OCD Compulsion: What It Is, Examples, & Treatment

What Is a Compulsion?

An compulsion in obsessive-compulsive disorder (OCD) is a thought or behavior that is in response to an OCD obsession. People with OCD may perform compulsions to seek relief from an intrusive thought, but by doing so, they feed the obsession. By acting on the anxiety that the thoughts give them, people with OCD are giving these thoughts a lot of control over how they spend their time.

Common OCD Compulsions

Common examples of OCD compulsions include:

• Counting compulsions: OCD counting could involve numbering items, steps, or so forth—either out loud or to themselves in order to achieve a state of feeling “right” or settled.
• Checking compulsions: Checking things like locks or the stove is a common compulsion for those with checking OCD as they may not trust their own memory or judgment, and they seek reassurance by checking multiple times.
• Washing compulsions: Compulsive washing may include skin washing until the skin is raw or even broken to the point of bleeding.
• Cleaning compulsions: Other items besides the body, like keys, phone, wallet, etc., can be compulsively washed if they are perceived as “contaminated.”
• Repeating or arranging compulsions: Arranging items in specific orders, categories, or colors, or repeating or re-doing behaviors. Common examples include excessive arranging of workspaces or rooms, re-writing emails and texts, or continual re-reading until it “feels complete” or “done the right way.”
• Mental compulsions: Mental compulsions can be more difficult for others to see than behavioral compulsions because they are not outwardly visible. Mental compulsions include mental reviewing of events, checking bodily sensations, and comparing situations or events.
• Avoidance as a compulsion: Avoidance is a common coping mechanism, even for people who do not have OCD. However, when avoidance is used as a compulsion, it can cause someone to ignore or avoid any people, places, or situations where obsessions might be triggered.
• Confessing: Someone who is obsessed with remaining religiously or spiritually pure (as with scrupulosity OCD) may engage in compulsive confessing to neutralize their anxiety; this may include formal confession in a church setting or confessing to self or others, internally or externally.
• Hoarding: For those with hoarding issues, hoarding may actually be a compulsive behavior in response to extreme anxiety about needing something later, regardless of its worth, value, or function.

Obsessions Vs. Compulsions

Obsessions and compulsions go hand in hand with OCD. Obsessions are intrusive thoughts or images that trigger someone with OCD to complete a compulsion in order to quell their anxiety. Someone may ruminate on their OCD obsessions to the point that it causes a great amount of interruption to their day. Compulsions are the behaviors that someone uses in order to try to neutralize the anxiety from the obsession, but it only works temporarily.

Compulsions Vs. Rituals

Compulsions and rituals are terms often used interchangeably. In general, compulsions are what make up rituals for someone who has OCD. Compulsions are mental or behavioral acts that a person may perform in certain ways, creating a specific OCD ritual. Rituals are often performed regularly and without treatment, a person with OCD may do these rituals without noticing they are locked in compulsions.

For example, an OCD ritual might be that someone wakes up at the start of the day and immediately begins to mentally review their schedule, then begins another compulsion of confessing how anxious they are and seeking reassurance from their partner. In this case, their ritual is made up of mental review, confessing, and reassurance-seeking behaviors.

What Do Obsessions & Compulsions Look Like Together?

Together, obsessions and compulsions can do a lot of harm and take up a lot of time for someone with OCD. Someone’s obsession could be related to almost anything, but causes them a significant amount of distress. Compulsions come in to help alleviate the obsessive, intrusive thought. When someone does the compulsive act, they reinforce the OCD anxiety cycle as a way to self-soothe.

Left unmanaged, the OCD cycle can really take over someone’s ability to function and lower their overall quality of life.

Here are some common obsessions and compulsions that may accompany them:

Signs of Compulsive Behavior

Although it can be hard to distinguish OCD compulsions from everyday tasks, there are differentiating factors. Compulsions are often not based in reality, and there is extreme anxiety until the person acts on their obsessive thoughts. Additionally, the behaviors only relieve the distress for a short amount of time, and the obsessive thoughts quickly return.

Compulsions can change or alter over time and become more severe the longer they go untreated.¹ For those with episodic or chronic OCD, factors like age or life changes may cause them to experience a surge of symptoms.

You may be experiencing an OCD compulsion if:

• You feel you need to complete a task or else something bad will happen
• Your focus on specific thoughts or actions takes up more time than you want
• You cannot refocus or experience relief without doing a specific behavior
• Your thoughts or behaviors in response to anxiety feel out of the ordinary, extreme, or unrealistic
• You start connecting the distress you feel to something you didn’t do or do correctly at some point in time (can be connected to real event OCD or false memory OCD)

What’s the Most Common OCD Compulsion?

