What Are OCD Dreams?

Obsessive-compulsive disorder, referred to as OCD, is a mental health condition characterized by intrusive, unwanted thoughts and repetitive behaviours or compulsions. Obsessions and compulsions can occur even during sleep, which is where the term OCD dreams comes from. This article will explain what OCD dreams are and how to treat them.
Klara Hatinova

Klara Hatinova

Klara is postgraduate researcher in experimental psychology at the
University of Oxford.

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In OCD dreams, individuals may experience vivid obsessions or intrusive thoughts that they encounter in their waking life. These could include themes of contamination, harm, or symmetry, among others. For example, individuals with OCD may experience dread over recurring abstract shapes that are not quite symmetric or an inability to get rid of dirt on their hands.

What are Dreams?

Dreams are an elusive phenomenon that occurs during sleep and has fascinated humans for millennia. Scientific breakthroughs in the past decades have helped us understand a bit more about the role of dreams and whether they have meaning.

At a biological level, dreaming can occur at any time of the night and arises from an intricate interplay of brain activity [1]. During sleep, the sensory input to the brain is shut off by the thalamus – the gatekeeper of incoming input into the brain – so the brain generates visual and sensory phenomena from information stored within it.

OCD Dreams

The fact that obsessive and compulsive perceptions occur in dreams is not surprising. Thoughts surrounding obsessive/compulsive behaviour are present in these individuals throughout the day and so would be reflected in dreams.

This is the ‘continuity hypothesis’ proposed in the 1970s and still holds true today. The continuity hypothesis explains that waking experiences continue into one’s dreams [2]. Indeed, a theme of mental health symptoms being recounted in dreams has been reported in depression, panic attacks and schizophrenia [3].

What are OCD Dreams like?

Dreams are abstract, vivid, and often distressing in OCD, but also in the general population [4]. This is partially why there are mixed findings about whether OCD dreams are different from the dreams of the general population.

Interestingly, research has shown that the content of dreams in OCD patients does not significantly differ from that of healthy individuals. Both groups expressed anxiety, sadness, or failure in their dreams – specifically, 60% of OCD patients and 73% of the control group recounted dreams expressing these emotions [3]. Similarly, vivid, compulsive, and distressing dreams were equally prevalent in OCD as in anxiety.

Furthermore, the presence of OCD dreams does not necessarily correlate with the severity of the disorder. No correlation was observed between the frequency of obsessive and compulsive themes in dreams and the severity of OCD symptoms [5]. This study also found an increase in obsessive/compulsive themes in dreams of both healthy controls and individuals with OCD.

In conclusion, while OCD dreams can be distressing and vivid, they are not exclusive to individuals with OCD and do not reflect the severity of the disorder.

Can you Treat OCD Dreams?

OCD dreams can be a disruptive symptom of OCD, especially if they impair sleep quality or cause additional distress. Fortunately, OCD dreams have been shown to reduce in frequency and intensity upon treatment of OCD, without a specific focus on removing OCD dreams [6].

Here are three strategies that can help reduce OCD dreams:

  • OCD Dreams are primarily addressed in Cognitive Behavioral Therapy (CBT), which teaches different ways of thinking, behaving, and reacting to obsessions/compulsions [7]. A specific type of CBT, known as Exposure and Response Prevention (ERP), involves gradually exposing you to your fears or obsessions and teaching you healthy ways to deal with the anxiety they cause [7]. This strategy is effective in the long term, although it may increase the incidence of OCD dreams at the beginning.
  • Medication is another common treatment for OCD Dreams. Antidepressants can be effective in up to 50% of individuals with OCD and help alleviate OCD symptoms, such as OCD dreams [7, 8]. Fluoxetine, clomipramine, and fluvoxamine are examples of antidepressants that reduce obsessions [8].
  • For individuals who don’t find CBT or antidepressants helpful, there are emerging experimental therapies that can help with OCD dreams. For instance, repetitive transcranial magnetic stimulation (rTMS), a brain stimulation procedure that uses magnetic waves, can target specific brain areas associated with OCD [7, 9].

Summary: OCD and Dreaming

OCD dreams are dreams with vivid representations of obsessions and compulsions, reflecting an individual’s specific OCD tendencies. Nonetheless, obsessions and compulsions are common in dreams of healthy controls, making OCD-specific dreaming difficult to separate. OCD dreams can subside through treatment of OCD, which should be discussed with your doctor, especially if you find the OCD dreams disruptive or disturbing.

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Klara Hatinova

Klara Hatinova

Klara is a postgraduate researcher in experimental psychology at the University of Oxford. She has worked across a spectrum of hot topics in neuroscience, including her current project measuring reinforcement learning strategies in Parkinson’s disease. Previously, she studied the efficacy of psilocybin as a therapy for critical mental health conditions and examined molecular circadian rhythms of migraine disorders. She completed her undergraduate degree in Neuroscience at the University of Glasgow and participated in a year abroad at the University of California, where she worked on a clinical trial for spinal cord injury.