The ‘C’ of OCD: What Are Compulsions?

What are compulsions?

The OCD cycle

To understand compulsions, we need to look at the full cycle of OCD. Every one of us has intrusive thoughts: they can be about anything, and typically don’t reflect the views we hold personally. For most people, they may think ‘that was strange’ or feel a bit uncomfortable about an intrusive thought, then they just let the thought pass. They don’t think about it any further, and don’t worry about it.

For those with OCD, when you have an intrusive thought you attach a great deal of significance to it. You might dwell on this thought and be unable to get it out of your head. You might fear the thought, think that it makes you a bad person, or think that something is bad is going to happen as a result of the thought. This is when intrusive thoughts become what we know as obsessions.

Obsessions can be around a wide range of themes. Obsessions produce a lot of anxiety, fear and worry. This causes the person with OCD to feel that they need to ‘deal’ with this obsession in some way. They need to relieve the anxiety and to prevent something terrible from happening. The actions they take are often rituals, checking behaviours, repetitive behaviours and so on: these are the compulsions.

Levels of self-awareness can vary. For some people, they may not be aware that the compulsions they’re carrying out are unfounded. For others, they may be completely aware that their compulsions are not based on logic, but not feel able to ignore them because the OCD cycle is so gripping. There are many types of compulsions, which we’ll cover later on in this article.

While compulsions may initially ease a bit of the anxiety caused by obsessions, this doesn’t last long. Compulsions actually feed into the OCD cycle and perpetuate anxiety. With rising anxiety, more and more compulsions need to be carried out. OCD UK explains that over time compulsions can become a habit, “where the original obsessive fear and worry has been forgotten, in this instance compulsions are often completed to enable the individual to feel ‘just right’, the key word being ‘feel’.” It’s a tough cycle to break: but not impossible!

Compulsions vs obsessions: what’s the difference?

To summarize, we’ve learnt that obsessions and compulsions are two very different, but equally important, aspects of OCD.

• Obsessions: Obsessions are the intrusive and obsessional thoughts which plague OCD sufferers.
• Compulsions: Compulsions are the actions taken to ‘deal’ with the obsessions.

Overt compulsions vs mental compulsions

There are two primary types of compulsions which you can experience: overt compulsions and mental compulsions. Overt compulsions, or physical compulsions, are those which are carried out physically and can be seen by others. This could include washing or cleaning behaviours, physically checking and so on.

Mental compulsions are those which are done in your mind, and cannot be seen by others. This includes mental rituals, mental checking and so on. Mental compulsions can be understandably hard to detect, even for the individual. If someone only engages in mental compulsions, you might hear this being referred to as ‘Pure-O’, which stands for ‘Purely Obsessional’. This is a common nickname for OCD with only mental compulsions which is often used within the mental health community.

How can compulsions affect your life?

Compulsions can be extremely detrimental to your life. Depending on the severity of your OCD, they can take up multiple hours a day. Individual types of compulsions may have their own specific effects on someone’s life. Let’s take a look at some of the general effects compulsions can have.

• Lack of time

  Since compulsions can take up so much time out of your day, you might find that you are lacking time to do other things. You may find that you’re often late to events or appointments, or even forget that you were supposed to be doing something else because the compulsions are so all consuming.

• Problems completing day to day tasks

  When so much of your attention is taken up carrying out compulsions, it can often be difficult to complete normal daily tasks. Things which would usually be a priority, such as housework, personal hygiene and hobbies, are overlooked because your attention is stolen by your OCD.

  If you need to re-do tasks you’re trying to carry out, this can take up a lot of time and be very distressing. When you’re constantly questioning and doubting yourself, it can make ‘normal’ functioning so much more complicated.

• Difficulty maintaining social connections

  Just as it’s difficult to focus on daily tasks, it can be tough to maintain social connections. Aside from the time taken up by compulsions, when you’re always feeling anxious or avoiding specific situations, this can take its toll on your social life. When you’re often late to social arrangements or have to cancel, this can be difficult for others to understand. This can often lead to tense connections with loved ones and even social isolation, which in itself is detrimental to your mental health.

• Issues keeping a job

  Problems with lateness and being unable to focus can understandably make it difficult for some people with untreated OCD to hold down a job. In the same way, it can be tough for those with OCD to study and keep up with school.

• Fatigue

  The experience of living with OCD, constantly fighting your mind and having to carry out compulsions, can be physically and mentally draining. It’s common for OCD sufferers to experience high levels of fatigue.

• Comorbid mental illness

  Many people with OCD experience a comorbid mental illness, meaning they have another mental illness alongside their OCD. This may be another anxiety disorder, depression or mood disorders for example. This can often be caused or worsened by their OCD.

