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Obsessive-Compulsive Disorder consists of two parts: Obsessions, often in the form of intrusive thoughts, and OCD Compulsions. Intrusive thoughts are usually deeply uncomfortable or anxiety-provoking. For example, “If I ride that bus, I’m going to contract a deadly disease and die” is an example of an intrusive thought common in contamination OCD.
OCD Compulsions are physical or mental behaviors that soothe an intrusive thought. People with OCD feel compelled to perform these behaviors to stop the intrusive thought from manifesting or to ease the anxiety the thought brings.
Note: Intrusive thoughts can be mental images, thoughts, a feeling, or an object of obsession, like the way you look or the alignment of magnets on a fridge. They are not backed by fact or logical reasoning, but that doesn’t mean they aren’t strong. To the person with OCD, the intrusive thoughts feel real, and that’s why they need compulsions to counteract the obsessions.
This article will cover what compulsions are, common types of OCD compulsions, how they work, and how to stop engaging in them.
What Is a Compulsion in OCD?
A compulsion is soothing to the person performing it, but only for a time. They are not solutions to the intrusive thoughts. Instead, they continue to strengthen the obsession-compulsion cycle. The relief only lasts for a short period of time before the anxiety comes back, and the compulsion must start back up again.
This can be incredibly time-consuming and exhausting. People with severe OCD will spend hours every day performing their compulsions.
Compulsions may also inhibit someone from performing daily tasks or maintaining relationships. For example, someone with a cleaning compulsion can’t have people over to their house. Someone with harm OCD may avoid driving cars out of fear of causing a car crash.
Compulsions, like obsessions, don’t care what other things you have lined up for the day or what responsibilities you have. When the urge to perform a compulsion hits, it feels impossible to ignore.
Learning to ignore compulsions and cope with the rise of distress that comes from that is part of what Exposure and Response Prevention Therapy does for people with OCD.
Types of OCD Compulsions
Every person will have a unique set of OCD compulsions and obsessions. There are generally two types of compulsions:
- Mental Compulsions: Internal compulsions like counting, repeating phrases, praying, or obsessively reviewing past events.
- Physical Compulsions: Behaviors like cleaning, washing your hands, or tapping out a pattern. These are done physically and can be observed by others.
Mental compulsions are often harder to recognize because they cannot be observed by others, but they are a real type of compulsion that many people with OCD struggle with.
Obsessions vs Compulsions
Where does the line between obsessions end and compulsions begin?
Obsessions cause compulsions. They are deeply rooted fears that manifest themselves as intrusive thoughts, urges, images, or obsessions. They are always mental.
Compulsions, on the other hand, can be physical or mental. They are the reaction to the obsession. You might think of them as a way to “cancel out” or negate the anxious, obsessive thought. Many people with OCD believe that if they engage in their compulsion, the bad thing their obsessions tell them won’t come true.
People with OCD do not have delusions; they know that counting won’t actually stop a car crash. But that’s the nature of OCD–despite knowing that, they can’t help but continue to practice the compulsion.
How Do Compulsions Work?
The loop of obsession to compulsion is one that could continue on forever, growing stronger. Fortunately, there are OCD medications and talk therapies that are designed to stop the loop. We’ll look into those solutions below.
The loop that powers compulsions is:
Obsession -> Distress -> Compulsion -> Temporary Relief
The relief eventually cycles back around to obsession, and the loop starts again.
The brain is being negatively reinforced to engage in compulsion again and again. Negative reinforcement means there is an emotional state it wants to get rid of– the anxiety– and it does that by engaging in the compulsion. To your brain, it was the compulsion that got rid of the anxiety. Next time the same anxiety crops up, it does what worked last time: it engages in the compulsion.
This also explains why you might have different compulsions for different obsessions. Your brain has learned that certain compulsions work for certain anxieties.
This cycle can be stopped through therapy. Medication helps too, especially for severe OCD.
Examples of Compulsions
Compulsions vary greatly. Some of the more common ones include:
- Excessively washing your hands
- Obsessively leaning your house
- Going back to make sure you locked the door multiple times
- Counting steps until you reach a “correct” or “safe” number
- Flipping light switches until it feels “just right”
- Mentally reviewing a conversation obsessively to ensure it was done “correctly”
- Constantly asking for reassurance from your partner that they aren’t mad at you
- Repeating phrases or prayers to prevent harm
- Arranging a magnet on the fridge so that it sits at just the right angle
- Needing everything to be in straight rows
- Checking your heartbeat repeatedly
- Ruminating on an upcoming event or task to try and avoid all possible bad outcomes
- Confessing minor or imagined mistakes to feel relieved
- Neutralizing intrusive thoughts with a counter-thought or mental image
- Hoarding items because throwing them away feels unsafe or wrong
Some of these behaviors might seem normal, and they are, when done on a small and manageable scale. If you feel like you can stop engaging in a behavior whenever you want, then it probably isn’t a true OCD compulsion.
This is far from a complete list of compulsions. You might struggle with compulsions outside the scope of this list.
How to Stop OCD Compulsions
How to Stop OCD Compulsions
The number one way to stop an OCD compulsion is through Exposure and Response Prevention Therapy (ERP therapy for short). This is the gold standard for OCD treatment.
Although we highly recommend you have a therapist walk you through it, (It’s more effective and safe that way!), there are ways you can use ERP therapy at home. This can be especially useful for mild OCD symptoms or compulsions that aren’t extremely harmful.
Here are the steps to stop OCD compulsions:
- Notice and name the intrusive thought.
- Do not engage in a compulsion. Instead, practice a replacement behavior or other coping mechanism.
- Sit with the anxiety until it passes.
It’s a simple process that’s hard to do. Everything in you wants to engage in that compulsion, but the only way to stop the loop is to cut it out entirely.
Many therapists recommend starting with small intrusive thoughts. You probably have some obsessions that are more powerful than others. Start with the ones that only bother you mildly.
Another strategy is to slowly increase the time you are withholding a compulsion from yourself.
For example, if you feel the need to take your pulse anytime your chest hurts, the next time your chest hurts, wait 10 seconds before allowing yourself to check your pulse. After that feels comfortable, wait 20 seconds. Then 30 seconds. Slowly increase the time you are withholding the compulsion. Eventually, you will stop needing the compulsion to feel better and will be able to calm yourself down without it.
The replacement behavior or other coping mechanism is very important in this process. This is the healthy behavior you will do instead of the compulsion. Some good examples are:
- Box Breathing
- 54321 grounding exercise
- Color Scanning
- Progressive Muscle Relaxation
- If your compulsion involves your hands, doing something to keep your hands busy, like using a fidget toy or a craft.
- If your compulsion is mental, loudly sing your favorite song or call a friend
What behavior can you engage in that stops your compulsion and soothes your anxiety?
Through this method of Exposure and Response Prevention therapy, you can strip the power from compulsions. You’re teaching your brain that the compulsions don’t provide real relief.
If you want help with this process or need help coping with compulsions, contact Lifebulb Counseling. We have therapists near you who specialize in OCD compulsions. They accept most major insurances and have little to no wait times.
