A Guide To Magical Thinking OCD

Obsessive-compulsive disorder (OCD) is a mental health condition that affects two to three million American adults¹ and about 500,000 children. OCD occurs in many forms that can range from mild to severe. With time, its symptoms can worsen and substantially decrease one’s quality of life.

Magical thinking OCD (also called mtOCD) is a subtype of OCD. The main driver behind mtOCD is superstitious thinking. While many people are superstitious, it doesn’t interfere with everyday life. For people with OCD, superstitions can cause fear, obsessive thinking, and compulsive behavior. 

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What is magical thinking OCD?

The key elements of OCD are obsessions and compulsions. Obsessions are repetitive thoughts about a subject that causes fear, anxiety, stress, and distress. Compulsions, on the other hand, are repetitive actions aimed at easing these thoughts and fears.

In magical thinking OCD, both obsessions and compulsions have to do with superstitions. Usually, thoughts and actions focus on possible harm. For example, you may think that a family member could get into a car accident if you don’t wear black pants to work.

You stress about the possibility of a car accident. Wearing black pants eases this obsession and makes you believe you are saving your loved one’s life.

Superstitions are common. They can have a positive calming effect, especially during a tough time in someone’s life. Studies show that superstitions can lead to an increased sense of control² and mental reassurance.

According to the American Psychological Association³, many people who know that superstitions aren’t true still don’t let go of the belief. Since it brings certain relief to their stress, these people are willingly exhibiting superstitious behavior.

When it comes to mtOCD, however, your belief in superstitions is so intense that it interferes with your daily life.

For example, you could refuse to take particular black pants off for weeks because you’re convinced that a loved one might have an accident if you do so. With time, this obsessive-compulsive behavior can get worse. You could refuse to wash the pants, for example, or even take a shower with them.

People with mtOCD usually make illogical (or “magical”) connections between cause and effect. They strongly feel that a serious problem could occur if they don’t engage in compulsive behavior.

Examples of mtOCD behavior 

Magical thinking OCD often involves avoidance. For example, you could avoid numbers, words, or actions that could, in your opinion, cause bad luck. When you encounter these “bad” elements, you start engaging in compulsive behaviors to “offset” the bad luck.

Examples of mtOCD obsessions are:

  • If I don’t put on a yellow T-shirt, I will get hit by a car

  • If someone calls me at 6:13, something terrible will happen

  • If I tell someone that I got a raise, I will get fired

  • If I look at the clock at 9:11, my plane will crash

Examples of compulsions⁴ include:

  • Praying

  • Counting numbers

  • Reciting (out loud or silently) specific words, numbers, or phrases in a particular order

  • Repetitive movements (crossing yourself, nodding your head, clenching your fist)

  • Arranging objects in a specific order

  • Repeating something a certain number of times

  • Touching certain things a preset number of times

  • Constantly seeking reassurance from someone you care about (e.g., “Are you sure that our car won’t crash?”)

Symptoms of OCD may be mild at first. However, without treatment, they can worsen over time⁵, causing you to spend a significant part of your daily life worrying about something or performing relief rituals.  

What causes magical thinking OCD

The definitive cause of OCD and its subtypes is yet to be discovered. Research shows that people with OCD have increased activity⁶ in the brain’s frontal area. This could explain obsessive thoughts and high levels of anxiety. Studies also show that treatment (medication and therapy) can normalize this brain activity⁷.

Research⁸ demonstrates that OCD has a genetic factor. People whose siblings, parents, or other relatives have OCD are more likely to develop it than those without a family history. While some roots of OCD can be genetic, scientists have yet to pinpoint the exact genes responsible for the condition. 

Researchers are also working on identifying environmental factors⁹ that could be causing OCD. For example, the condition could be triggered by abuse, sexual assault, or alcohol withdrawal.

Treatment for Magical Thinking OCD

While a cure for OCD doesn’t exist, it’s possible to keep its symptoms under control. 

Like other types of OCD, people with mtOCD respond well to cognitive behavioral therapy (CBT) and medications, specifically SSRIs (selective serotonin reuptake inhibitors).

