OCD Compulsions Explained

Compulsions  are very common to OCD, but does having an OCD compulsions mean you are mad?

Obsessive-compulsive disorder (OCD) is a severe and debilitating anxiety disorder afflicting about one adult in 40, making it twice as common as schizophrenia and bipolar disorder, and the fourth most common psychiatric disorder. OCD exists throughout the world and affects men and women at an equal rate.

What Are OCD Compulsions?

Compulsions are:

  • Repetitive behaviors or mental acts that a person feels driven to perform.
  • The impact of these OCD compulsions can be significant on a person’s life and every aspect of their life can be affected.
  • This impact will pervade the way the person thinks, feels and behaves.
  • The intensity of the symptoms can range from mild to severe and the symptoms usually wax and wane over time.

In severe cases, which can be up to 20 per cent of those  diagnosed as suffering from OCD, obsessions and compulsions can occupy the entire day and unfortunately can result in profound disability.

Where Do These OCD Compulsions Come From?

Approximately two-thirds of the people with OCD develop the disorder in adolescence or early adulthood.  The symptoms  start off quite mildly and then progress into a more frequent and severe form.  OCD does seems to have a strong genetic base to it as it ‘runs’ strongly in families.  Unfortunately, people with OCD live with the disorder for quite a while before doing something about it or getting it diagnosed.

If you are concerned that you are or are going mad because you have acknowledged you compulsive behavior or have been diagnosed as suffering from OCD is an unnecessary concern as OCD compulsions are not a sign of madness in any way.  OCD compulsions are an extension of every day behavior conducted in an extreme form in order to mitigate feelings of anxiety.

Despite some of the negative bias towards the use of medication for the treatment of OCD compulsions, medications one of the means for treating OCD compulsions and symptoms that has a very good outcome.  So don’t fall foul to these prejudices and avoid using medication to treat OCD.  Also note, that whilst SSRIs are also used  to treat OCD compulsions, the dosage levels are substantially higher than what is used for depression (almost three times higher) and the medication can take much longer to have an effect (up to 16 weeks).

A Bit More About OCD Compulsions

OCD compulsions are repetitive behaviors or mental acts, which can either be observable on covert, such as, as continuously checking locks or repeating certain phrases over and over respectively. These acts in themselves is not what is the difficulty, because most people do this at one stage or the other during their lives.  The real problem is that the compulsion is not pleasurable at all, which differentiates it from everyday similar practices and these rituals can become quite extreme taking over a persons entire life.

What are the most common OCD compulsions?

Obsessive-compulsive disorder is characterized by the presence of either obsessions or compulsions, but commonly both.

An obsession is defined as an unwanted intrusive thought, image or urge, which repeatedly enters the person’s mind.

Compulsions are repetitive behaviors or mental acts that the person feels driven to perform.

An OCD compulsion can either be overt and observable by others, such as checking that a door is locked, or a covert mental act that cannot be observed as in repeating a certain phrase in the mind. Covert compulsions are generally more difficult to resist or monitor than overt ones as they are can be performed anywhere without others knowing and are easier to perform.

A compulsion is not in itself pleasurable which differentiates it from impulsive acts, such as shopping or gambling, that are associated with immediate gratification.

What Are The Different Types Of OCD Compulsions?

There are many types of compulsions as we can see from the table below:

Common Compulsions In OCD

Compulsion Percent
Checking (e.g. Taps, lights, locks, etc.) 28.8
Cleaning, washing 26.5
Repeating acts 11.1
Mental compulsions 10.9
Ordering, symmetry, exactness 5.9
Hoarding/collecting 3.5
Counting 1.1

The term ‘ritual‘ is synonymous with compulsion but usually refers to behaviors that other people can see.

‘Rumination’, which refers to prolonged thinking that is experienced as uncontrollable around and around the same subject, includes both intrusive thoughts, often in the form of doubts or questions, and repeated attempts to find an answer. In this way it covers both the obsession (the doubts or question) and the accompanying compulsive thinking which attempt to answer the question.

The Most Common OCD Compulsions

The most common way a compulsion is manifested is in checking behavior and this can be seen as merely an extension of a common every day activity of checking and cleaning.

Repeating compulsions can consist of any type of behavior and can result from a broad range of concerns or fears (an anxiety). In some instances the activities of ordering, symmetry and exactness may appear to have a tic-like character to them, but in other cases they are clearly related to dealing with a perceived threat.

Hoarding consists of the acquisition and/or failure to discard objects. In some cases this may be excessive quantities of particular materials that may have some apparent value related to perceived threat or may result from the inability to dispose of materials because of the threat associated with it. In many cases, hoarding consists of accumulating material that appears to have little or no value.

Mental compulsions by definition are not observable by others and people may be less likely to be able to describe these cognitive acts. For example, mental compulsions may consist of complex sequences of counting in one’s head or special thoughts that must be formed according to specific rules.

‘Neutralizing‘ resembles a mental compulsion but is not identical to it. Both, mental compulsions and neutralizing are anxiety reducing or undertaken in an effort to reduce levels of anxiety. Neutralizing is not stereotypical, however, as a compulsive urge, but is aimed at the ‘undoing’ of the perceived harm. Neutralizing, for example, could consist of briefly forming a positive image to counter an intrusive negative image.

The term ‘safety seeking behaviors’ is also used in the cognitive behavioral therapy (CBT)  to refer to any actions in a feared situation that aims to prevent feared catastrophes and thus reduce harm and will therefore comprise both compulsions and neutralizing behaviors.

The aim of a compulsion or neutralizing behavior is thus:

  • To reduce harm or
  • To feel ‘comfortable’ or
  • ‘Just right”

The manifestation of OCD compulsions and the purpose they serve in reducing or warding of the effects of anxiety is not the only criteria used to identify OCD.  What is also important is the way or manner in which the OCD compulsive behavior is terminated and the conditions that must exist for the person suffering from OCD to cease or terminate the compulsion.

Someone not suffering from OCD may undertake the same behavior or ‘ritual’, such as,  hand-washing, but when they can see that their hands are clean they stop the hand-washing. A person with OCD however and a fear of contamination finishes the hand-washing ‘ritual’ only when they can see that their hands are clean and when they feel ‘clean’, ‘comfortable’ or ‘just right’.

The severity of OCD compulsions differs markedly from person to person and unfortunately they can have a major negative impact on social relationships leading to frequent family and marital discord or dissatisfaction, separation or divorce.

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