• Physical health issues

  Prolonged, high levels of stress can have significant impacts on physical health, putting you at risk for a range of health conditions. Often compulsions themselves may cause physical health issues, such as repeated self-cleaning causing skin irritation.

Types of overt compulsions

If your particular compulsion is not mentioned here, know that you have not been overlooked. Everybody’s compulsions are valid, and every individual with OCD deserves acknowledgement and appropriate treatment to help them reclaim their lives.

Checking

Checking is a fairly common compulsion and can involve checking anything psychically or visually. This might involve checking that plug sockets and appliances have been turned off before leaving the house for example. It could entail checking and rechecking a piece of work or an email to ‘ensure’ there are no mistakes.

Typically an individual who carries out checking compulsions will need to check and recheck multiple times to ‘cope’ with their obsessions. Checking can go on for minutes or hours, and can have a significant impact on an individual’s life. If an individual is repeatedly checking an object, for example locking and unlocking a door multiple times, or checking the handle over and over again to check the door is locked, it can also cause damage to property.

OCD UK explains that other effects of checking compulsions can include, “being late for school, work, social occasions and other appointments. This can impact on a person’s ability to hold down jobs and relationships.”

Washing and cleaning

If you carry out washing or cleaning compulsions, you may clean your hands or body, an area of your home or an object repeatedly until you ‘feel’ it’s clean enough. This could involve washing your hands multiple times, taking multiple showers, scrubbing a specific area of your home, or even repeatedly cleaning any area you touch. As with the checking compulsions, this can go on for hours.

If you are cleaning your own skin, this can lead to bleeding, skin rashes and irritations. Despite these issues, you are likely to be unable to stop yourself carrying out the compulsion, even if you can see you are hurting yourself, which of course worsens the problem. Some people will even wash themselves in substances which are not meant for human use, such as bleach and other strong cleaning liquids, in desperation to make themselves ‘feel’ clean.

Those who clean objects and areas around the home compulsively can damage them with excess cleaning. Some people may even excessively clean electronics, causing them to break, or clothes causing them to be worn out: this can be costly when replacing them. It can also be costly (as well as time consuming) to constantly buy large amounts of cleaning products.

Repeating

Someone with OCD may need to repeat a specific action a certain number of times for it to ‘feel’ right. For example someone may need to get dressed and undressed four times before they start their day, because four is their ‘lucky’ number. Another individual may pick up something, for example a bar of chocolate from the kitchen cupboard, and have to put it back down and pick it back up again repeatedly until it feels right.

For others, it may be that they need to touch or tap surfaces or themselves repeatedly. For some, it may be that they need to repeat a specific phrase over and over again. If someone who struggles with repeating compulsions places a plate down on their dinner table, and it didn’t make the right noise as it met the table surface, they may need to repeat the action until it ‘sounds right’. Someone else may need to walk back and forth through a doorway a specific number of times, or turn a light switch on and off a number of times when they enter a room. The list goes on.

Arranging and symmetry

This can entail the person with OCD arranging and placing things in specific places where they ‘belong’ and becoming very distressed if this system is disturbed. For example, someone may organise their clothes in their wardrobe in a specific order, or need to put their keys in the same exact place every night when they return home. Some people may be preoccupied with symmetry and may need to arrange things so they line up exactly on a shelf, or even arrange food on their plate so that it looks ‘just right’ before they eat.

Seeking reassurance

Some people with OCD may involve loved ones in their compulsions: it’s important to remember that this isn’t done deliberately and is something they don’t have control over. This entails asking for reassurance over and over again. This may be asking their family member to confirm that they (the individual with OCD) carried out a task correctly. It may be asking if the family member turned an appliance off in the home or locked the door once they’re out of the house.

As with other compulsions, this reassurance seeking can revolve around anything the person with OCD is anxious about. It can be tough for family members to recognize that they are contributing to the OCD cycle: it’s normal to want to help someone you love by giving reassurance when they ask for it!

Avoidance

Many people with OCD will avoid things that may trigger their obsessive thoughts or compulsions. This may entail avoiding specific places, people or situations. For example, if someone struggles with obsessive thoughts around contamination, they may have compulsions which include avoiding places that they perceive as ‘dirty’ or which are more likely to be contaminated, such as public toilets. Someone with OCD may also avoid ‘unlucky’ numbers, letters or colours which don’t ‘feel’ right.

