OCD compulsions are repetitive physical or mental behaviors that a person feels driven to perform in response to obsessive thoughts. People engage in compulsions to reduce anxiety or prevent a feared outcome, even if they recognize the behavior may not be necessary or aligned with their real goals. The relief is temporary, which is why compulsions keep the OCD cycle going.
How do OCD compulsions work?
Compulsions work by providing short-term relief from the distress caused by obsessions. When you have an intrusive thought or fear, your brain may send a “false alarm” signal. Performing a compulsion—like checking, washing, or repeating certain thoughts—temporarily quiets that alarm.
However, because the relief fades, the obsession returns, leading you to perform the compulsion again. This reinforces the cycle of obsession → distress → compulsion → temporary relief. Over time, compulsions can become more frequent and complex.
How do OCD compulsions develop?
Compulsions develop through negative reinforcement. Each time you perform a compulsion and feel temporary relief, your brain learns that the compulsion is the solution. “Sometimes, there is a very brief period where the anxiety goes down, but it comes back even stronger the next time, making us think we need to repeat that compulsion,” says Tracie Ibrahim, LMFT, CST, NOCD’s Chief Compliance Officer.
This is why compulsions can become habitual. Your brain links the action to safety, even though it doesn’t stop the obsession from returning.
Why do I feel the need to perform compulsions?
The urge to perform compulsions is driven by anxiety, fear, and a need for certainty.
You might:
- Try to prevent harm to yourself or others
- Attempt to “undo” a disturbing thought
- Seek reassurance that something bad won’t happen
Even if you logically know the compulsion won’t help, the emotional urge can overpower reason. Patrick McGrath, PhD, Chief Clinical Officer at NOCD, compares it to a slot machine: “As long as it works now and then, you’re going to keep doing it.”
Common types of OCD compulsions
OCD compulsions fall into two main categories:
- Physical compulsions: Repeated handwashing, checking locks, arranging objects, tapping, or cleaning
- Mental compulsions: Counting, repeating phrases in your head, mentally reviewing events, or silently praying
You might start performing compulsions deliberately, but over time, they can become automatic behaviors.
Why should you seek help for compulsions?
You may want to seek professional mental help if:
- You can’t stop the behavior, even when you try
- The behavior temporarily relieves anxiety caused by an obsession
- The compulsion takes up significant time or disrupts daily life
- It has become your automatic reaction to intrusive thoughts
If you recognize these signs, remember—it’s not a weakness. It’s a symptom of OCD, and effective treatment exists.
How to stop OCD compulsions
The most effective treatment for OCD compulsions is exposure and response prevention (ERP) therapy. ERP is a specialized form of cognitive behavioral therapy (CBT) proven to be effective for OCD. General CBT, if not tailored for OCD, can sometimes be unhelpful or even worsen symptoms.
In ERP, you gradually face situations that trigger obsessions while resisting the urge to perform compulsions. Over time, you learn that anxiety naturally decreases without the compulsion and that feared outcomes don’t occur.
Studies show that ERP therapy is highly effective, with 80% of people with OCD experiencing a significant reduction in their symptoms.
ERP can be combined with other approaches, such as:
- Medication (often SSRIs)
- Mindfulness-based strategies to tolerate uncertainty
- Acceptance and commitment therapy (ACT) to change your relationship with thoughts
Find the right OCD therapist for you
All our therapists are licensed and trained in exposure and response prevention therapy (ERP), the gold standard treatment for OCD.
Severe or treatment-resistant OCD may benefit from the following therapies:
- Intensive outpatient programs (IOPs)
- Partial hospital programs (PHPs)
- Residential treatment centers (RTCs)
- Transcranial magnetic stimulation (TMS)
- Deep brain stimulation (DBS)
- Gamma knife radiosurgery (GKRS)
Bottom line
OCD compulsions are powerful because they tap into the brain’s natural desire for certainty and relief. They work in the short term but keep the OCD cycle going. With ERP therapy—and sometimes medication—you can retrain your brain to resist compulsions, break the cycle, and regain control over your life.
Key takeaways
- OCD compulsions are repetitive physical or mental actions done to reduce anxiety or prevent a feared event.
- They provide temporary relief, which reinforces the OCD cycle.
- Compulsions develop through negative reinforcement, making them feel necessary over time.
- ERP therapy is the most effective treatment, sometimes combined with medication and supplemental approaches like mindfulness and ACT.
