OCD & Checking: Part 2 (Mental Checking)

Mental Checking (Covert Rituals)

Mental checking can involve mentally analyzing whether or not a behavior was completed properly.

Behavioral Checking (Overt Checking)

Many examples of compulsive checking rituals in OCD involve direct inspection of a target stimulus by sight, sound, or feel.

Common OCD checking behaviors include relocking doors, visually examining the position of one’s parking brake, or holding one’s hands above stove burners in order to detect warmth.

Behavioral checking is often accompanied by the thought, “Did I do it the right way?”

These checking behaviors are often referred to as behavioral checks, manual checks, or overt checks. Overt rituals (by definition) are visible behaviors that can be perceived by external observers. However, in some cases, overt rituals may be subtle or purposefully hidden in order to avoid embarrassment.

Mental Checking (Covert Checking)

In contrast, other compulsive checking rituals can only be perceived by the individual engaging in the behavior. These types of OCD rituals are thought-based and are sometimes referred to as mental checking or covert checking rituals.

Mental checks are often accompanied by thoughts such as, “Did I do it the right way?”, “Am I feeling the right way?”, or “Did I do this for the right reason?”

Mental checking is the cognitive counterpart of behavioral checking, and many covert checking rituals overlap extensively with the mental rituals that characterize Pure-O OCD.

Whereas overt checking involves obtaining evidence directly from the current physical environment (i.e., obtaining visual, auditory, or tactile feedback from physical objects or behaviors), mental checking typically involves an evaluation (or reevaluation) of information already obtained. This information may exist in the form of memories, feelings, motivations, or other internal states of being.

Mental checks can occur both in the presence and absence of a given target stimulus. Individuals may engage in mental checking rituals shortly after an event, but covert checking is not bound by time or space. Some people with OCD continue to check hours, days, or even years after the original event. For example, some individuals may review or check the content of conversations that occurred many years ago.

Let’s identify some examples of mental checking. This list is not exhaustive but is intended to illustrate the diversity of situations in which mental checking might be present.

Examples of Mental Checking

1. Memory Checking Rituals – Reviewing one’s memory to “make sure” or verify that a behavior was completed properly.
Did I lock the door?  Was the stove really off? Was the “H” on the faucet handle facing the way it normally does when it’s off? I know the answer was “B”, but did I circle “A”? Was that sound similar to the sound of a stick hitting the underside of my car, or did it sound “wet”?

This mental ritual involves retrieving memories or trying to recreate mental pictures of past events. These images are then mentally examined, checked, or scrutinized to determine if a specific criterion has been met. For example, one might try to remember the exact angle of a stovetop dial in order to obtain reassurance that the gas valve has been closed. Memories in any sensory modality can be mentally retrieved and checked – sights, sounds, or physical sensations. Because there is often OCD doubt about whether these mental images do, in fact, represent what one has actually seen, mental checks often fuel additional behavioral checks.

Other memory checking rituals involve categorization and probability estimation, which are more complicated processes than when one evaluates a simple dichotomy. With these more complex rituals, multiple possible outcomes are considered, each of which differs with regard to its undesirability. These checks occur in nearly all forms of OCD, including contamination OCD and hit-and-run OCD.

2. Feeling Checking Rituals – Comparing current feelings to how they “should” feel.
Do I feel as secure in my relationship with God as I should?  Did my prayer feel genuine?

This mental checking ritual is based around comparing one’s current emotions to an idealized version of how they should be. This desired feeling state may be based on history (i.e., previous feeling states) or on aspirational feeling states. These symptoms often characterize scrupulosity, ROCD, and HOCD. For example, scrupulosity often involves a discrepancy between how “close” or “connected” one should feel in their relationship with God vs. how they actually feel at a given moment. There may also be perceived discrepancies related to feelings of “genuineness” about one’s prayers.

3. Relationship Checking Rituals – Comparing current relationships to how they “should” be.
Am I still in love with my partner?  Does the fact that I found that other person attractive or had that dream mean that I should end my current relationship?  Do doubts about my current relationship mean that there’s somebody better out there for me?

These checking rituals are often based around the premise that if one is in the “right relationship,” one shouldn’t experience any doubts about their relationship or their partner. Individuals with these types of OCD checking rituals compare current relationships to past relationships or to potential idealized future relationships. They often experience significant doubt and distress about their personal relationships and may have a history of relationship “ping pong.” They may worry about “missing out,” hurting their partner’s feelings, or not “being on the right path.”

