OCD, or obsessive-compulsive disorder, is a mental health disorder defined by two kinds of symptoms: obsessions and compulsions. You may know about obsessions—these are intrusive, unwanted thoughts, ideas, memories, or urges—even intrusive dreams can become obsessions. They play on repeat in an OCD sufferer’s mind and tend to cause a lot of distress.
And that’s where compulsions come in. To cope with the distress caused by the obsession, someone feels compelled to engage in certain behaviors (this includes both mental and physical actions), which are known as compulsions.
Compulsions, however, only offer temporary relief from obsessions. When the relief ends, the obsession returns, and so does the compulsion—as if on an endless, exhausting loop.
As a therapist who specializes in evidence-based treatments for disorders including OCD, I often help people who aren’t sure if what they’re experiencing is a compulsion or something else—and I understand how important it is for your recovery journey to identify the compulsions you engage in. Read on for the answers that you, too, might be looking for.
Why do people perform compulsions?
While not rational, compulsive behaviors that OCD sufferers engage in are done with the goal of preventing perceived danger or harm coming to oneself or someone else.
In many cases, the person even recognizes that their compulsive actions are irrational, but this awareness alone is not enough to stop them. The OCD brain relies on compulsions to cope with emotions such as fear and anxiety, which are very powerful motivators. Something tells you that a certain action would help you feel better and even if you don’t understand why it works, you do it. Soon it becomes your first response to those intense, distressing thoughts and seems to be the only thing that helps alleviate discomfort or make the thoughts go away. Despite the repeated compulsions and attempts to neutralize recurrent intrusive thoughts, the thoughts come back, time and again and you remain stuck in the cycle of OCD.
Examples of Compulsions in OCD
The stereotypical idea that people draw to mind when they think about OCD is compulsive hand-washing. Because of obsessive fear of contamination, someone might spend an unreasonable amount of time scrubbing and washing their hands each day. They may “feel” that their hands are dirty and can cause illness, even when they are not contaminated at all.
That’s one example of a compulsion, but there are countless others. This list below is not exhaustive — you can certainly have a compulsion that isn’t listed here. But here are some of the common themes:
- Checking stoves, doors, locks, etc.
- Cleaning
- Repeating acts (e.g. walking back and forth through a doorway multiple times)
- Mental compulsions (e.g. special words or phrases repeated in a specific way)
- Symmetry or making sure things are “just right”
- Hoarding
- Counting
- Mental reassurance (e.g. replaying an incident in your mind countless times to soothe yourself from the belief that you did something wrong)
- Avoiding particular places or situations
How to know if you’re engaging in compulsions
Because compulsions 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 compulsion to this checklist, paraphrased from the National Institute of Mental Health:
- It feels like something you can’t prevent yourself from doing, even if you know it’s an excessive response
- It temporarily relieves the intense feeling of anxiety that goes along with an obsessive thought
- It takes up so much time that it interferes with your daily life
- It becomes your automatic response to obsessive thoughts
If you experience compulsions, be compassionate with yourself. Feeling like you are not able to resist them isn’t a sign of weakness.
How compulsions develop
Compulsions are a kind of negative reinforcement, not entirely different from the coffee habit you’ve developed. You feel tired; you drink coffee; you feel less tired. The next morning when you feel tired, you reach for the coffee, and you feel less tired again. You could choose to go to bed earlier and get more sleep so you’re better rested—or you could keep drinking coffee to pep yourself up.
The same mental process is responsible for the compulsion. You find yourself obsessing over an intrusive thought. You do something that relieves that thought, such as cleaning. You temporarily feel better. Your brain notices the reduction in anxiety from acting on that thought, and the next time you start obsessing over it, your mind tells you that the same compulsion will help. You do the compulsion; you feel better. This is the most difficult thing about a compulsion — it reinforces itself. To break the cycle, you need to convince your brain that there are other options and commit to resisting compulsions.
Getting treatment for your OCD compulsions
Compulsions are powerful. They feed on your brain’s natural desire for certainty, calm, and the illusion of control. You can choose to end the cycle of OCD, but will need the help of a qualified professional and the right treatment in order to do so.
The gold standard for OCD treatment is exposure and response prevention (ERP) therapy. ERP helps to break the cycle of obsession and compulsion by teaching you to better tolerate upsetting situations. You learn, over time, to not respond to the fear and distress by giving into the compulsion.
In ERP therapy, you start slowly so that you don’t end up overwhelmed and give up. Working with a trained ERP therapist, you’ll expose yourself to situations that are only mildly triggering at first. In time, you learn to face your most triggering situations, tolerating the distress so that you can choose responses other than compulsions and take your life back from OCD.
At NOCD, our ERP-trained therapists have helped thousands of people struggling with OCD to break from the cycle of compulsions. Believe me: recovery is possible, and the results could be much greater than you imagine.