When Habits Become Compulsions: Understanding OCD Behaviors

By Farid Alsabeh, LLP

Farid is a Limited Licensed Psychologist in Michigan

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Everybody has habits, quirks, and even superstitions that come up during an average day. Listening to a specific playlist on our drive to work, doing a last-minute check on the stove before leaving for vacation, and drinking out of our “lucky mug” before a big exam are all examples of these kinds of repetitive behaviors.

But what happens when these behaviors stop being harmless, and start interfering with our mood, relationships, and responsibilities? In these cases, the behaviors may actually be compulsions associated with a mental health condition known as Obsessive-Compulsive Disorder (OCD).

What are OCD compulsions, what makes them different from regular habits, and how can they be treated? In this article, we’ll take a closer look at OCD compulsions to answer these questions.

What Are OCD Compulsions?

In order to understand OCD compulsions, we first must understand OCD as a mental disorder more broadly. OCD is defined by the presence of obsessions and compulsions, which are defined as follows:

• Obsessions: Repetitive, intrusive, and unwanted thoughts that usually center around a certain theme
• Compulsions: Actions that are performed to deal with the distress caused by the obsessions

As we can see, OCD compulsions don’t just arise on their own. Rather, they’re a response to an obsession, a response that’s designed to manage the distress or anxiety associated with that obsession.

To see how this happens, consider the following example. Jay suffers from repeated intrusive thoughts about the quality of his friendships. In response to the distress caused by these thoughts, he compulsively checks in on his friends by calling and texting them, and makes mental comparisons between his friendships and other friendships that he observes around him.

As we see from this example, Jay feels compelled to repeat his compulsions in order to deal with the distress associated with his obsession about his friendships. We can also see how two different compulsions – calling his friends, and making mental comparisons – are both responses to the same obsession. Finally, we note that these compulsions can be either physical (calling) or mental (making comparisons).

What Are Common OCD Compulsions?

Although every person’s presentation of OCD is unique to them, there are general themes that seem to underlie both the obsessions and compulsions associated with OCD.

Research has shown that the following are common themes for compulsions:

• Washing and cleaning behaviors: These are commonly responses to obsessions about cleanliness and the risk of contamination, and can manifest as washing hands, cleaning one’s space, or disinfecting objects.
• Symmetry and counting behaviors: These can be responses to a wide variety of obsessions, which center broadly on risks of danger or harmful outcomes
• Safety-preserving actions: These are commonly responses to obsessions about the fear of doing harm to one’s self or others, including obsessions of an aggressive or sexual nature, and can manifest as moving carefully or checking on the wellness of close ones.

Another important aspect of OCD compulsions is that they can be purely mental. Here are some examples of purely mental compulsions:

• Counting to a certain number: This can happen through internal counting or counting objects in the environment a certain number of times.

• Reviewing feelings or memories: This is often done to ‘prove’ to one’s self that an obsessional idea is untrue, or to refute the content of an obsessional idea.

Why Do OCD Compulsions Happen?

To understand why OCD compulsions happen, we must first understand the prevailing model of OCD. This model says that OCD is associated with an overactivation of a circuit in our brain called the orbitofrontal-subcortical pathway. This leads to an exaggerated perception of danger, which drives our attention towards the themes we later recognize as obsessions.

According to this model, obsessions are the primary feature of OCD, and compulsions develop as a response to them. In the face of an overwhelming feeling of danger posed by the obsession, the compulsion develops as a false, but oftentimes comforting, way of neutralizing that danger.

One important reason why compulsions are so hard to stop is that they actually become self-reinforcing. When we fear an outcome and perform the compulsion, we observe that the feared outcome doesn’t happen. Of course, in reality, performing the compulsion had nothing to do with being safe. But over time, we begin to associate the compulsion with being safe from the feared outcome.

The tendency for OCD compulsions to self-reinforce explains why it’s so important to break the cycle of distress, compulsions, and reward. This leads us to consider some effective ways of treating OCD compulsions.

Treating OCD Compulsions

One of the most effective treatments for OCD and its accompanying compulsions is Exposure-Response Therapy. This consists of gradually exposing a person to their obsession, while instructing them not to rely on their compulsion to deal with the accompanying distress. Over time, this allows the person to deal with the obsession without the compulsion.

The exposures involved in ERP can be of three types:

• In-vivo (real-life): A person faced a feared outcome as it exists in the world, such as a person with obsessions about contamination who plays in dirt
• Imaginal: A person faces a feared outcome in their imagination, such as a person who thinks about snakes
• Interoceptive: A person faces feared physical sensations or feelings, which can be particularly helpful with recurrent fears related to one’s physical health

Research shows that ERP is effective for the treatment of OCD and its compulsions, and one leading theory about why is called Emotional Processing Theory. This theory posits that pathological reactions to feared situations happen when these situations activate a cognitive ‘fear structure’ which involve intense negative emotions. ERP helps us to add new information to this fear structure, allowing us to ‘unlearn’ it and preventing a wide variety of stimuli from activating it.

The effectiveness of ERP can also be understood from the lens of Acceptance and Commitment Therapy (ACT). According to ACT, exposure to a distressing stimulus without resorting to compulsions teaches us that there are more adaptive ways to respond to distress. As we grow in our ability to flexibly adapt to psychological distress, we empower ourselves to engage in the world in a way that better reflects our values.

Cognitive Behavioral Therapy (CBT) has also been shown to be effective for treating OCD and its accompanying compulsions. This treatment begins with identifying and challenging the maladaptive thoughts that are associated with obsessions, such as “If I have doubts about my relationship, that means my partner isn’t the right person for me”. By restructuring our thoughts in a way that gives us a more realistic expectation of our inner mental landscape, we become less likely to form obsessions about ourselves or the world.

Conclusion

OCD compulsions are repetitive actions that are taken to manage the distress associated with OCD obsessions. These compulsions take common forms like cleaning or hoarding, but can also be mental, such as self-monitoring and reviewing.

Treating OCD compulsions starts with breaking their self-reinforcing cycle. This involves allowing ourselves to experience the distress of the obsessions without resorting to compulsions. Over time, we come to learn more adaptive ways of dealing with this distress.

Treatments exist for OCD compulsions. If talking to somebody may help you, consider using FindMyTherapist, to choose your therapist and schedule your first appointment online instantly.