What Is Obsessive-Compulsive Disorder?

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In modern formulations of OCD, compulsions are defined by their functional relationship with obsessions.

Compulsions are often not unpleasant or involuntary.

Contemporary understanding of OCD shows that many compulsions are actually quite consciously voluntary.

A typical example of OCD consists of someone compulsively washing their hands in an agitated state, feeling compelled to follow OCD-imposed “rules” about how to, and how many times to, wash, and when it is safe or acceptable to stop washing. They seem to know that most people do not feel the need to wash this way; they know there is something wrong going on here but they just can’t help it. They are clearly miserable.

The term “compulsion“ implies behaviors that are irrationally driven and irresistible. In modern formulations of OCD, compulsions are defined by their functional relationship with obsessions – they lessen the impact of an unwanted intrusive thought or a doubting narrative or a stuck repetitive image

The purpose of a compulsion is to counteract the anxiety, disgust, guilt or discomfort that the obsession (intrusive thoughts, doubts or imagined story) has raised. Sometimes a compulsion can be a response to a “not just right“ feeling. Compulsions typically provide some measure of safety, certainty, morality, balance, or relief of discomfort, but almost universally, only temporarily.

Sometimes the compulsion is apparently logical (“I feel dirty, so I wash”) and sometimes not ("I might have hurt someone, so I will tap three times and turn around"). Whether it makes sense or not, this temporary relief completes a reinforcing loop in which the obsession returns. And the OCD persists. One can think of the compulsions as the engine that drives the next obsession.

Often OCD rituals are burdensome because of the time they take, the unpleasantness of the tasks themselves, the disappointment of others, or the self-critical awareness of behaving irrationally. (e.g., “what is wrong with me?”)

But Many Compulsions Do Not Feel Like Burdens

Contemporary understanding of OCD shows that many compulsions are actually quite consciously voluntary. We know now that many compulsions are justified or valued, adopted voluntarily as coping skills, or misidentified as positive personality characteristics.

Examples of this include what people with OCD call research or planning or analyzing. Exhaustive and repetitive internet searches may seem like actively being an educated consumer or a diligent medical patient. Self-analyzing and compulsive ruminating may be framed as self-help, self-improvement, seeking insight, or looking for even better solutions to problems. Monitoring and evaluating thoughts and feelings may be valued as “being mindful”.

Staying loyal by checking and communicating with someone constantly fits this category. It may be quite enjoyable to talk twice a day with your child, reassuring oneself they are okay or that you are connected.

Repeatedly imagining intended actions without doing them can seem like preparation, whether it is planning to (some day) undertake exposure tasks in treatment, envisioning what you will buy with future savings, or planning escape from situations should they become overwhelming. Seeking reassurance repeatedly surely feels good when you get the response you want — at least until your sources of reassurance become annoyed or refuse. Other “coping” by having a support person or a script to follow may well be compulsion at work.

What Is Obsessive-Compulsive Disorder?

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Find a therapist to treat OCD

Similarly, ways of not committing to actions can be compulsive responses to obsessive “what if” stories and anticipatory anxiety. Examples would be buying only returnable things or refundable tickets, or keeping all options open. This can also occur in over-scrutinized relationships, probing for “red flags”, doubting the validity of feelings, or nurturing constant ambivalence without taking action. Responding to doubts by staying uncommitted bypasses the discomfort of ambivalence or catastrophizing.

Another class of compulsions that are justified or valued as personality characteristics includes excessive neatness, cleanliness, attention to detail, being highly responsible, or avoiding risks that most people ignore. Perfectionism can fuel compulsions that some people take pride in.

Thinking mistakes that fuel obsessions need to be corrected. Examples are mistaking thoughts for facts, confusing distress for danger, believing imagination over reality, and treating possibility as probability.

It can be bewildering to watch yourself do things that your own wise mind knows are irrational or unnecessary. But these kinds of compulsions are at least easy to identify. It can be much harder to spot compulsions if they are mis-identified as coping skills, positive traits, or valued behavior.

Still, there is a need to identify and evaluate all the compulsions. