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Draw your own OCD loop

Write the four parts of the pattern in your own words and this page draws them as a loop. It is meant to help you describe what happens, to yourself or to a therapist, and it keeps nothing you type.

What an OCD loop is

OCD tends to run in the same order each time. Something sets it off, a thought or doubt arrives with a sense of threat, anxiety or discomfort rises, and you do something to make that feeling stop. The last step is the compulsion. It can be something other people could see, such as washing or asking for reassurance, or something done silently, such as reviewing a memory or repeating a phrase in your head. The relief it brings is real and it comes quickly, and that relief is what brings you back round to the start the next time the trigger appears.

Seeing your own version written down can make it easier to explain to someone else, and easier to notice when the loop is starting. The page on exposure and response prevention explains how treatment works on the loop. This page only draws it.

Before you start

This is an illustration to help you describe the pattern. It is not a diagnosis and it is not a treatment plan. Nothing you type here is stored or sent anywhere. It stays on this page, on your own device, and it is gone when you reload or close the page. If you are finding it hard to keep yourself safe, the numbers for urgent help are just below the tool.

My loop

An example loop

My loop A loop of 5 steps, each leading to the next and the last leading back to the first: Trigger, Thought or doubt, Feeling, What I do, Relief, for now. The step "What I do" is marked as the point where treatment steps in. Linked to the first step are other situations that now set it off too: Door handles, the kitchen bin, shaking hands. The steps are listed in full after the drawing. TRIGGERTouching thebin at workTHOUGHT OR DOUBTWhat if I pass germson to my kids?FEELINGDread, and a feelingthat it is urgentWHAT I DOWash my handsuntil it feels rightRELIEF, FOR NOWIt eases for awhile, then thedoubt comes backMy loopDoor handlesThe kitchen binShaking hands My loop A loop of 5 steps, each leading to the next and the last leading back to the first: Trigger, Thought or doubt, Feeling, What I do, Relief, for now. The step "What I do" is marked as the point where treatment steps in. Linked to the first step are other situations that now set it off too: Door handles, the kitchen bin, shaking hands. The steps are listed in full after the drawing. TRIGGERTouching the bin at workTHOUGHT OR DOUBTWhat if I pass germson to my kids?FEELINGDread, and a feelingthat it is urgentWHAT I DOWash my handsuntil it feels rightRELIEF, FOR NOWIt eases for a while, thenthe doubt comes backNOW ALSO SETS IT OFFDoor handlesThe kitchen binShaking hands

Where treatment steps in. This is the step exposure and response prevention works on. You meet the trigger on purpose, in planned steps, and practise not doing this.

New triggers. Over time, more situations become linked to the trigger and start the loop off too.

The trigger or situation
Touching the bin at work
The thought or doubt
What if I pass germs on to my kids?
The feeling
Dread, and a feeling that it is urgent
What I do to make it stop
Wash my hands until it feels right
Other situations that now set it off
Door handles, the kitchen bin, shaking hands

Why the relief keeps it going

The last step in the loop, “Wash my hands until it feels right”, is what keeps it going. It brings relief, often within seconds, and anything that takes the anxiety away that quickly becomes more likely next time. The relief also makes the doubt seem to have mattered, as if doing something about it is what kept things safe.

Because the compulsion ends things early, there is no chance to learn that you can carry the doubt and the discomfort without it, whether or not the feeling eases. So the next time “Touching the bin at work” comes up, the doubt arrives with the same force and the same fix seems necessary. Over time the loop tends to run faster, and more situations start to set it off.

What exposure and response prevention would look at next

Written generally, not as advice for your situation. A therapist would usually start by listing everything that happens at the last step, because compulsions are often wider than they first look. Avoiding the trigger, asking someone for reassurance and checking something in your head all do the same job.

The work then goes in small, planned steps. You meet a milder version of the trigger on purpose and delay the compulsion, or leave it out, and repeat that in different places and at different times before moving on. The aim is not to prove the doubt wrong but to get better at living with it without the compulsion. The steps are chosen together so that each one is a stretch but manageable, and you start with an easier one rather than the one you fear most. Each step you complete tends to make the next one feel more possible.

