OCD Counting: Everything You Need To Know

Counting OCD, also known as arithmomania, is a common subtype of Obsessive-Compulsive Disorder (OCD) characterized by an intense preoccupation with numbers and a compulsion to engage in repetitive counting behaviors.

Individuals with counting compulsions might feel an excessive need to count various things, such as steps, ceiling tiles, or passing cars. etc., due to their preoccupation with numbers. Some people are more aware of their counting behavior whilst it may manifest as a subconscious or automatic behavior for others with less awareness.

Counting OCD can manifest in a number of different ways: common symptoms include mental counting (i.e., counting the number of steps you take), item counting (i.e., counting the number of items in your bag or shopping cart), measuring, or waiting for a particular time to perform a specific task.

Additionally, some people who experience counting OCD will attach certain meanings to particular numbers where certain numbers will induce additional anxiety, while others will make them feel calm. 

For example, someone with counting OCD may place special significance on the number four and will therefore do things in sets of four. When drinking water, they will only take four (or a multiple of four) sips at a time, or when walking, they might count their steps in increments of four. 

“Everything has to be in groups of ten. I can only adjust things by increments of five, even though it will ultimately end up on a multiple of ten. I have to count certain things out loud, or my brain will make me eventually stop and start over when I get past ten.”

The act of compulsive counting can be comorbid with other subtypes of OCD, specifically “just right” OCD or “symmetry” OCD. 

Obsessions & Compulsions

Obsessions are often at the root of the OCD experience. An obsession is an intrusive and unwanted thought that causes anxiety or distress for the person experiencing it.

Having intrusive thoughts is common in the general population, and it does not mean you have OCD, but if you find yourself trying to suppress these unwanted thoughts and fears with compulsions, this can be a sign of OCD.

Compulsions are behaviors or rituals that people with OCD perform in response to an obsession, or intrusive thought. People perform these compulsions to suppress their anxiety and neutralize their fears.

They also carry them out to keep things safe, ensure that the thoughts do not come true, and ensure that something bad does not happen.

Why People With OCD Count

Counting can happen automatically without specific intrusive thought, but rather just a ritual that the person performs without conscious thought.

Other times, the person might count because they have a perpetual feeling of wrongness, and counting just feels “right.” 

For people with counting OCD, counting provides a sense of control and comfort and helps ease the mind and block out intrusive thoughts. Most people with OCD tend to be bombarded with invasive, scary thoughts of upcoming danger or hardship, so counting can serve as an outlet to suppress or neutralize these thoughts.

They might believe that counting to a certain number or doing things a particular number of times will prevent something bad from happening to themselves or to others, so they count to try and guarantee safety. 

For example, someone might fear that harm will come to themselves or someone they love if they don’t perform the compulsion of counting.

They might think that if they count to a particular number, they will somehow protect them. This is similar to people who suffer from Harm OCD, another common OCD subtype. 

Additionally, counting can bring a sense of order and routine to the chaos and stress of an OCD sufferer’s life. It can give an individual a feeling of satisfaction and accomplishment when things are systemized and numbered appropriately. 

However, these are only short-term reliefs that will eventually perpetuate their level of anxiety and maintain the vicious cycle of their problems with OCD.

What People With OCD Count

Symptoms of counting OCD manifests differently in each sufferer; however, some common thoughts and behaviors may indicate someone is experiencing this type of OCD.

Below is a list of common repetitive behaviors or mental acts that an individual with counting OCD might feel driven to perform in response to an obsession or according to specific “rules”:

• Counting words (i.e., counting the words in a conversation, text, or email)
• Counting objects (i.e., counting stairs as you walk up them, the number of objects in your room, the number of items in your shopping cart, the tiles on the floor, letters in a word)
• Performing mathematical calculations
• Counting to a specific number aloud or in your head before doing something (i.e., counting to 25 before leaving a room)
• Doing actions in certain numbered increments (i.e., sitting your coffee five times before drinking it)
• Favoring / preferring certain numbers (i.e., repeating behavior sets as many times as necessary to avoid “bad” numbers)
• Avoiding looking at anything that contains a “bad” number (i.e., house numbers, price tags, clocks, or volume indicators)
• Counting to whatever number happens to feel “right” at that moment
• Preferring odd vs even numbers (i.e., always placing an even number of ice cubes in your glass)

People with counting compulsions might also count just for the sake of counting, without a specific number in mind. They might count all of their steps when walking, count cars driving past, or count the number of strokes they take when brushing their teeth. 