OCD compulsions can vary from person to person, however the most common compulsions revolve around cleaning and hygiene. Counting and arranging are also common compulsions for people with OCD.

Other common OCD compulsions include:

• Checking things
• Repetitive behaviors
• Counting things
• Hoarding
• Avoidance
• Reorganizing

OCD Compulsion Examples

Compulsions vary across individuals, but common types of compulsions may include behaviors such as washing and re-organizing, or thought-based mental acts such as compulsive praying or counting. It is also possible for those with OCD to experience the waxing and waning of symptoms with relapses triggered by specific life events.

Here are three examples of OCD compulsions:

Example of a Hygiene Compulsion

If someone with hygiene-related obsessions feels that they were exposed to something unhygienic or were “contaminated” in some way, this will likely lead them to shower as their compulsive act. Although it is understandable that anyone would want to shower when they feel unclean, a person with this compulsion will experience obsessive, intrusive thoughts and intense anxiety about their desire to shower. Additionally, the person may have never been exposed to the contaminant that is causing them to feel unclean, and instead it is an unrealistic intrusive thought.

Example of a Spiritual Compulsion

When a person has religious or spiritual OCD compulsions, they may experience extreme fears of punishment or worry something terrible will happen unless they recite a saying, phrase, prayer, or mantra. They might obsessively think about how god will punish them because they are bad or have done something to deserve punishment. This can also result in behavioral responses that attempt to right their conceived spiritual wrongdoings.

Example of a Mental Compulsion

When someone has mental OCD compulsions, they are often trying to reconcile something to feel more at ease and peace with themselves. This could involve reviewing certain memories or situations to ensure there will be no harm done to others. It can look like praying or using other types of mental interventions to self-soothe to prevent something that is beyond your control.

Impacts of OCD Compulsions on Daily Life

OCD compulsions can lead to substantial challenges for people and their loved ones.² For some, mild OCD compulsions may have only a minor impact on their lives. However, those with more debilitating OCD may be unable to maintain a job, leave the house, or engage in relationships because of the severity of their compulsive behaviors.

Negative impacts of OCD compulsions may include:

Family Dysfunction

A loved one’s compulsions may impact a family overtly or subtly. When a person spends an abnormal amount of time performing compulsive rituals, such as compulsively washing their hands, other family members’ schedules are naturally impacted, and it could cause conflict. Additionally, family members may become concerned and struggle to know how to help their loved one with OCD, especially when help is unwanted.²

For those with more debilitating OCD, loved ones may assist in compulsions even when they don’t want to. This may look like helping someone undress before they shower because the person with OCD is afraid to have more exposure to the contaminant, causing them to feel additional distress.

Increased Stress

OCD compulsions can cause an increase in stress for the individual and the people around them. Because of how much compulsions can interfere with someone’s life, tasks that are simple for people without OCD compulsions can become quite taxing. Additionally, the longer the person struggles with their compulsions, the stress can turn into chronic stress, leading to co-occurring disorders, such as anxiety and depression. In fact, depression and OCD commonly overlap due to these factors.

Decreased Social Functioning

Compulsions can impact a person with OCD’s career, schooling, and relationships. It is common for people with OCD to feel guilt, shame, or embarrassment and avoid opening up to others. This often leads them to isolate and decreases their ability to experience quality time with their loved ones. Also, they may struggle to get to work on time, perform job duties, and communicate with their superiors about what they are going through.

Are Compulsions Always a Sign of OCD?

Compulsions are not always a sign of OCD. Compulsive behaviors can happen in mental conditions other than OCD, such as eating disorders and phobias, some of which share symptoms, causes, and triggers for the behaviors.

Compulsions can also exist as part of other mental health conditions, like: 

• Body-focused repetitive behaviors: Compulsive behaviors that are considered body-focused repetitive behaviors include any habitual grooming that is excessive and causes distress.³ For example, hair-pulling, nail-biting, or skin-picking that causes physical damage to the body.
• Eating disorders: Compulsions can show up in eating disorders through behaviors like calorie-counting, purging, excessive exercise, or ritualistic preparing or consuming of foods.⁴ Sometimes, there can be an overlap between eating disorders and OCD, which is why the motivation behind compulsive behaviors should be assessed by a professional for diagnosis.
• Body dysmorphic disorder: In body dysmorphic disorder, a person obsesses about perceived flaws in their appearance.⁵ These perceived flaws lead them to engage in compulsive behaviors like mirror checking, excessive grooming, reassurance seeking, and skin picking.⁵
• Phobias: Specific phobias are fears of a generalized category of things, such as heights, animals, or doctors.⁶ The most common compulsive behavior related to specific phobias is avoidance, however people can also engage in reassurance-seeking, excessive research, and mental review.⁶
• Behavioral addictions: In behavioral addictions, the behavior continues despite harm to the person’s body, mind, and relationships.⁶ Behavioral addictions might include compulsions like gambling, sex, or internet use.⁶
• Impulse control disorders: Impulse control disorders are characterized by external aggressive or impulsive behaviors.⁶ Some examples of compulsions in impulse control disorders include setting fires, stealing, or excessive sexual activity.⁶

Can Obsession Exist Without Compulsions?

