Compulsions in Obsessive Compulsive Disorder

Compulsions are a key symptom of obsessive-compulsive disorder (OCD). At one time or another, we've certainly all double-checked that we locked the front door, knocked on wood to ward off disaster or adjusted a picture a couple of times until it was hanging perfectly. While most people go about their daily lives without giving these experiences a second thought, if you have OCD, compulsions such as these can take over your life and become a source of disability.

Behaviors that you repeat over and over again are compulsions. You might repeatedly check to make sure that the front door is locked or that the stove is turned off. These are behaviors that you feel you must carry out over and over, often for hours on end. For example, if you are obsessed with contamination, you might wash your hands over and over again. Other common types of compulsions include cleaning, counting, checking, requesting or demanding reassurance, repeating phrases or sequences of words, and ensuring order and symmetry.

Compulsions are aimed at getting rid of your anxiety or to try to stop a situation that you are afraid of from happening, such as the death of a loved one. Of course, compulsions are often unrealistic solutions to the problems they are supposed to prevent. For example, it is unlikely, if not impossible, that folding laundry in a particular way or counting up to a particular number could ever prevent the death of a loved one. If you have OCD, you usually have insight into the fact that the compulsion has little to do with the actual event, but feel an intense need to carry out the compulsion anyway.

Compulsions are usually so debilitating that you have difficulty keeping up at work or maintaining personal relationships. In addition, although any intimate relationship has its ups and downs, dating someone with OCD who has severe and unmanaged compulsions can present some additional challenges.

There are a number of other disorders that, while not technically meeting the DSM diagnostic criteria for OCD, have very similar symptoms and fall within the so-called OCD spectrum. This spectrum captures different clusters of symptoms that are reminiscent of, but not exactly the same as, OCD. Often, but not always, the only difference between OCD and a given OCD spectrum disorder is the specific focus of the obsessions and/or compulsions. For example, people with pathologic skin picking feel compelled to pick or dig at their skin to remove small irregularities such as moles or freckles. 

Compulsions are treated effectively with medication and/or psychotherapy. Medical treatment of OCD has focused on drugs called selective serotonin reuptake inhibitors (SSRIs). Well-known SSRIs include Prozac (fluoxetine), Zoloft (sertraline), and Paxil (paroxetine). Anafranil (clomipramine), a tricyclic antidepressant, also may be used to treat OCD.

Psychological therapies are effective treatments for reducing the frequency and intensity of symptoms of OCD. Effective psychological treatments for OCD emphasize changes in behavior and/or thoughts. When appropriate, psychotherapy can be done alone or combined with medication. The two main types of psychological therapies for OCD are cognitive-behavioral therapy (CBT) and exposure and response prevention therapy (ERP). ERP is particularly effective for treatment of compulsions.