Did you just feel as if you had to do it?
If you’ve ever felt like you just had to do something—regardless of the consequence—you’ve just displayed a compulsive behavior.
Sometimes, these things happen in everyday life:
You got a craving for a certain food and felt as if you just had to eat it.
You signed up to go on a reality dating show on a whim.
You walked into work and decided to quit your job.
Many of these you’d get a pass—we’re all human, after all. You eat a candy bar and move on with your day. You wince as you realize you made a big mistake trying to communicate with your ex. And you can move on. No one calls you from the reality dating show, so no worries there. You had planned to quit your job next week anyway.
However, sometimes compulsive behaviors are part of a mental health disorder. Here’s how to know what a compulsive behavior is, what conditions it’s associated with, and where to look for help, if it’s needed.
What is compulsive behavior?
A compulsive behavior is done out of a seemingly uncontrollable urge. But there’s a goal behind it: It can be done to relieve stress, cope with difficult emotions or other conditions, gain control over something, or to relieve an uncomfortable physical sensation. “People will describe a compulsion as something they feel they have to do—or are drawn to do,” says Patrick McGrath, PhD, Chief Clinical Officer at NOCD. “And if they don’t do it, they’ll be amazingly uncomfortable,” he says.
One thing you can do is replace “compelled” with “I have to.” For example: I have to do this…or else. Or if I don’t do xyz, then xyz will happen. That’s how to tell if a behavior or decision could be deemed compulsive.
Is there a difference between a compulsive behavior and a compulsion?
These two terms “don’t have to be different at all,” Dr. McGrath says.
Technically, a “compulsion” is defined as a type of behavior or a mental act that one engages in to reduce anxiety or distress, according to the American Psychological Association (APA). “Compulsive behaviors can be mental or physical,” says Dr. McGrath. Some you can see, like washing, cleaning, repeating, or arranging things “just right.” Other compulsions are things you cannot see, he says, such as praying over and over until you do it in the correct way.
Compulsive behavior is a main feature in obsessive-compulsive disorder. Also called OCD, this disorder affects 2.5 million adults in the U.S., according to the Anxiety & Depression Association of America. OCD is a chronic mental health disorder in which someone experiencing it has obsessions (unwanted, intrusive thoughts, images, sensations, feelings or urges) and compulsions (behaviors done to neutralize the discomfort caused by an obsession or prevent an unwanted outcome), explains the International OCD Foundation. You feel compelled to engage in a behavior—repeatedly washing your hands, ritualistic prayer, checking, avoidance, reassurance-seeking—because you want to avoid distress or out of a belief that something bad will happen if you don’t do it.
What’s more, a compulsion in OCD may be triggered by an underlying fear, and compulsions may show up in unexpected ways. For example, says Dr. McGrath, you may be walking along the sidewalk and see a twig. You feel compelled to kick the twig off onto the grass because if you don’t, there is a pervasive fear that someone could trip over it, get hurt and then the incident would all be your fault.
That said, there are disorders that are related to or have been linked with OCD that are driven by compulsions, such as eating disorders or hoarding disorder. People with these mental health disorders feel compelled to engage in certain actions and they may have compulsive behaviors, but they are distinct from OCD. Let’s dig a bit deeper to understand the connection.
What conditions come with compulsive behavior, and what does it look like?
Not every compulsive behavior is OCD. “People can tell you they’re compelled to do something, but it doesn’t have to mean that it’s OCD,” Dr. McGrath says. There are other conditions that involve compulsive behaviors, some of which commonly occur alongside OCD. Here’s what you need to know about four of them:
- Body-focused repetitive behaviors, or BFRBs
This is an umbrella term for conditions where people do repetitive behaviors to their own body, including hair-pulling, skin-picking, nail-biting, or cheek-biting. With these, people feel compelled to pull, pick, or bite even to the detriment of their health.
For example, they may pull out enough hair to leave a bald spot or pick at a certain area of their skin enough to cause bleeding or scarring. It’s likely more common that you’d assume, with 1.7% of U.S. adults currently experiencing hair-pulling disorder and another 2.1% of U.S. adults currently experiencing skin-picking, according to the Anxiety & Depression Association of America (ADAA).
While these disorders are considered OCD-related disorders, they can be differentiated from OCD because the compulsion to pull or pick is not only comforting, but pleasurable, as well.
- Eating disorders
Anorexia, bulimia, binge-eating disorder are three of the most common eating disorders, according to the American Psychiatric Association. The association describes these disorders, which affect 1 in 20 people, as a “severe and persistent disturbance in eating behaviors and associated distressing thoughts and emotions.”
