Obsessive compulsive disorder - OCD treatment and therapy from NOCD

What makes a behavior compulsive? An OCD expert explains

By Elle Warren

Sep 28, 20239 min read minute read

Reviewed byApril Kilduff, MA, LCPC

It’s hard to think that a behavior you perceive as keeping you safe, or one that relieves anxiety, could actually be harmful to you. If you’re wondering if something you do is compulsive, you might feel defensive of it or in denial about its extent. 

When I learned that self-reassurance was a common compulsion in OCD (“I’m going to be okay no matter what!”), I thought something along the lines of this: Can I not have anything that soothes me? The answer is both yes and no. Yes, there are plenty of things I find soothing that are not compulsive nor harmful to engage in: drinking tea, lighting a candle, going for a walk. And no, I cannot engage in thought patterns or actions that are done to alleviate myself of the distress brought on by obsessive triggers—because in the end, those actions only make my anxiety worse and lead to more and more compulsions. As you’ll learn below, OCD compulsions and compulsive behavior are two different phenomena, but I’ll explain them both so you can better determine what you’re experiencing. 

It can be difficult to recognize when a behavior becomes compulsive; they can be sneaky. In some cases, the behavior, when not done in compulsory excess, might be a healthy, positive one. Take exercise, for example. Generally speaking, exercise has a multitude of benefits for your body and mind. Though if it’s done too often, too intensely, and out of an irresistible urge to do so, it becomes compulsive and not healthy for your body or mind. Dr. Nicholas Farrell, a licensed psychologist, Regional Clinical Director at NOCD, and OCD expert, explains what makes a behavior compulsive. 

The distinction between compulsive behavior & an OCD compulsion

A compulsive behavior and a compulsion certainly sound like different versions of the same thing—but are they? Dr. Farrell starts our conversation by pointing out a key difference. A compulsive behavior, he says, is “any repetitive behavior that a person feels extremely drawn or compelled to do.” The individual can feel compelled for a number of reasons, Dr. Farrell says, like more “positive consequences.” For example, one engages in compulsive gambling in anticipation of a “significant experience of satisfaction from the behavior.” One might engage in other compulsive behaviors out of an attempt to regulate their stress, have control over a particular outcome, or otherwise self-soothe.

A compulsion that stems from obsessive-compulsive disorder (OCD), on the other hand, is performed for the specific reason of relieving the distress that accompanies obsessive triggers, trying to gain certainty or reassurance, and/or to prevent something “bad” from happening. Obsessive triggers include intrusive, unwanted thoughts, images, sensations, emotions, or urges, and the ensuing compulsions are done in an attempt to reduce one’s distress or “prevent the feared consequence from happening,” Dr. Farrell says. In the context of OCD, compulsions can be physical, as in performed externally, or mental, as in performed internally. One might feel a strong urge to touch the dials on their stove every night to make sure they’re turned off, or one might have to mentally review their evening, over and over, in an attempt to remember for sure that they turned the burners off.

A little more about OCD

Because it’s common for people who recognize their compulsive behavior to have OCD, let’s dive into the condition a bit further. It’s a widely misunderstood disorder, tending to be reduced to either a love of cleanliness of a love of organization. While it can look like this, such as in contamination OCD and perfectionism OCD, those are just two of many possible manifestations. Some of the most common subtypes, or themes, of OCD include:

  • Harm OCD
  • Relationship OCD
  • Sexual Orientation OCD
  • Existential OCD
  • Sensorimotor OCD
  • Hyper-Responsibility OCD
  • Pedophilia OCD
  • Scrupulosity OCD

Even beyond these identifiable themes, OCD can latch onto anything. OCD goes after what each individual values and cares most about, which means it’s highly idiosyncratic and unique to each person. The unwanted thoughts, images, feelings, sensations, feelings, or urges that come with any theme of OCD are so distressing that one performs compulsions, which also vary widely. Common compulsions include:

  • Rumination (spending an excessive amount of time thinking about something)
  • Repeatedly seeking reassurance from yourself or others (i.e. asking your partner, “we’re not going to break up, right?”)
  • Mentally reviewing past situations to “check” that you didn’t do anything wrong
  • Avoiding places, people, or activities that trigger your obsessions 
  • Thought suppression (trying not to think certain thoughts)
  • Thought neutralization (countering a “bad” thought or image with a “good” one to cancel it out)
  • Repeatedly checking to make sure you did something, such as turning off the stove or locking the door
  • Excessive handwashing and showering

Again, these are a few common examples of compulsions, but a compulsion can be anything done to relieve oneself of the anxiety brought on by intrusive triggers. Keep reading to learn about other conditions where compulsive behavior can be present, and how you can get help for compulsive behavior or OCD compulsions. 

Other conditions that involve compulsive behavior

There are several mental health conditions in which compulsive behavior may occur. Note that it’s possible for someone to experience both OCD compulsions as well as compulsive behavior that signifies another condition. In fact, there is a strong link between obsessive-compulsive disorder and eating disorders, for example. Still, they are two separate diagnoses, and the intention behind compulsive actions differ from one to the other.

