Magical Thinking OCD and How It's Treated

Magical thinking OCD is a form of obsessive-compulsive disorder (OCD) in which people believe their thoughts, words, or actions could have specific, irrational, real-life consequences.

OCD is a mental health condition that involves recurring intrusive and unwanted thoughts (obsessions) and repetitive actions (compulsions). Compulsions are performed in an attempt to reduce anxiety caused by the obsessions. Magical thinking, such as with superstition or in childhood, does occur outside of OCD, but for people with OCD, magical thinking is far more disruptive.

This article covers examples and treatment for magical thinking OCD.

What Is Magical Thinking OCD?

Magical thinking is when you believe a thought or action can influence unrelated things in the real world. Superstitions are an example of magical thinking. Walking under a ladder or opening an umbrella indoors are unlikely to make bad things happen, yet many people still avoid doing these things.

Many people experience magical thinking to a certain degree—such as believing that a lucky charm can influence the outcome of a sporting event. However, people with magical thinking OCD experience magical thinking in a way that is consuming and disrupts multiple areas of their lives.

People with magical thinking OCD often feel responsible for the well-being of others. They worry that their thoughts or actions could cause harm. Often, those thoughts or actions are unrelated to the things they are afraid might happen.

For example, they may repeat a phrase a set number of times to "prevent" harm to themselves or a loved one. The harm may be something specific (like a car accident) or more general. They may realize rationally that they do not have the power to make bad things happen, but failing to perform the task will cause severe anxiety.

Superstitions vs. OCD

Even the most superstitious people tend to limit their magical thinking to specific things. Breaking a mirror might cause distress in the moment or wearing a lucky shirt when giving a presentation may make them feel more confident. But these thoughts don't linger outside of those situations.

However, people with magical thinking OCD have intrusive thoughts and compulsions that interfere with their everyday lives. The anxiety and fear that come with magical thinking OCD are usually farther-reaching and more intense than with typical superstitions.

Manifestations and Magical Thinking

Manifestation happens when you believe that aspirational thoughts about the things you want can make those things happen in the real world. While there is some evidence that thinking positively can make it easier to achieve your goals, it can be harmful to believe the opposite—that negative thinking can cause bad things to happen.

This is especially true for people with OCD, who often have intrusive negative thoughts and can experience severe anxiety if they believe those thoughts could make bad things happen in their lives.

Examples of Magical Thinking

The obsessions and compulsions that characterize magical thinking OCD can be about anything, but some are more common.

Common Obsessions

Most obsessions in magical thinking OCD involve anxiety over harm coming to themselves or other people. This harm might be specific, such as failing a test if certain rituals aren't performed, or it may be broader, like a general feeling that something terrible will happen. For example:

• If I don't complete my morning tasks in a specific order, I will crash my car.
• If I don't open and close my textbook 10 times, I will fail the test.
• If I don't hug my kids before they go to school, something bad will happen to them.
• If I don't call my mom every day, she will die.
  

Common Compulsions

Compulsions in magical thinking OCD often fall into one (or more) patterns. They include:

• Avoiding certain "bad" numbers, colors, words, etc.
• Repeating "good" words, numbers, or phrases
• Repeating actions (such as turning on a light switch) repeatedly until it feels "right"
• Counting to or beyond specific numbers or performing actions around those numbers (such as eating three slices of apple intentionally, regardless of hunger level)
• Wearing certain clothes or colors
• Repetitive hand movements
• Touching things a certain number of times or in a specific way
• Neutralizing bad thoughts with good thoughts, such as saying "life" if they have said the word "death"
• Arranging objects in a specific way, such as lined up in a row or at right angles
• Moving their body or gesturing in a certain way
• Doing specific things at a certain time or date
• Performing "rituals" where certain actions are repeated
  

Treatment for Magical Thinking OCD

Typical treatment for magical thinking OCD involves behavioral therapy and/or medication. Often both are used together to enhance the effectiveness of both treatments.

Behavioral Therapy

Exposure and response prevention (ERP) is a form of cognitive behavioral therapy that can be used to treat OCD. It is usually performed in an outpatient setting by a mental health professional, such as a psychologist. ERP is often done through individual appointments, but group settings and videoconferencing (teletherapy) are also options.

In ERP, the person is gradually exposed to their fears, with increasing intensity over time. For a person with magical thinking OCD, this may involve exposure to intrusive thoughts but resisting the compulsions that the person would typically do to alleviate their anxiety. This type of exposure is only performed with consent from the affected person.

Over time, the person sees that nothing bad happens when they don't perform the compulsion. This can help their anxiety decrease even without the compulsive response, leading to a reduction in magical thinking.

Medication

Antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs), can help with symptom relief. These may include:

• Anafranil (clomipramine hydrochloride)
• Prozac (fluoxetine)
• Zoloft (sertraline)
• Luvox (fluvoxamine)
• Paxil (paroxetine)
• Celexa (citalopram)

Higher doses of SSRIs may be needed to treat OCD than are used in treatment for depression. It can take two to three weeks for the medication to start being effective and eight to 12 weeks to see the full effect.

Medication may not be effective enough on its own for everyone, but it can provide symptom relief while behavioral therapy takes place.

Summary

Many people experience a form of magical thinking from time to time but it isn't disruptive. However, people with magical thinking OCD experience much more intrusive and severe unwanted thoughts.

These obsessions, and the compulsions that come with them, interfere with functioning. For example, a person may feel harm will come to themselves or others unless they act on a certain compulsion.

Magical thinking OCD is typically treated with behavioral therapy and/or medication, such as antidepressants.