Obsessive-compulsive disorder (OCD) is a mental health condition defined by two symptoms: obsessions and compulsions. You may already be familiar with the obsessions aspect of OCD—they can manifest as intrusive thoughts, ideas, images, feelings, urges, sensations, memories, and even dreams. These obsessions can play on repeat in your mind and can cause high levels of anxiety.
This is where compulsions factor in—they’re the physical or mental actions people with OCD perform to cope with the distress caused by obsessions. Compulsions may also be done in an attempt to prevent something awful from occurring—either way, the relief that they provide is temporary, which is why the OCD cycle is reinforced each time.
If you feel stuck doing compulsions, you may already know how stressful it is to deal with them. The good news is that there is a way to break the OCD cycle and get your symptoms under control.
Keep reading to learn more about compulsions in OCD and how evidence-based treatment can help you resist performing them.
How do compulsions work in OCD?
Compulsions are the physical or mental behaviors performed in response to the fear and anxiety caused by obsessions and/or to try to stop something terrible from happening. They are safety behaviors that can fall into the realm of coping techniques or mechanisms.
The issue with compulsions is that they only offer temporary relief from obsessions. When the relief ends, the obsession returns, and so do the compulsions—as if on an endless, exhausting loop. Over time, compulsions tend to grow and become more complex if left untreated.
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How do compulsions develop?
Compulsions are a form of negative reinforcement that are used to get rid of unwanted feelings. According to Tracie Ibrahim, LMFT, CST, NOCD’s Chief Compliance Officer, OCD triggers false emergency alarms in your brain that make you feel an urgent need to “solve” problems—which is where compulsions develop.
“We don’t realize it’s a compulsion—we think we are helping or solving whatever it is that the false alarm told us is the problem,” she explains. “Sometimes, there is a very brief period where the anxiety goes down, but it comes back even stronger the next time, making us think we need to repeat that compulsion.”
This is how obsessions lead to compulsions—you get into a pattern where the anxiety and fear trigger you, and then you think you need to do that same compulsion as a response.
Why do I feel the need to perform compulsions?
You might engage in compulsive behaviors to try to prevent perceived danger or stop potential harm from coming to yourself or others. You may even recognize that your compulsions are irrational, but awareness alone is not enough to stop them.
To better understand this reaction, let’s return to the analogy of the brain as a faulty alarm system. For someone with OCD, the alarm goes off even when there’s no actual danger present. Triggering an obsession sets off waves of fear and anxiety, and the brain then relies on compulsions to cope with these emotions—which are powerful motivators. Something tells you that a certain action will help you feel better, and even if you don’t understand why it works, you do it anyway.
Something tells you that a certain action will help you feel better, and even if you don’t understand why it works, you do it anyway.
Before you know it, compulsions become your first response to intrusive thoughts, and seem to be the only way to relieve your discomfort. Despite the repeated compulsions and attempts to neutralize obsessions, the alarm goes off again and again, and you remain stuck in the OCD cycle.
“Compulsions give you quick relief, which people search for,” explains Patrick McGrath, PhD, Chief Clinical Officer at NOCD. “It works once in a while, but it doesn’t work every time. Otherwise, you’d do the compulsion once and be done. As long as it works now and then, you’re going to keep doing it. It’s like a slot machine—as long as it pays out once in a while, you’re good.”
Also, understand that while compulsions can directly link to an obsession theme (e.g., a fear of cheating and compulsively checking your partner’s phone), the symptoms don’t necessarily have to connect to each other (e.g., counting your steps to prevent a catastrophe from occurring).
Examples of OCD compulsions
Compulsions can be split into two categories—physical and mental. The list below is not exhaustive—you can definitely have a compulsion that isn’t listed. Here are some of the most common compulsive behaviors:
Physical compulsions
- Checking stoves, doors, locks, etc.
- Seeking reassurance from others
- Excessive handwashing and cleaning
- Repeating acts (e.g., walking back and forth through a doorway multiple times)
- Ordering or arranging items in a certain way until they are “just right”
- Performing rituals, such as repeating certain words or phrases
- Excessively researching to find answers to your doubts with 100% certainty
- Body-checking, such as weighing yourself, pinching your skin, taking your measurements, or looking for a groinal response
- Hoarding possessions
- Counting steps, objects, or other things in a particular way
- Avoiding particular people, places, objects, or situations
- Excessive prayer
- Excessive confession of perceived wrongdoings
Mental compulsions
- Mentally reviewing or replaying past events over and over again as you try to find clarity
- Counting in your head while performing tasks
- Scenario twisting by dissecting and scrutinizing past situations with “what-if” scenarios
- Hyper-awareness
- Distraction
- Mental or self-reassurance (e.g., replaying an incident in your mind countless times to soothe yourself from the belief that you did something wrong)
- Rumination or overthinking
- Mental checking
- Memory hoarding
- Thought suppression
- Replacing “bad” thoughts with “good” ones
- Mental rehearsal
You may initially perform compulsions consciously, but it could become an unconscious behavior over time.
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How do I know if I’m engaging in compulsions?
Because compulsions can become second nature, it can be hard to know if you’re doing a compulsion or simply coping with your OCD. If you’re not sure, compare your suspected compulsions to this checklist:
- Does it feel like something you can’t prevent yourself from doing, even if you know it’s an excessive response?
- Does it temporarily relieve the intense feeling of anxiety that goes along with an obsessive thought?
- Does it take up so much time that it interferes with your daily life?
- Has it become your automatic response to obsessive thoughts?
If you experience compulsions, be compassionate with yourself—feeling like you cannot resist them isn’t a sign of weakness, it’s a sign of OCD.
Getting treatment for OCD compulsions
Compulsions—along with the obsessions that cause them—can be treated with a form of cognitive behavioral therapy (CBT) known as exposure and response prevention (ERP) therapy. Unlike other forms of CBT, ERP is specially designed to treat OCD, with 80% of people seeing a significant reduction in their symptoms.
“The goal of ERP is to teach people that the discomfort created by the obsession is manageable and that they can live with it,” says Dr. McGrath. “They don’t have to neutralize it. They can learn how to handle it.”
The goal of ERP is to teach people that the discomfort created by the obsession is manageable and that they can live with it. They don’t have to neutralize it. They can learn how to handle it.
Patrick McGrath, PhD
ERP helps to break the cycle of obsessions and compulsions by teaching you how to tolerate uncertainty. With the help of a therapist trained in ERP and OCD, you’ll work through exercises that help you refrain from engaging in compulsions when triggers pop up in your day-to-day life.
Another treatment option that may help reduce the frequency of compulsions is medication. A combination of medication and ERP may be an effective treatment plan if you have co-occurring mental health conditions (such as anxiety or depression) or are experiencing severe OCD symptoms.
Bottom line
OCD compulsions are powerful, as they feed on your brain’s natural desire for certainty, calm, and the illusion of control. While the urge to do compulsions may never completely go away, you can learn strategies to refrain from performing them with ERP, the most effective form of treatment for OCD.
Key takeaways
- Compulsions are repetitive physical or mental behaviors performed to relieve the distress from obsessions and/or to prevent something bad from happening.
- Some examples of common OCD compulsions include checking, excessive handwashing, avoidance, and seeking reassurance.
- Compulsions reinforce the OCD cycle as they only provide temporary relief for obsessions, and there’s no guarantee that they’ll be effective each time you do them.
- Exposure and response prevention (ERP) therapy is the best treatment for getting your compulsions under control.