Eating disorders are characterized by ritualistic, compulsory methods of eating, dieting, and/or exercising. The compulsive behavior is propelled by incessant thoughts surrounding body image, body shape, weight gain, and food intake. One performs compulsive behavior out of the desire not to gain weight, to lose weight, to keep their body “clean,” or other motivations involving the body. Some of the most common eating disorders include anorexia, bulimia, binge eating disorder, and orthorexia (an obsession with only eating “pure” foods). Some behavior to watch out for that could indicate an eating disorder include: 

  • Excessive thinking/worry over calories, weight, dieting, fat grams, or anything involving food
  • Excessively logging calories or extremely detailed dietary information
  • Not wanting to eat in public, or even around loved ones
  • Avoiding mealtimes 
  • Intensely restricting the kinds and amounts of food one will eat
  • Repeatedly expressing the need to “burn off calories” or “work off” a meal they just ate
  • Frequently weighing oneself
  • Having strict rituals around mealtimes or food

Another condition that includes compulsive behavior is addiction. Addiction consists of a compulsive, physiological, chronic need for a specific substance, activity, or behavior. Though the addiction harms their life and the lives of those around them, the sufferer is not able to stop. Compulsive behavior is performed in order to get the often euphoric feeling one derives from the stimuli. The most well-known addictions are to drugs and alcohol, but one can also become addicted to gambling, sex, love, pornography, social media, food, exercise, and anything else that brings feelings of euphoria. Some behavior to watch out for that could indicate addiction include:

  • Wanting to keep the substance/activity/behavior a secret so no one can interfere 
  • Withdrawing from typical social activities and interests
  • Excessive lying in order to hide the substance/activity/behavior and/or in order to be able to engage in it
  • Recognizing that the substance/activity/behavior is negatively impacting your life but being unable to stop
  • Being unable to fully function at work, school, and/or home

Other conditions that include compulsive behavior are known as body-focused repetitive behaviors (BFRBs). BFRBs include skin picking, nail biting, hair pulling, and any other repeated act one does to their own body (note, however, that self-harm is not a BFRB). The urge to perform the BFRB is intense and typically feels out of control. People engage in BFRBs for a variety of reasons, including an attempt to regulate stress or emotions, derive pleasure, or relieve some physical sensation. Like eating disorders, there is also a relationship between BFRBs and OCD, but they are still two separate diagnoses with different motivating factors behind the compulsive actions. Signs and symptoms of BFRBs include:

  • Red, swollen, bleeding, or broken skin (common areas of focus include the area around the fingernail, the scalp, or the inside of one’s cheek)
  • Thinning hair or bald spots from pulling hair repeatedly
  • An intense, even automatic urge to perform the act 
  • You find yourself engaging in the behavior without remembering when you started
  • You feel shame/embarrassment around the act, and may attempt to hide it from friends and family 

Seeking treatment for compulsive behavior or compulsions

If your compulsions or otherwise compulsive behaviors are negatively impacting your life in any way—whether it’s your ability to take care of yourself properly, your ability to maintain relationships, your ability to feel present and joyous, or any of the other destructive possibilities—it’s a good time to seek help. Your treatment will depend on the motivation behind your compulsive behavior and if it’s a manifestation of one of the conditions listed above. A licensed mental health professional can help you determine where your compulsive behavior is stemming from, but there are evidence-based treatments for every condition we’ve discussed.

Obsessive-compulsive disorder is treated with exposure and response prevention therapy (ERP). Dr. Farrell suggests that speaking with an OCD specialist is a good place to start if you’re not sure whether you’re experiencing OCD compulsions or some other sort of compulsive behavior, as “they are familiar enough with non-OCD compulsive behavior that they’ll be able to help them connect with resources and treatment options.” ERP consists of gradually exposing someone to their feared stimuli and giving them the tools to resist engaging in compulsions beforehand, during the exposure exercise, or afterward. 

Eating disorders are most often treated with cognitive behavioral therapy (CBT). CBT rests on the belief that one’s thoughts and feelings influence their behavior. Thus, the client and therapist work together to gain perspective on the client’s thoughts and feelings in order to change their behavior—in this case, dangerous patterns around food and eating. 

There are several different treatment options for addiction, based on the severity of the condition and what the addiction is. For drug and alcohol addictions, inpatient or outpatient rehab may be necessary. In these settings, one can receive more intense, frequent care. There are also 12-step programs for various addictions, beyond drugs and alcohol, that hinge on communal support and self-accountability, and many people find these programs to be integral to their recovery. Specific therapeutic modalities often used to treat addiction include CBT and dialectical behavioral therapy (DBT). DBT is designed for individuals who experience emotions particularly intensely. It helps the client to both accept their reality and change the elements of their reality and behavior that are harmful.

BFRBs are best treated with habit reversal training (HRT) or comprehensive behavioral intervention (ComB). Both of these models focus on learning why someone is engaging in a behavior and then, ultimately, working to change that behavior. ComB takes an especially individualistic approach. Client and therapist will spend more time focusing on the where, when, and why behind the client’s BFRB before developing strategies that are highly specific to them. 

Whatever your situation, know that compulsive behavior and compulsions are highly treatable—there are people specially trained to treat what you’re experiencing. From one compulsive person to another, know that there is hope for you to thrive.

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