As if the physical and emotional fallout of eating disorders wasn’t enough, it’s common for people to have an eating disorder alongside depression, anxiety, or OCD. When someone has an eating disorder, they feel compelled to engage in disordered behaviors. For example, someone who has bulimia feels as if they have to binge; when the binge is over, there is a similar, if not stronger, urge to neutralize it with purging in order to relieve the distress that purging has caused.
- Substance use disorder
A compulsive need to drink alcohol, use tobacco, or use drugs to the point where it affects your functioning is considered a substance use disorder, according to the American Psychiatric Association. Due to changes in brain functioning, these behaviors may feel out of your control; you may feel powerless to stop using and get help for your addiction.
Also, it is not uncommon for someone with OCD to use substances (and therefore develop addiction) in order to cope with the distress of having OCD. In fact, research suggests that 10 to 40 percent of people with OCD also have a substance use disorder, though alarmingly less than half seek help, according to the Substance Abuse and Mental Health Services Administration. With addiction, compared to other compulsive behavior, there is an added sense of pleasure in using alcohol or drugs, which reinforces the compulsion to misuse these substances.
- Hoarding disorder
If you collect and keep useless items or those of little value, allow these items to clutter your living spaces in a way that prevents you from using the areas as intended, and find that the amount of items is distressing, you may have hoarding disorder, notes the International OCD Foundation. Compulsive behaviors around hoarding typically stick around for a very long period of time and cause isolation from friends and family.
Hoarding is related to OCD, though you can also have what’s called hoarding OCD, a subtype of OCD that’s different from hoarding disorder because intrusive thoughts are centered around possessions and the terrible things that might happen if you were to get rid of them. For example, you may believe that something bad might happen to the person who gave you a certain item if you got rid of it, or you might not throw anything away out of fear of contamination from touching the garbage. In all of these instances, you feel compelled to keep things without throwing them away, due to a fear of possible repercussions.
How is compulsive behavior treated?
The first step is to seek out a mental health evaluation from the right specialist, such as a psychiatrist or licensed therapist. This is important for identifying any mental health disorder you may experience, especially since so many tend to co-occur together, which is called comorbidity.
The unfortunate news is that physicians misdiagnose OCD symptoms about half of the time, especially for people who have certain subtypes of OCD, such as obsessions centered around sexual, aggressive, and religious themes, according to 2023 research in the Journal of Obsessive-Compulsive and Related Disorders. That’s why there’s a delay of over a decade in the U.S. from the time OCD symptoms start and when one first starts treatment.
After you have been properly diagnosed, that will naturally lead you to the right treatment. Here’s what that may look like, depending on the disorder:
Several psychotherapy options are available, including habit reversal training (HRT) and comprehensive behavioral treatment (ComB), according to The TLC Foundation. ComB may be used because it focuses on the sensory triggers, cognitive reasons behind the behavior, what feelings surround the action, and other factors that drive picking, pulling, or biting, a study in Behavior Therapy in 2021 suggests.
- Eating disorders
People with BDD generally respond well to a varied range of cognitive behavioral therapy (CBT) modalities and techniques: exposure and response prevention (ERP), cognitive restructuring, and perceptual training techniques are often used in BDD treatment, and may be supplemented with medication. When people also have a co-occurring Eating Disorder, Family-Based Treatment may also be used.
- Substance abuse disorders
Individualized treatment is critical, and that often includes medication and individual or group therapy, according to the American Psychiatric Association. One type of community-based group is Alcoholics Anonymous 12-step program.
- OCD and OCD-related disorders
The gold-standard treatment is exposure and response prevention therapy, or ERP. This treatment tackles compulsions by purposefully triggering an obsession. For example, if you have an OCD-related fear of needles, you might first be asked to look at pictures of needles. This will cause a surge of anxiety, and you’ll instinctively want to perform a compulsion to neutralize that distress. Instead, you will stop yourself from engaging in that compulsion. In a relatively short period of time, OCD symptoms decrease and you’ll find you won’t need to lean on your compulsive behaviors anymore.
Where to go for help with compulsive behavior
If you are struggling with compulsive behaviors in OCD or an OCD-related disorder, such as a BFRB or hoarding disorder, NOCD Therapy provides insurance-backed, evidence-based treatment with specialized therapists across North America.
If you think you may be struggling with compulsions or other compulsive behaviors, I encourage you to learn more about NOCD’s approach to treatment—as much as it may feel like it, you don’t have to live this way forever.