OCD and Decision Making

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Janet Singer's son Dan suffered from obsessive-compulsive disorder (OCD) so severe he could not even eat. What followed was a journey from seven therapists to ...Read More

How Does OCD Affect Decision-Making?

Obsessive-compulsive disorder (OCD) can influence decision-making by causing people with this condition to become excesisvely focused on details, doubt their choices, and fear making mistakes. This can lead to issues making decisions, as they may feel overwhelmed by intrusive thoughts an the need for certainty.[1]

Some coping strategies for decision-making problems related to OCD include:

  • Practice mindfulness techqniues to stay grounded in the present moment
  • Break decisions into smaller, manageable steps to decrease overwhelm
  • Challenge irrational beliefs about making mistakes or needing certainty
  • Seek support from a trusted family member, friend, or mental health professional
  • Use relaxation exercises like deep breathing or progressive muscle relaxation to reduce anxiety

Understanding OCD

OCD is a mental health condition characterized by persistent intrusive thoughts called obsessions and repetitive behaviors or mental acts called compulsions. In OCD, decision-making becomes challenging due to the overwhelming need for certainty and fear of making mistakes.[1]

Symptoms of OCD include indecisiveness and chronic doubt, where people may struggle to make choices or feel uncertain about their decisions.[2] This can lead to excessive checking, seeking reassurance, or repeating actions to alleviate anxiety and gain a sense of control over intrusive thoughts.

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The psychological mechanisms behind OCD’s effect on decision-making involve cognitive processes like cognitive rigidity and intolerance of uncertainty.[3] Those with OCD may engage in compulsive behaviors as a way to cope with distressing thoughts and reduce uncertainty, despite knowing their actions are irrational. This cycle of obsessions and compulsions can perpetuate decision-making difficulties and interfere with daily functioning.

Decision-Making Challenges in Daily Life

Decision paralysis can make daily living difficult for individuals struggling with OCD. For instance, someone with OCD may spend an excessive amount of time deciding what clothes to wear due to fears of making the wrong choice or concerns about cleanliness.[4]

Another example is ordering food at a restaurant. In this situation, someone with OCD may struggle to decide on a meal, worrying about potential contamination or whether the choice aligns with their perceived rules or rituals.[4]

The emotional effect of OCD on making routine choices can be profound, leading to heightened anxiety, frustration, and feelings of helplessness. The constant need for certainty and the fear of making mistakes can create a sense of urgency and distress, making even simple decisions feel overwhelming and exhausting.

Practical Coping Mechanisms for Those with OCD

Decision paralysis can be really distressful for individuals with OCD; however, there are some strategies that can help improve decision-making, such as:[4]

  • Identify obsessive thoughts: Recognize intrusive thoughts and obsesisons that may be influencing decision-making processes.
  • Challenge perfectionist standards: Acknowledge that it’s okay to make mistakes or have uncertainties. Challenge the belief that every decision must be flawless.
  • Set time limits: Limit the amount of time spent on making decisions to prevent excessive rumination and anxiety.
  • Prioritize choices: Focus on making decisions that are most important or time-sensitive. 
  • Seek support: Reach out to trusted loved ones or professionals for guidance and reassurance when faced with challenging decisions.

Managing Anxiety Related to Decision-Making

Some techniques you can use to manage your anxiety related to decision-making include:

  • Deep breathing: Practice deep breathing exercises to calm the body and mind when feeling anxious or overwhelmed.
  • Progressive muscle relaxation: Relax different muscle groups in the body systematically to release tension and reduce anxiety levels.
  • Mindfulness meditation: Engage in mindfulness meditation to cultivate awareness of the present moment and develop a non-judgmental attitude toward thoughts and emotions.

Part of managing anxiety related to decision-making also involves the ability to embrace uncertainty, which can in turn reduce the fear of making “wrong” decisions. You can do this by accepting imperfections, engaging in exposure therapy, and practicing flexible thinking and behavior.

Decision-Making OCD vs. Non-OCD Comparison

When it comes to decision-making, people with OCD and those without OCD demonstrate many differences.

Rumination and Overthinking

Individuals with OCD often ruminate excessively over decisions, leading to prolonged indecision and heightened anxiety. On the other hand, non-OCD individuals may consider decisions but typically do not engage in compulsive rumination.

Fear of Making Mistakes

People with OCD may experience intense fear of making the wrong decision, resulting in avoidance behaviors and repeitive checking. However, people without OCD may feel concerned about mistakes but usually make decisions without excessive worry.

Need for Certainty

Individuals with OCD often exhibit an overwhelimng need for certainty, resulting in rigid thinking patterns and difficulty accepting uncertainty. Non-OCD individuals can generally tolerate varying levels of uncertainty and make decisions based on available information.

Effect on Daily Functioning

Decision-making problems in OCD significantly impair daily functioning and interfere with work and relationships. People without OCD may experience occasional decision-making challenges but typically don’t face the same level of impairment.