Hoarding

Hoarding refers to collecting specific items or finding it difficult to throw items away. This tends to revolve around items which are not particularly useful. Hoarding disorders have been reclassified as disorders in their own right. However those with OCD who hoard due to specific obsessions, will still be diagnosed with OCD rather than a hoarding disorder, as OCD UK explains.

Counting

If you struggle with counting compulsions, you may need to carry out tasks a specific number of times while counting out or in your head. You may have ‘safe’ or ‘lucky numbers which you gravitate towards, and likewise ‘unsafe’ or ‘unlucky’ numbers which you need to avoid. Someone with OCD may need to count to a specific number over and over again in their mind or out loud: if this is done in their mind with no outward actions, this would be defined as a mental compulsion.

Confessing

People with OCD typically feel an inflated sense of responsibility for their own safety and that of other people. It’s also common to feel like a ‘bad person’ as a result of intrusive thoughts. Sometimes this can lead to intense feelings of guilt which can manifest with the individual confessing every time they feel they have done or thought something ‘wrong’. These confessions may be to a loved one, to a mental health professional or to a religious figure.

Types of mental compulsions

Mental review and mental checking

Mental review or mental checking involves an individual going over events, memories or thoughts. If you struggle with this type of compulsion, you might go over past events to try to ‘prove’ to yourself that these events don’t make you a bad person, or don’t mean your intrusive thoughts are true.

You might mentally check you’ve turned appliances off for example. You may have a checklist you need to ‘think through’ when you leave the house. For example, you may think back to whether you locked the door and picture the process of leaving the house repeatedly to see if you did.

Some people who struggle with mental checking may check their reactions to their intrusive thoughts. This article explains that, “The OCD sufferer may bring up OCD thoughts intentionally for the purpose of checking if the thoughts still bother them.”

Mental rehearsal

With this compulsion, an individual will focus on mentally practicing and rehearsing for a future scenario with the aim of ‘ensuring’ it goes perfectly. They may go over what they are going to take to a medical appointment for example, or plan what they are going to pack repeatedly in their mind if they are going on holiday. They may plan what they’re going to say on a phone call and so on.

Mental reassurance

Rather than seeking reassurance from others, mental reassurance involves seeking reassurance from oneself. If you struggle with this compulsion you might mentally ‘tell’ yourself that you’re a good person, that your intrusive thoughts aren’t going to come true or that you don’t need to feel guilty for the thoughts you’re having.

Rumination

Rumination refers to excessively focusing on an intrusive thought, going over and over it in your mind. You may focus on feelings, memories and situations revolving around a specific intrusive thought.

Thought neutralization

Sometimes when a person with OCD has an unpleasant or disturbing intrusive thought, they will actively try to think about a pleasant or neutral thought instead to ‘cancel out’ the bad thought.

Prayers and mantras

Some people with OCD may pray or repeat specific phrases in their mind to ‘cope’ with their obsessions. For example if someone is having intrusive thoughts about harming someone and is convinced they are a bad person, they may pray to God to forgive them, or may repeat a phrase like “I’m a good person, this isn’t my fault”.

Wishing

Some people may spend a great deal of time wishing that their obsessive thoughts would go away. While it seems logical to wish for this, this wishing becomes so repetitive that it becomes a compulsion. Although this may appear harmless, wishing enforces to the brain that these intrusive thoughts are important and significant, therefore feeding into the cycle of OCD.

Solving

Solving compulsions stem from logic: the desire to ‘solve’ or ‘fix’ their OCD and be free of their symptoms. While this is understandable, the individual will excessively think about ways they can ‘solve’ their OCD, which can take up many hours of the day. Unfortunately this does the opposite, and feeds into the OCD cycle.

Self-punishment

If you struggle with self-punishment, you will mentally tell yourself how much of a bad person you are for the intrusive thoughts you’re having, repeatedly and regularly. This may stem from being ashamed of your thoughts, and not wanting yourself to ‘get away’ with them. By punishing yourself, you might feel that you are alleviating some of the guilt.

‘Giving in’

Some people may ‘give in’ to their intrusive thoughts, meaning they will try to ‘come to terms’ with the fact that they’re a bad person and that their intrusive thoughts are true. They may feel that by coming to terms with this, they will be able to move on. Unfortunately, as with the other compulsions we’ve mentioned, this only exacerbates the OCD cycle.

What to do if you’re struggling with compulsions

Monitor your symptoms

A great first step is to start monitoring your symptoms. Write them down and keep note of when they happen, if there’s any noticeable trigger, how they feel and how they affect you. This can help you to see patterns in your symptoms, and enable your doctor to see how your OCD is affecting you. This will better inform them so they can get you the help you need.

