness obsessions)
• Checking to see if harm was done to self or others
• Checking to see if memories are accurate or ideas perfectly understood

To the outside eye, checking compulsions can seem frivolous, self-absorbed, neurotic, or just annoying. While being delayed by another person’s checking behaviors certainly can be off-putting, it’s important to remember that these urges to check are extraordinarily powerful. The urges are often paired with stories of unimaginable horror about the unwanted outcomes of failure to check. My temporary checking symptoms around the cat were significantly milder than what I would typically see in a clinical setting. Imagine leaving your kitchen after cooking a meal and then being forced to watch a documentary about a person who lost their family to a fire because a moment of distraction caused them to leave the stove on. Now imagine the documentary is not only incredibly detailed and believable, but also being livestreamed from inside your head on a loop. It can be suffocating.

It’s easy to understand how checking compulsions can get out of control. Like other OCD symptoms, they follow a familiar pattern. It usually starts with a thought about uncertainty. Is this thing the way that it should be? The intuitive response may be, yeah, probably, I think. But in the absence of a confident answer, the uncertainty leaves the thinker in a state of distress. They then go back to the subject of the uncertainty and verify. The door is locked, the stove is off, the memory is correct, no harm has been done, etc. The distress melts away and the checker feels a sense of relief and gratitude for having checked. But there’s another lesson that gets picked up by the brain in this process. Because the initial intuition was not trusted (that the object in question was probably fine) and the checking behavior effectively rendered that trust irrelevant, the brain learns insecurity. In other words, the next time a similar question arises, the brain goes straight to we can’t be trusted, better check. Checking, like all compulsions, leads to more doubt in the long run and more compulsive behavior.

Thankfully, OCD is a treatable disorder and exposure and response prevention (ERP) can be an effective way to reduce checking and checking urges.  

Check out Part Two of this series here.