Compulsions are mental or physical acts that a person with OCD feels the urge to carry out in response to obsessions—unwanted thoughts, images, or urges that cause significant distress. Often, they perform the compulsion to alleviate uncomfortable emotions that stem from obsessions: anxiety, guilt, a “not right” feeling, etc. Compulsions might also be carried out in an attempt to “solve” the obsession, reassure oneself about the obsession, prevent the obsession from coming true, or adhere to nonsensical rules made up by OCD.
Common examples:
- Sanitizing three times after touching a door handle to reduce a feeling of disgust about contamination
- Asking someone for reassurance that you are not a pedophile to alleviate distress from intrusive sexual thoughts
- Confessing an intrusive thought about your relationship to your partner to alleviate guilt
- Driving your car back around the block to reassure yourself that you didn’t hit anyone
- Neutralizing an intrusive thought (replacing a “bad” thought with a “good” thought) in an attempt to prevent the intrusive thought from coming true
Such compulsions might make a person feel better by temporarily reducing discomfort. The reduction in discomfort is typically short-lived, as compulsions negatively reinforce obsessions that come back stronger and louder, but there can still be momentary relief.
As such, people with OCD commonly worry that anything that makes them feel better or provides relief must be a compulsion. This is a fallacy. While compulsions might make a person feel better in the short-term, not everything that makes a person feel better is compulsive.
If you’re not sure whether something you like doing is compulsive, or just feels good, consider not just what you’re doing—look at why and in what manner you’re carrying out the behavior.
Compulsions are often:
- Accompanied by a sense of urgency → “I have to do this now or else something bad will happen”
- Excessive → Ex. Washing your hands four times in one sitting
- Time-consuming → Ex. Continuing to read a paragraph over and over until you “feel right” enough internally to move onto another paragraph, which greatly slows the reading down
- Ritualized → A set of rules that must be followed, even though they don’t make logical sense and are not connected in a realistic way to what you’re trying to prevent from happening
- Rooted in fear as opposed to genuine desire and values → Ex. praying over and over again until you feel “right” internally because you worry God will punish you, as opposed to praying to genuinely connect more to your faith
- Carried out to get rid of anxiety and obsessions
For example, someone with Harm OCD might spend hours a day driving—an act that was previously feared—because they worry the hit-and-run obsessions will come back if they do not. The driving is excessive and rooted in fear, as opposed to driven by genuine desire. It is also time-consuming, accompanied by a sense of urgency, and carried out to prevent something bad from happening (the return of obsessions). In fact, excessive driving is not taking away from their life.
When considering whether something is compulsive or not, here are some questions to ask yourself:
- Do I want to do this thing, like going on a run, or is OCD telling me that I have to, or else I’ll be anxious the rest of the day?
- Does this feel imminent and urgent? Is there flexibility?
- Am I worried that something bad will happen if I don’t do this thing?
- Is this rooted in my values and not fear?
The reality is that sometimes there’s a grey area: we might do something to alleviate anxiety and that still doesn’t mean it’s compulsive. For example, going on a run might trigger endorphins that reduce anxiety. This is not inherently a bad thing. This might be a part of values-based living for someone. Even if it was done solely to reduce anxiety, it still doesn’t mean it’s compulsive. As a clinician, I would look at:
- Flexibility: Is the person okay not exercising or is the exercising ritualized and absolutely necessary?
- Urgency: Does the person feel like they have to exercise right now, every time that they’re anxious?
- Excessiveness: Is the person working out multiple times a day?
- Values: Is flexible movement a part of their wellness routine and important to them?
This grey area can become especially confusing when it comes to treatment, or witnessing your OCD symptoms lessen. As you learn to reduce compulsive rituals, you might start to feel better long-term. That’s because when you do not engage in a compulsive ritual, you are not reinforcing to your brain that the obsession is meaningful, important, or dangerous. You are not reinforcing to your brain that the only way to cope is to perform that ritual. Over time, your brain may be less likely to register stimuli as dangerous when danger isn’t present. You are more likely to learn safety. As such, not performing compulsions leads to feeling better.
Thought defusion techniques, such as singing an unwanted thought in the tune of “Happy Birthday,” and mindfulness skills, like accepting the presence of unwanted thoughts and feelings while turning your attention to what is more helpful, might also contribute to relief. It does feel better, long-term, to stop fighting with unwanted thoughts and feelings and to stop engaging with them compulsively. Taking the power out of scary thoughts through defusion techniques can feel better. This is not inherently compulsive. This is using a skill.
The same goes for meditating, yoga, walks outside, prayer, reading, petting your animal, etc. Engaging in self-care and values-based living is not inherently compulsive. It’s okay to reap the physiological and psychological benefits of exercise, breathwork, spirituality, and time with loved ones.
But can such things be compulsive? Yes! Almost anything can become compulsive. In fact, you may even find yourself wondering if therapy can become compulsive, since it can feel good to engage with. Exposure and response prevention (ERP) therapy for OCD—facing a feared stimulus while simultaneously cutting out compulsive rituals—can help you feel less sensitive to that original stimulus. Through repeated exposure, and a change in response to the exposure (no compulsions), the stimulus becomes less activating over time. It’s likely that a person will feel better when they’re able to face what was previously feared without as large of a physiological reaction. This isn’t a compulsion. This is treatment.
But, it’s also possible to approach ERP in a compulsive way—especially if you aren’t working with a trained specialist. This might look like urgently and excessively carrying out exercises to try and get rid of obsessions and anxiety, instead of moving at a pace that promotes long-term growth and learning by gradually increasing discomfort. This is part of why it’s so important to work with an ERP-trained, licensed, specialized therapist. They deeply understand OCD and are trained to treat it effectively, so they can make sure you don’t take on too much too soon—and don’t accidentally start to approach exercises in a compulsive way.
The important thing to remember is that feeling better is not the problem. Compulsions are the problem and the key is understanding whether or not you are performing them.
If you’re struggling to escape the OCD cycle, you don’t have to feel shame or suffer alone. At NOCD, you’ll find specialty-trained, non-judgmental OCD specialists who deeply understand all the ways OCD can show up—including the sneakiest ways it can try to keep you stuck. NOCD Therapists can help you take back the power from intrusive thoughts with exposure and response prevention (ERP) therapy, the most effective treatment for OCD. I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment, and how it can help you start living life according to your true values again.
Alegra Kastens is a Licensed Marriage & Family Therapist and received her master’s degree in clinical psychology from Pepperdine University. She specializes in the treatment of obsessive-compulsive disorder (OCD), anxiety disorders, eating disorders, body-focused repetitive behaviors (BFRBs), and body dysmorphic disorder (BDD). Her passion for OCD treatment, education, and advocacy comes from her own personal experience with the disorder. She understands firsthand the relentlessness of OCD and how painfully it holds one’s life captive. She also understands that relief and recovery are real with a large dose of evidence-based treatment and an equally large dose of willingness.