Making decisions by counting is another common counting compulsion. For example, someone may make a decision about what food they should order from a menu or which item they should buy by following rules that involve counting. 

However, while compulsions might “help” in the short term, they only make the intrusive thoughts worse and serve to keep the OCD cycle going long-term.

Whenever one engages in a compulsion related to the obsession, the thoughts will only become stronger in a powerful and debilitating loop.

Compulsions will never make the intrusive thoughts go away; they will only reduce your anxiety at the moment and give you a short-term reprieve from your thoughts.

If your brain has a pattern of carrying out a compulsion each time you get an intrusive thought, you will never be able to reduce the compulsions.

Do I Have Counting OCD?

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is a diagnostic manual used by healthcare professionals worldwide to guide their diagnosis of mental disorders.

According to the DSM-5, to be diagnosed with OCD, you must fit the following criteria:

• You experience obsessions, compulsions, or both.

• You have obsessions or compulsions that take up at least an hour of your day
• You experience obsessions or compulsions that cause significant distress or affect your social, occupational, or other important areas of functioning.

Like all OCD subtypes, arithmomania can significantly affect a person’s quality of life. Counting compulsions tend to be time-consuming and draining.

They can impede one’s ability to perform household tasks, maintain a job, enjoy leisure activities, and spend time with loved ones. 

It makes it nearly impossible to perform sufficiently in assigned tasks and be attentive in social interactions.

Some people can become so obsessed with numbers and counting that it consumes their thoughts, so they can’t focus on anything else.

How Do We Treat Counting OCD?

One can understand how their symptoms affect their daily life and learn how to manage them through medication, therapy, and mindfulness. 

Similar to any other form of OCD, counting OCD can be treated and managed effectively with Exposure and Response Prevention (ERP), a type of CBT that is considered the first-line psychotherapy for OCD.

In ERP, patients work with a therapist to identify both external and internal triggers that cause them stress and make them want to behave compulsively.

ERP is designed to gradually reduce the anxiety that feeds the obsessions and compulsions through a process called habituation. The goal of habituation is to purposely face your anxiety in an attempt to disrupt the neural circuit between the processing and action parts of the brain.

For example, an ERP therapist might encourage a patient with counting OCD to perform a particular action without giving in to their counting ritual. They might be encouraged to learn how to sit with their obsessive thoughts without giving in to the compulsive behavior of counting.

At least half of the patients who seek treatment for OCD will show symptomatic remission over the long term and experience an increased quality of life and improved functioning.

The best outcomes occur in individuals diagnosed early and managing it sooner. Depending on the severity of OCD, some people may need longer-term treatment. 

There is a critical focus on compulsions in treating counting OCD because this is usually the most concrete and accessible way to target the disorder.

While we can’t always control our thoughts and feelings, we can control our behavior and response to them. A person with OCD should accept their thoughts and understand that the distressing thoughts they experience are not necessarily something that reflects reality.

While you may be unable to control whether an intrusive thought pops into your head, you can control how you respond.

Finding a way to discontinue compulsions is how you can decondition your anxiety and learn to have less frequent and intense obsessions. 

Sources

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Henderson Jr, J. G., & Pollard, C. A. (1988). Three types of obsessive compulsive disorder in a community sample. Journal of Clinical Psychology, 44(5), 747-752.

Hezel, D. M., & Simpson, H. B. (2019). Exposure and response prevention for obsessive-compulsive disorder: A review and new directions. Indian journal of psychiatry, 61(Suppl 1), S85.

Leckman, J. F., Denys, D., Simpson, H. B., Mataix‐Cols, D., Hollander, E., Saxena, S., Miguel, E. C., Rauch, S. L., Goodman, W. K., Phillips, K. A. & Stein, D. J. (2010). Obsessive–compulsive disorder: a review of the diagnostic criteria and possible subtypes and dimensional specifiers for DSM‐V. Depression and anxiety, 27(6), 507-527.

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