Exposure and response prevention therapy

Exposure and response prevention (ERP) therapy is a type of CBT that helps people with mtOCD face their fears and obsessive thoughts without easing those fears and thoughts with compulsions. 

During ERP sessions, patients:

  • Confront situations that cause anxiety

  • Learn to accept the role of chance

  • Figure out how to let go of the responsibility

  • Replace rituals with activities that they can control

  • Learn how to be skeptical about superstitions

Around 80%¹⁰ of patients who choose to go through with ERP respond to it well. This therapy can help people with OCD control their symptoms and reduce anxiety. With time, they begin to understand that nothing bad happens if they stop performing their rituals.

SSRIs

Around 70%¹¹ of patients with OCD experience relief after implementing pharmacological therapy. The first line of treatment for this condition is SSRIs. These medications affect serotonin, a neurotransmitter (chemical messenger) in your brain.

Scientists have yet to discover exactly why SSRIs help people with OCD. However, the effect of this medication is impressive. While SSRIs don’t allow patients to achieve remission, they offer substantial symptomatic relief.

Both ERP and SSRIs don’t have an immediate effect. It may take 10 to 12 weeks¹² for the benefits of medication to show. Meanwhile, the number of ERP sessions depends on the intensity of the symptoms and other personal factors.

Studies¹³ show that patients treated with ERP or a combination of ERP and SSRIs experience significant improvement after 12 weeks.

How to help someone with magical thinking OCD

Living with someone who has mtOCD can be challenging. However, there is a lot you can do to help¹⁴.  Family support or support groups can be an essential element of mtOCD treatment.

To support a person with mtOCD, you can:

  • Learn to recognize compulsive behavior

  • Prepare yourself to support the person through treatment

  • Show emotional understanding of the situation

  • Help the person find the right therapist and implement treatment

Sometimes, while trying to help, family members inadvertently do the opposite. For example, they may unknowingly facilitate rituals or assist with avoidance behavior. Educate yourself about the condition to support a loved one with OCD and avoid encouraging compulsive actions.

If you think you or your loved one needs extra support, you could find an OCD support group in your area¹⁵.

The lowdown

Magical thinking OCD is a subtype of obsessive-compulsive disorder characterized by making irrational connections between one’s actions and events. Patients with mtOCD respond well to therapy (CBT, ERP) and medications (SSRIs).

If you or your loved one have symptoms of magical thinking OCD, speak to your doctor about them. Comprehensive treatment can improve your quality of life and prevent the condition from worsening.

Frequently asked questions (FAQs)

What is OCD magical thinking?

Magical thinking OCD or mtOCD is a subtype of OCD. People with this form of OCD have an obsessive approach to specific superstitions. They make irrational connections between events and their actions. For example, a person may be afraid that a bad thought may come true if they don’t stomp their feet 100 times.

Do people with OCD have magical thinking?

People who have magical thinking OCD tend to have a persistent need to engage in specific rituals to prevent problems from occurring.

Is magical thinking a mental illness?

Magical thinking OCD is a subtype of OCD, which is a mental health disorder.

Can mtOCD be cured?

Currently, there is no cure for magical thinking OCD. However, most patients respond well to treatment that includes cognitive behavioral therapy, medication, or a combination of the two.

How do I stop OCD magical thinking?

If you have magical thinking OCD, you can benefit from cognitive behavioral therapy and medication. Keep in mind that the condition doesn’t go away on its own. Symptoms may even get worse over time. Consult your doctor so you can begin treatment as soon as possible.

At what age does magical thinking stop?

Magical thinking OCD doesn’t stop on its own. In fact, symptoms can get worse over time. With the right approach to treatment, it’s possible to keep the condition under control at any age.

Have you considered clinical trials for Obsessive compulsive disorder (OCD)?

We make it easy for you to participate in a clinical trial for Obsessive compulsive disorder (OCD), and get access to the latest treatments not yet widely available - and be a part of finding a cure.

Joining community groups and exercise programs for my condition made me feel empowered – but I want to be part of finding a cure.
Peter, 64

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