These types of symptoms often characterize ROCD. In addition to the symptoms described above, ROCD may also involve making faulty inferences about one’s future behavior on the basis of their current doubts (see Intention Checking rituals below). For example, one might infer that having doubts about one’s current relationship might mean that they secretly want to cheat (or will cheat) on their partner (despite having no desire to do so). Parallel symptoms can also characterize scrupulosity, in which individuals may worry that they secretly want to reject God and/or worship the devil.

4. Intention Checking Rituals – Examining one’s own motivation for engaging in particular behaviors.
Am I changing my child’s diaper because I thought it was really soiled or because I wanted to look at my child’s private parts? Does the fact that I noticed that person’s attractiveness mean that I want to have a relationship with them? Does the fact that I’m clenching my fists in anger mean that I want to punch or harm that person? Does the fact that I’m having suicidal thoughts mean that I want to kill myself? What kind of person would be having these kinds of thoughts?  

These checking rituals cause one to question their own motivations for engaging in certain behaviors which commonly results in extreme guilt, shame, or confusion. These types of checking rituals are often present in OCD characterized by harm, sexual, or suicide obsessions, as well as in cases of HOCD, ROCD, and scrupulosity.

Individuals with these types of rituals often assume that their thoughts have significant meaning. They might think that all thoughts are purposeful or may reflect one’s “true” character or desires. This is problematic in that these types of rituals often involve morally taboo topics or unwanted thoughts.

These rituals are sometimes called “figuring out” rituals, as they involve trying to understand the “real” reason for doing something. They also are frequently accompanied by reassurance seeking rituals. Reassurance seeking rituals may involve other people (“Do you think I could ever do that?”) or may consist of personal attempts to convince oneself that one’s behavior is motivated by sound reasons.

5. Sensation Checking Rituals – Attempting to understand the meaning of physical sensations in one’s body.
Does that tingling sensation in my groin mean that I want to have a sexual relationship with that person? Does that fluttering in my chest mean that I’m about to lose control and scream something inappropriate?

This type of mental ritual involves trying to figure out the meaning of specific bodily sensations. Individuals with these types of compulsions often become hyper-attuned to small changes in their own physiology. Sensations associated with this type of ritual are often sexual, violent, or frightening in nature.

6. People Checking Rituals – Mentally reviewing the meaning of other people’s behaviors, words, or facial expressions.
Did his expression indicate that I insulted him? Did she invite me to lunch because she really wanted to see me, or because she thinks I’m pathetic? If I hadn’t locked the door, wouldn’t my spouse have said something? If I had left the gas stove on, wouldn’t my kids have commented on the smell?

These rituals involve reviewing other people’s actions, words, or facial expressions in order to better understand their reactions or intentions. These rituals can also involve establishing the safety of current situations by reducing doubt and uncertainty through reassurance or diffusion of responsibility. For example, “If that person wasn’t concerned, then I shouldn’t be concerned either” or “If this situation is really dangerous, then that person would have taken proper precautions.”

7. Understanding/Information Checking Rituals – Mentally replaying conversations or reviewing written materials to check their content.
Did I really understand their advice? Did I express myself properly? Did I leave any important information out that could cause something bad to happen? Did I understand what I just read?

These rituals involve a fear of misunderstanding and/or miscommunicating information. Individuals with these types of rituals may fear that they have misunderstood something that was said to them, or they may be afraid of mispeaking or leaving out essential details when talking to others. This fear is based around the idea that something important might be missed, or that there is a moral imperative to avoid misleading other people.

Common forms of OCD that are based around this ritual include OCD perfectionism (rereading, rewriting rituals), and moral OCD based around the fear of unintentionally lying to others. Many individuals with these types of compulsions do not recognize that they have OCD.

As you can see, covert checking is incredibly diverse and can be easily overlooked.  Whether behavioral or mental, checking rituals provide short-lived reassurance that ultimately backfires and reinforces OCD. The most effective treatment for OCD is exposure and response prevention (ERP). In my South Florida psychological practice, I treat individuals with OCD by helping them learn to recognize and resist their behavioral and mental checking rituals.

Questions? Comments? Do you engage in covert checking rituals? Sound off below.

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