Compulsions in Obsessive-Compulsive Disorder (OCD)

hand washing
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Compulsions are one of the two primary symptoms of obsessive-compulsive disorder, a psychiatric disorder that affects approximately 1.2% of adults in the United States in a given year.

A compulsion is a repetitive behavior or mental act that a person with OCD is driven to perform in response to an obsession or according to rigidly applied rules (which are often used to help manage feelings of anxiety or distress).

Compulsions vs. Habits

Not all repeated behaviors and routines are compulsions. Many people follow a familiar pattern or routine when getting ready for bed at night, for example, or they may perform other self-care tasks, such as showering, in a specific order.

These tendencies, or habits, can occur subconsciously, and habits can serve a positive purpose in daily functioning. Habits are considered to be within the range of “normal” human behavior.

Similarly, just because someone is particularly orderly and feels good about keeping their living environment tidy does not mean they "are OCD" or have OCD.

Neatness is a personality trait or aesthetic preference; obsessive-compulsive disorder is a mental illness.

With OCD, compulsions are time-consuming and accompanied by significant emotional distress. The behaviors are typically carried out for two reasons:

  • To neutralize or reduce the anxiety, disgust, or distress
  • To minimize or prevent the perceived risk/feared outcome associated with an obsession

For example, a person with OCD might perform compulsive behaviors because they feel that something bad will happen if they do not. Performing the compulsion can also be a way for a person with OCD to quiet recurrent, persistent, intrusive, and unwanted thoughts, images, or urges that cause significant anxiety or distress.

Compulsions are often driven by internal tension and a sense that the behaviors must be carried out in a particular order such that it feels “just right.”

Common Compulsions

The experience of OCD is different for everyone with the condition, but there are several types of compulsive behaviors that are common.

Washing and Cleaning

Compulsive behaviors related to cleanliness are often in response to obsessions about germs and contamination. Examples of these behaviors include hand washing or washing another part of the body in a certain way; excessive use of sanitizers, soaps, and other cleaning agents; excessive grooming and toileting routines; excessive cleaning of objects or items in the environment; and any other behaviors aimed at removing germs/dirt/contamination.

Checking

"Checking" behaviors are those that are carried out to provide reassurance that one did not or will not harm oneself or others. People with OCD may also perform these compulsions to reassure or ensure that they not make a mistake or do something perceived as unethical or immoral.

Sometimes people with OCD find that checking behaviors help them ensure nothing bad has happened or will happen, for example, regarding the health and safety of themselves and others.

Mental Rituals

People with mental compulsions may spend a great deal of time thinking through something for clarification or attempting to figure out or better understand.

They may perseverate on past events, mentally review communication, pray to prevent harm, or count in a specific way or to a specific number.

Sometimes, people will verbalize (aloud or in their minds) a specific word or phrase that feels “good” to replace or fix something that feels “bad" or imagine a “good” image to replace a “bad” image.

Repetition

Compulsions that must be done over and over again can involve re-reading, re-writing, or repeating routine actions/activities, repeating body movements, or carrying out any other action a certain number of times.

Need to Tell

People with OCD may have obsessions and related compulsions about lying. To address the anxiety these obsessions cause, they may be compelled to tell or confess, in detail, even innocuous information.

They may use statements of uncertainty like "maybe" instead of a more definitive "yes" or "no" to ensure that they are accurate and have not inadvertently lied (for example, if they later change their mind about something).

Rituals Surrounding Morality & Ethics

Some people with OCD are focused on morals or ethical standards. They may carry out excessively rigid behaviors to live according to specific values (such as practices around religion, environmental concerns, health, and wellness).

“Just Right" / Tourettic / Tic-Related Compulsions

"Just right" compulsions can involve counting, symmetry or evening up, arranging, ordering, positioning, touching, and tapping. There may be no elaborate obsession or feared outcome that drives this behavior. Sometimes it's an intense somatic and/or psychological tension or discomfort—often described as something feeling incomplete or “not right”—which is relieved by performing the behavior.

Ordering or arranging objects or items until it feels “right" is another facet of these compulsions.

Avoidance

People with OCD may avoid any anxiety-provoking stimuli associated with an obsession to minimize harm and decrease anxiety or distress.

Diagnostic Criteria for OCD

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), outlines diagnostic criteria for “Obsessive-Compulsive and Related Disorders."

To be diagnosed with OCD, a person must meet the following criteria:

  • The presence of obsessions, compulsions, or both.
  • The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause significant distress or impairment in one’s daily functioning.
  • The symptoms are not better accounted for by the physiological effects of a substance, medical condition, or other mental disorder.

Compulsions are defined as:

  • Repetitive behaviors or mental acts an individual is driven to perform in response to an obsession or according to rigidly applied rules.

  • Behaviors or mental acts are aimed at reducing anxiety or distress, or preventing a feared outcome; however, they are clearly excessive or not connected in a realistic way to that which they are intended to address.

Obsessions are defined as:

  • Recurrent, persistent, intrusive, unwanted thoughts, images, or urges that cause anxiety or distress.

  • Attempts to ignore or suppress obsessions or neutralize them by performing a compulsion.


It's not uncommon for a person with OCD to have good insight. They may express an understanding of the unreasonableness of the behaviors, yet the very definition of compulsion is that even with the awareness that their behavior is extreme, the person feels unable to stop.

When someone has poor insight, the symptoms can appear more like delusions. It's important that mental health professionals differentiate between symptoms of OCD and those of disorders such as schizophrenia.

Sometimes, the symptoms of OCD are related to tics, especially if a person has a history of a tic disorder (such as Tourette syndrome).

A Word From Verywell

People with OCD may feel compelled to perform certain actions or behaviors, both internal and external, to minimize anxiety, fear, or other intense emotions. The drive to perform these behaviors can be distressing, as the person may be aware that they are extreme, but feels unable to stop.

If someone has symptoms of OCD, a doctor or mental health professional can use a specific set of criteria to diagnose the condition, which is the first step toward treatment. The symptoms of OCD, including compulsions, can be difficult to live with, but the condition can be managed with a combination of therapy, medication, and behavior modification. There are also in-person and online support communities that can be safe spaces, provide reliable information, and help people with OCD connect with resources.

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Article Sources
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