It is possible for people to have OCD without acting out any obvious behavioral compulsions, and this is referred to as pure O, or purely obsessional OCD. In this dynamic, someone has a lot of obsessions and intrusive thoughts which they respond to with mental rituals.

Why Do OCD Compulsions Develop?

Compulsions usually develop due to trauma or stress, plus an OCD genetic predisposition. A person who experienced trauma may develop compulsive behavior to try to prevent another accident.⁷ Alternatively, compulsions may be an attempt to soothe the anxiety resulting from childhood trauma. The risk of developing OCD compulsions is significantly higher in those with a family history of this disorder.^8,9 Rumination or excessive thinking may also develop into OCD compulsions, because it can be used as a way to cope with the distress.¹⁰

Treatment for OCD Compulsion

Exposure and response prevention (ERP) is generally considered the most effective treatment for compulsions because it involves confronting the anxiety rather than just talking about it. Medication can be a helpful addition to ERP, but it is not a cure-all for OCD symptoms.¹¹

Exposure Therapy (ERP)

Exposure and response prevention (ERP) is the most recommended therapy for OCD compulsions. When receiving ERP treatment, a person is repeatedly exposed to their trigger. With the therapist’s help, they work through the distress and urges to respond to compulsions behaviorally. Ideally, ERP reduces anxiety over time until the person no longer reacts to the compulsive trigger. Exposures may be in vivo (meaning in real life) or imaginary.

Medications

In addition to ERP, medication may help manage compulsions. Some medications for OCD, like SSRIs, are also designed to target symptoms of depression, which often co-occurs with compulsive behaviors. However, it is important to recognize that medication alone will not stop obsessive thoughts and compulsive behaviors.

Schedule an appointment with a psychiatrist to discuss all the benefits and the risks of medication. Psychiatrists can also make specific medication recommendations based on your experiences, other mental health diagnoses, and unique genetics.

How to Stop a Compulsion

It is common for people with OCD to experience a lot of distress when struggling with compulsive behaviors. People navigating more debilitating compulsive behaviors may find compulsions interfere with their daily functioning. Even minor compulsions can be frustrating because they are unwanted and invasive. Taking the time to learn healthy OCD coping skills is an essential part of a comprehensive treatment plan.

Here are five healthy ways to stop compulsive behavior:

1. Practice mindfulness: Mindfulness helps a person with OCD compulsions as it encourages people to try to experience intrusive thoughts without judgment.
2. Start journaling: Keeping a journal of things that are going well can be a hopeful reminder that relief is possible even when it seems as though the thoughts and behaviors are uncontrollable.
3. Practice healthy stress management: Stress does not cause OCD, but stress management can be beneficial to reducing triggers that impact OCD.
4. Attend to your basic needs: Attending to basic needs like adequate nutrition, exercise, and sleep help reduce the severity of impact when triggers arise.
5. Identify safe people to talk to: Even if it initially seems difficult to open up to those around you, identifying safe supports, such as a group chat or online support, may validate or provide strategies for communicating with others about OCD.

Supporting a Loved One With OCD

Helping someone with OCD may not be as straightforward as simply encouraging them. It is normal and natural to want to comfort a loved one when they are in distress. Unfortunately, reassurance-seeking is a common compulsion and reassuring them will actually make symptoms worse. You can think of not providing them with constant reassurance as a long-term effort for your loved one to gain confidence in dealing with obsessions on their own.

Here are some tips for actually helping someone with their OCD compulsions:

• Educate yourself on OCD so that you can feel empowered through knowledge
• Make a plan with your loved one as to how you will be involved in their treatment
• Seek your own therapy to process emotions related to your loved one and their diagnosis
• Explore your own emotions through journaling or other expressive means
• Instead of reassuring your loved one in moments of distress, reframe the moment as an opportunity for them to practice tolerating uncertainty on their own
• If you feel discomfort in refusing to offer reassurance, use your own self-care to ground yourself in this decision
• Finally, it is okay to offer comfort and support after your loved one has dealt with the obsession on their own. You can observe that they are growing stronger through treatment and acknowledge that changing the relational dynamic is difficult, but worth it.