Reach out for help

The next step is reaching out for help. This can feel scary. You might feel ashamed, guilty, embarrassed, or frightened. All of these feelings (and any others you have) are completely natural and valid. However even though it’s tough, it’s vital you do reach out for help because that’s how you can tackle your OCD and reclaim your life.

Your first point of call if you don’t have a diagnosis, should be your GP. They will chat to you about your symptoms and should refer you to see a mental health professional for a psychological assessment.

Advocate for yourself

It’s really important you do see a mental health professional because they are well versed in OCD and can help you to get the diagnosis and treatment you need. It’s important you advocate for yourself with your doctor to make sure this happens. If you need help with this, you could take a loved one with you, or use a professional advocate (you can find these online, through your local council or mental health charities).

Once you have a diagnosis, you can get treatment. There are lots of ways you can get treatment. Some treatments, such as medication, you may receive directly from your doctor or mental health professional. For psychological therapy, you may be referred to a therapist for face to face therapy. Alternatively you could seek face to face treatment privately, or use online OCD therapy which enables you to get treatment when you need it, in your own home.

Types of treatment

There are a few types of treatment which can be useful, but the primary types (meaning the ones which are typically used first) are shown below.

Exposure and response prevention (ERP)

ERP is a form of cognitive behavioural therapy (CBT) which is used to treat OCD. ERP helps patients to face their fears, guiding you through facing your obsessions without reacting with compulsions. This happens in a gradual, manageable way. Over time ERP helps you to break the OCD cycle.

Acceptance and commitment therapy (ACT)

ACT is another form of CBT which focuses on helping you to let go of negative thoughts without them affecting your life. In essence ACT teaches you that intrusive thoughts are just thoughts, and don’t have to be followed up with compulsions. The therapy then helps you to commit to more positive coping strategies to deal with your OCD.

Mindfulness

When you live with OCD, you are almost constantly on alert. You’re stuck in a state of prolonged stress, in that ‘fight or flight’ state, and this alone can have a detrimental impact on your quality of life. Mindfulness can be incredibly useful to help OCD patients relax and reduce stress.

Medication

Medication can help to ease symptoms and is often most effective when used alongside therapy. The type of medication primarily prescribed for OCD are antidepressants known as selective serotonin reuptake inhibitors (SSRIs).

Fighting compulsions: delaying and changing

Changing compulsions

Gradually changing your compulsions over time can be an effective, manageable way to fight your OCD. For example if your OCD wants you to turn a light switch on and off 20 times when you walk into a room, you could try only doing it 19 times for a while. When you feel ready, you could try for 18 times and so on.

If you have a ritual with a number of steps, you could swap two of the steps around: you’re still doing all of the steps of your ritual, but not in the order your OCD wants you to. You could change where you carry out the ritual or change the objects you use or interact with. These changes may feel uncomfortable at first and that’s natural, but as you get into the habit of gradually challenging your OCD, you’ll feel more and more in control.

Shortening compulsions

Compulsions can take up a lot of time, and this is partly why they can be so disruptive to your life. By gradually shortening the time your compulsions take, or even the time one step of a ritual takes, you are actively tackling your OCD.

For example, if you have a ritual which entails walking in and out of a doorway; then turning the light on and off; then tapping the wall so many times before you leave a room, you could shorten one step.You could estimate how long it takes you to walk in and out of the doorway, and try to shorten this time by a few seconds. Over the next few weeks you could continue shortening this amount of time, then move onto the next step and so on. This article from Anxiety Canada explains that, “It’s up to you how many minutes and when you’re ready to shorten further, but at least it’s you who’s deciding how long it will take and not the OCD.”

Delaying compulsions

OCD will ‘tell’ you that you need to act on your compulsions immediately when you begin to feel uncomfortable or experience a trigger. Instead of acting straight away, you can try to delay the compulsions by a couple of seconds or more. You can build up this time as much as you feel able. This way, you’re gradually taking charge over your OCD.

This article explains that, “This practice will help in two ways. First, you will begin to tolerate longer periods of distress instead of instantly reducing the discomfort through ritualizing. Second, successful postponement will enhance your sense of control.”

Slowing down compulsions

Sometimes an individual with OCD might need to get a compulsion done in a certain amount of time to ‘satisfy’ their OCD, or because they’re trying to rush through it to get on with other aspects of life. Often they may have multiple times they need to carry out the compulsion, so try to fit as many in as possible. This can sometimes cause you to doubt whether you carried out each step properly, and lead to you carrying out the compulsions yet another time to ‘make sure’.

