Obsessive-compulsive disorder (OCD) compulsions are intrusive thoughts followed by urges to respond to those thoughts. Compulsions are intended to neutralize the anxiety resulting from intrusive thoughts but only do so short-term. Compulsions can be thought or behavioral based. The obsessive thoughts and the harmfulness of compulsive behaviors vary in severity among individuals. Recommended treatments include exposure-based therapies and medication.
What Is a Compulsion?
An obsessive-compulsive disorder (OCD) compulsion is a thought or behavior that is in response to an OCD obsession. Individuals 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 them.
Common forms of OCD compulsions include:
- Counting: One may engage in counting items, steps, or so forth—either out loud or to themselves in order to achieve a state of feeling “right” or settled.
- Checking things repeatedly: checking things 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.
- 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 functioning.
- Washing: Compulsive washing may include skin washing until the skin is raw or even broken to the point of bleeding.
- Cleaning: Other items besides the body, like keys, phone, wallet, etc., can be compulsively washed if they are perceived as contaminated.
- Harm thoughts: For those who experience experience repeated thoughts about harming others, they may compulsively check themselves as they experience distressing, imagined scenarios of doing harm.
- Religious purity: Someone who is obsessed with remaining religiously or spiritually pure 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.
How to Identify an OCD Compulsion
Although it can be hard to distinguish OCD compulsions from everyday tasks, there are differentiating factors. Differences include that compulsions are often not based in reality, and there is extreme anxiety until the individual acts on the 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. 3
For those with episodic or chronic OCD, factors like age or life changes may cause one to experience a surge of symptoms.
You may be experiencing an OCD compulsion if:
- You feel you need to complete a task, or 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 or thoughts 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
Examples of OCD Compulsions
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 two examples of OCD compulsions:
Example of a Hygiene Compulsion
One common type of OCD compulsion is when an individual thinks they were exposed to something unhygienic, which leads them to shower. 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.
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.
Impacts of OCD Compulsions on Daily Life
OCD compulsions can lead to substantial challenges for individuals and their families or loved ones.4 For some, 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:
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, especially when help is unwanted.4
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.
OCD compulsions can cause different types of stress for the OCD individual and the people around them. Because of how much compulsions can interfere with an individual’s life, tasks that are simple for people without OCD compulsions can become quite taxing. Additionally, the longer the individual struggles with their compulsions, the stress can turn into chronic stress, leading to co-occurring disorders, such as anxiety and depression.
Decreased Social Functioning
Compulsions can impact a person with OCD’s career, schooling, and relationships. It is common for people with OCD to feel 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.
Why Do OCD Compulsions Develop?
Compulsions usually develop due to trauma or OCD genetic predisposition. A person who experienced trauma may develop compulsive behavior to try to prevent another accident.5 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.6, 7 Rumination or excessive thinking may also develop into OCD compulsions, because it can be used as a way to cope with their distress.2
Treatment for OCD Compulsion
Exposure therapy for OCD (ERP-OCD) 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. Thought-stopping techniques practiced in cognitive behavioral therapy (CBT) are generally unhelpful and potentially harmful.8
Exposure Therapy (ERP)
Exposure therapy for OCD (ERP-OCD) is the most recommended therapy for OCD compulsions. When receiving ERP-OCD 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.
In addition to seeking exposure-based therapy, medication may help manage compulsions. Additionally, 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 Cope With an OCD 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 coping mechanisms is helpful in grounding someone when they are suffering.
Here are five healthy ways to cope with OCD compulsions include:
- Practice mindfulness: Mindfulness helps a person with OCD compulsions as it encourages people to try to experience intrusive thoughts without judgment.
- 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.
- Practice healthy stress management: Stress does not cause OCD, but stress management can be beneficial to reducing triggers that impact OCD.
- Attend to your basic needs: Attending to basic needs like adequate nutrition, exercise, and sleep help reduce the severity of impact when triggers arise.
- 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.
OCD compulsive behaviors are complex and confusing as the behaviors generally have no rationale or basis for reasoning in reality. This can be extremely frustrating and confusing for individuals with OCD and their loved ones. It is important to seek appropriate therapeutic support to understand the disorder fully and face worries or fears related to the compulsions with a trained professional.