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Compulsions

Compulsions are Troublesome Behaviors That can Become a Source of Disability

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Updated August 22, 2010

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Compulsions are a key symptom of obsessive compulsive disorder (OCD). At one time or another, we've all double-checked that we locked the front door, knocked on wood to ward off disaster, or adjusted a picture a couple of times until it was hanging perfectly. While most people go about their daily lives without giving these experiences a second thought, if you have obsessive compulsive disorder (OCD) compulsions such as these can take over your life and become a source of disability.

What Are Compulsions?

Behaviors that you repeat over and over again are compulsions. For instance, you might have to repeatedly check to make sure that the front door is locked or that the stove is turned off. These are behaviors that you feel you must carry out over and over, often for hours on end. For example, if you are obsessed with contamination, you might wash your hands over and over again. Other common types of compulsions include cleaning, counting, checking, requesting or demanding reassurance, repeating phrases or sequences of words, and ensuring order and symmetry.

Compulsions are aimed at getting rid of your anxiety or to try to stop a feared situation, such as the death of a loved one, from happening. Of course, compulsions are often unrealistic solutions to the problems they are supposed to prevent. For example, it is unlikely (if not impossible) that folding laundry in a particular way or counting up to a particular number could ever prevent the death of a loved one. If you have OCD, you usually have insight into the fact that the compulsion has little to do with the actual event, but feel an intense need to carry out the compulsion anyway.

Compulsions are usually so debilitating that you have difficulty keeping up at work or maintaining personal relationships. In addition, although any intimate relationship has its ups and downs, dating someone with OCD who has severe and unmanaged compulsions can present some additional challenges.

Because of the repetitive nature of many OCD symptoms, there has been some suggestion that people with OCD may experience some sort of problem with memory and simply forget that they’ve already carried out their compulsion, although research to date has been mostly inconclusive.

Compulsions and OCD Spectrum Disorders

There are a number of other disorders that, while not technically meeting the DSM diagnostic criteria for OCD, have very similar symptoms and fall within the so-called OCD spectrum. This spectrum captures different clusters of symptoms that are reminiscent of, but not exactly the same as, OCD. Often (but not always) the only difference between OCD and a given OCD spectrum disorder is the specific focus of the obsessions and/or compulsions.

For example, people with pathologic skin picking compulsively pick their skin to remove small irregularities such as moles or freckles. Although classified as an impulse control disorder it has been suggested that skin picking is related to OCD.

In another example, people affected by trichotillomania repeatedly pull out their hair from any part of the body for non-cosmetic reasons.

Treatment of Compulsions

Compulsions are treated effectively with both medication and psychotherapy. Medical treatment of OCD has focused on drugs called serotonin reuptake inhibitors (SSRIs). Well-known SSRIs include Prozac (Fluoxetine), Zoloft (Sertraline), and Paxil (Paroxetine). Anafranil (Clomipramine), a tricyclic antidepressant, also may be used to treat OCD.

Psychological therapies are effective treatments for reducing the frequency and intensity of symptoms of OCD. Effective psychological treatments for OCD emphasize changes in behavior and/or thoughts. When appropriate, psychotherapy can be done alone or combined with medication. The two main types of psychological therapies for OCD are cognitive behavioral therapy (CBT) and exposure and response prevention (ERP) therapy. ERP is particularly effective for treatment of compulsions.

Habit reversal training is a behavioral therapy that is effective in reducing tics associated with Tourette’s syndrome as well as troublesome behaviors associated with so-called impulse control disorders.

Source:

American Psychiatric Association. "Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision" 2000 Washington, DC: Author.

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