Instead, you can try to slow down your compulsion. Try to focus on each step, taking notice of the fact that you’ve done it. As you do so, not only are you tackling OCD by not moving as fast as it wants you to, you’re also lessening the chances you will have to repeat the compulsion to make sure you’ve done it right.

This article explains, “As you physically and mentally slow down, you can better remember the details of your actions. Since this technique provides you with a stronger memory of your actions, it will reduce your doubts.”

No AIR (Avoidance, Interaction, or Reassurance seeking)

No AIR means you are using the other tools we’ve covered to try to eliminate avoidance, interaction or reassurance seeking. You can think of this like taking away the OCD’s ‘AIR’, and therefore you are winning because you aren’t allowing it to breathe.

• Avoidance

  OCD often wants you to avoid things that are perceived as ‘dangerous’. You may also get into the habit of avoiding things that may trigger your OCD. However as we mentioned earlier, avoiding things actually feeds into the OCD cycle and gives it power. Tackling avoidance by gradually doing things that your OCD ‘forbids’ can help you to take your power back.

• Interaction

  In order to stick around, your OCD needs you to interact with it by engaging in compulsions. As you stop doing so, you take away the ‘C’ of OCD, and therefore break the cycle!

• Reassurance seeking

  Over time, gradually seeking less reassurance from others, and even gradually doing less self-reassuring, can help you to tackle OCD. This can allow you to feel more empowered and in control.

Other ways to help yourself

Seek support

Having support is so important when you’re dealing with OCD. If you have loved ones you trust, seeking support from them and allowing them to be there for you can be pivotal in your recovery journey. Sometimes having support from others with OCD can be incredibly helpful. You can find support from local support groups, or even online through social media.

Eat well

It may seem cliche but eating well is so important for mental health as well as general health. Giving your brain the right nutrients to help it perform optimally is even more important when you are facing extra challenges like OCD. Ensure you have a balanced, healthy diet and that you’re eating regular meals (even when you’re struggling if possible). It’s also important to ensure you’re staying hydrated!

Exercise

Just like eating well, saying exercise can help can feel a little cliche, but there’s a good reason you hear so much talk about it! Exercise is not only good for physical health, but also for mental health. The endorphins and other chemicals released during exercise help to boost your mood, reduce stress and anxiety, and give you greater emotional control. This article explains that, “Exercise is a natural and effective anti-anxiety treatment that helps to control OCD symptoms by refocusing your mind when obsessive thoughts and compulsions arise.”

Sleep hygiene

Sleep can be really tough when you live with OCD: it’s so hard to relax when you’re stuck in this state of high anxiety. It’s really important to try to improve sleep quality, as sleep is vital for all of us. Sleep hygiene refers to healthy habits we use to improve our quality of sleep. These can include:

• Going to bed and getting up at roughly the same time each day
• Trying to minimize naps during the day
• Ensuring you don’t consume stimulants before bed (alcohol, caffeine and nicotine for example)
• Making your bedroom a comfortable and calming place
• Unwinding before bed (this could include mindfulness!)

Keep up with treatments

This might sound obvious, but it’s absolutely pivotal to be dedicated and consistent with your treatment for it to work optimally. Take your medication as instructed, every day. Attend all of your appointments on time. Complete any ‘homework’ you are given between appointments. Use therapy techniques you’ve learnt to combat compulsions in between therapy sessions and continue using them going forward after your therapy has ended. Overcoming OCD is hard work and you must be persistent, but it is well worth the effort!

Reduce stress

As we’ve mentioned, mindfulness and exercise can help you to reduce stress. Other ways you can reduce stress include setting aside time to relax during the day; setting boundaries with others if you feel they are increasing your stress levels; getting out in nature; doing things you enjoy and so much more.

Be kind to yourself

Last but never least, even though your OCD might be convincing you to be hard on yourself, it’s so important to be kind to yourself as much as you can. Be compassionate and gentle with yourself. Remember that you’re trying your best, and bumps in the road are natural. You’re doing great!

References

New England OCD Institute, (2018), “About Obsessive-Compulsive Disorder”.

OCD UK, (2020), “Introduction to Obsessive Compulsive Disorder”.

OCD UK, (2020), “Types of OCD”.

OCD Specialists, (2018), “Compulsions in OCD”.

Anxiety Canada, (2020), “Changing or delaying OCD rituals”.

Anxieties.com, (2020), “How to Postpone Your OCD Compulsions”.

Anxieties.com, (2020), “Slow Down Your OCD Compulsion With This Trick”.

Melinda Smith, M.A., Lawrence Robinson, Jeanne Segal, Ph.D., (2019), “Obsessive-Compulsive Disorder (OCD)”. HelpGuide.org