Inflexibility and Perfectionism

People with OCD may demonstrate inflexible decision-making processes characterized by an inability to adapt to changing circumstances and a pursuit of perfection. Conversely, people without OCD are often more flexible in decision-making and accept imperfection.

Empowering Community and Family Involvement

Family and friends play an important role in helping loved ones with OCD make decisions, reduce anxiety related to decisions, and feel comfortable expressing their challenges. Here are some tips:

  • Encouraging open communication: Families and communities can create safe spaces for those with OCD to express their thoughts and concerns about decision-making without judgment or criticism.
  • Providing emotional support: Offer reassurance, empathy, and understanding can help reduce anxiety and stress associated with decision-making for those with OCD>
  • Assisting in problem-solving: Families and communities can assist by breaking down decisions into smaller, manageable steps, offering guidance, and brainstorming solutions together.
  • Encouraging professional help: Encourage your loved ones to seek professional help from therapists or counselors specializing in OCD can provide additional resources and strategies for managing decision-making challenges.
  • Reducing stigma: Educate yourself and others about OCD helps to reduce stigma and misconceptions surrounding the disorder, fostering a supportive environment.

One Mother’s Personal Story

We are very lucky. We live in a society of unlimited possibilities. From what clothes to buy, to what to eat, to deciding when or if to marry, to career paths and lifestyle choices, we are barraged by seemingly endless decisions daily. This combination of freedom and abundance affords us opportunities galore to create ideal lives for ourselves.

Not surprisingly, however, many of us often feel overwhelmed by the complexity of our lives. There are just so many choices. Whereas we used to go to the library (or perhaps a bookstore) to get that book we wanted, we now have the additional options to read it on Kindle (or perhaps Nook) or order it online (but from which site?), or perhaps get the audio version (but which one and from where?).

While these daily choices can be distressing for anyone, they can be especially difficult for those who suffer from obsessive-compulsive disorder. Since doubt is the cornerstone of OCD, sufferers often have the need to know, for certain, that all these decisions they are making are the right ones. This is much easier said than done. Sure, you like the way your new jacket looks, but maybe the cheaper one you didn’t choose would have been just as nice. The restaurant you took your co-worker to for lunch was great, but maybe the “other one” would have had better specials. You love your job, but maybe if you’d continued on with your education, you’d have an even better job now. And so the ideal life that freedom and abundance offers doesn’t exist. Perfection eludes us; there is always doubt.

OCD sufferers might also worry how their choices will affect others, and agonize (to the point of obsession) over even the most minor decisions. “What if the movie I choose is boring for my friend?” “Will I insult my child’s teacher if I say no to a volunteer project?” “Will my doctor be upset if I choose another healthcare provider?”

Or those with OCD might make a decision they are quite sure of, only to then have OCD sabotage it. A vacation destination you’ve been dreaming about for years can now finally be a reality, but OCD might force you to second-guess your choice. The weight attached to all kinds of decisions can be too much to bear, at which point OCD sufferers may avoid making decisions whenever possible. Unfortunately, avoidance is never the answer, and while this tactic may temporarily quell anxiety, in the long run it will make OCD stronger. Exposure Response Prevention Therapy can help sufferers learn to accept the uncertainty that inevitably comes with decision making. Feeling mentally drained by overthinking? Take our online repetitive thoughts test to assess the impact of overthinking on your overall mental well-being.

Barry Schwartz, a psychologist and author of The Paradox of Choice, explores the connection between depression and the abundance of choice. He talks about how when we have no choice in a matter and something goes wrong, we have no reason to blame ourselves. If a tornado comes along and destroys our home, we don’t go around assigning blame; instead we begin to rebuild. When we do have a choice, whether it’s something as trivial as which jeans to buy, or something more significant like a career move, we have high expectations and expect everything to be perfect. When these expectations fall short, we blame ourselves. After all, we are the ones who made the decision. Maybe we should have made a different choice? There is often regret that may lead to depression.

According to Dr. Schwartz, too much choice undermines happiness. I agree and believe this is as good a reason as any to simplify our lives as much as possible. We need to be grateful for all that we have because yes, we are indeed lucky. But none of our lives is perfect. And whether we have OCD or not, we need to be able to accept the decisions we make and continue on. If we don’t, our mental health will surely suffer.


  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
  2. National Institute of Mental Health. (2022). Obsessive-Compulsive Disorder (OCD).
  3. Wheaton, M. G., Messner, G. R., & Marks, J. B. (2021). Intolerance of uncertainty as a factor linking obsessive-compulsive symptoms, health anxiety and concerns about the spread of the novel coronavirus (COVID-19) in the United States. Journal of obsessive-compulsive and related disorders, 28, 100605. https://doi.org/10.1016/j.jocrd.2020.100605
  4. Veale, D., Eshkevari, E., Kanakam, N., Ellison, N., Costa, A., & Werner, T. (2014). The Appearance Anxiety Inventory: validation of a process measure in the treatment of body dysmorphic disorder. Behavioural and cognitive psychotherapy, 42(5), 605–616. https://doi.org/10.1017/S1352465813000556
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