Although obsessions without overt rituals are now considered relatively common among people with OCD, this OCD symptoms has generally been understudied and until recently has been considered resistant treatment. Beliefs regarding the importance of thoughts and the need to control them are common in people with this type of OCD. The meanings associated with unwanted thoughts may be related to views of self, for example, the ideaa that “Having a bad thought means I am a bad person.”

People with mental compulsions are usually coping with thoughts are that are unacceptable or taboo in nature (sexual, harming, religious thoughts), or worries about illness and health. Rather than perform an overt ritual, such people will engage in these covert rituals and mental neutralizing. This might include repeating silent prayers, replacing “bad” thoughts with “good” thoughts, or erasing unpleasant mental images. They might also engage in excessive silent prayer or confession, perform some form of mental checking (e.g., reviewing one’s behaviors), or engage in excessive self-reassurance (e.g., “I have never done that bad thing before so I won’t do it now.”) These mental compulsions result in the same temporary relief from anxiety, and are thus are thus equivalent to more overt rituals.