This drawing is an illustration to help describe a pattern. It is not a diagnosis and it is not a treatment plan. It was made with the free tool at anxietycbt.co.uk/ocd-loop, which stores and sends nothing. In an emergency call 999. For urgent mental health help call NHS 111, or Samaritans on 116 123.

Using what you have drawn

If you are thinking about treatment, bringing the drawing to a first appointment can save time, because it shows the pattern in your own words. There may be more than one compulsion in your loop, including quieter ones such as steering clear of the trigger or checking something in your head. The page on types of OCD describes the common themes, and the page on Pure O covers loops in which most of the compulsions are mental.

A drawing like this is a simplification. It leaves out why OCD starts in the first place, which is still not well understood and probably involves several factors acting together, genes and life experience among them. It also cannot tell you whether what you have is OCD. What it does show is the part that keeps OCD going, which is the part treatment works on. The loop follows the cognitive-behavioural account set out by Paul Salkovskis in 1985, and NICE recommends CBT that includes exposure and response prevention for OCD.

Common questions

Is my information saved?

No. What you type stays on this page, on your own device. It is not stored, it is not sent to me or to anyone else, and nothing is kept in your browser, so it is gone when you reload or close the page. If you want a copy, the print button lets you print it or save it as a PDF on your own device.

What if my compulsion is in my head?

Write it down in the same way. Mental compulsions are common and they count as much as washing or checking. Going over a conversation to make sure you did nothing wrong, repeating a phrase or a prayer, checking how you feel, and replacing a bad thought with a good one are all examples. They bring relief and keep the loop going in the same way. Because they are silent they are easy to miss, so it can help to ask yourself what you do to feel that something is finished or safe.

Does this mean I have OCD?

No, the drawing cannot tell you that. Most people have unwanted intrusive thoughts from time to time (Radomsky and colleagues, 2014), and many have habits that follow a loop like this. OCD is diagnosed when obsessions and compulsions take up a lot of time, often more than an hour a day, or cause real distress or get in the way of daily life. If you are not sure, a GP or a qualified clinician can assess it properly, and a free call with me is another place to start.

Can I use this for my child?

Yes. Choose My child at the start and the wording changes. With children the last step often involves a parent, for example answering the same question again or checking something for them. It is worth including, because it is part of the loop and usually part of the treatment. If your child is old enough, drawing it together can help, as long as it does not become one more thing that has to be done perfectly.

Should I try to stop the compulsion on my own?

Small changes can be worth trying, but it is better not to begin with the hardest one or to try to stop everything at once. Exposure and response prevention works through planned steps that are a stretch but manageable, and a therapist helps you choose them and spot the compulsions that are easy to miss. If the loop is taking hours of your day, or you are finding it hard to cope, speak to your GP or a specialist.

Sources
  • Salkovskis, P. M. (1985). Obsessional-compulsive problems: a cognitive-behavioural analysis. Behaviour Research and Therapy, 23(5), 571-583. doi.org/10.1016/0005-7967(85)90105-6 (opens in a new tab)
  • National Institute for Health and Care Excellence. Obsessive-compulsive disorder and body dysmorphic disorder: treatment. Clinical guideline CG31 (2005; an update is in development). nice.org.uk/guidance/cg31 (opens in a new tab)
  • American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), criteria for obsessive-compulsive disorder, including the guide of more than one hour a day.
  • Radomsky, A. S., Alcolado, G. M., Abramowitz, J. S., et al. (2014). Part 1: You can run but you can’t hide: Intrusive thoughts on six continents. Journal of Obsessive-Compulsive and Related Disorders, 3(3), 269-279. doi.org/10.1016/j.jocrd.2013.09.002 (opens in a new tab)

Written by Dr Daniel O’Rourke, PhD, ABPP, CPsychol, HCPC-registered Clinical Psychologist Last reviewed:

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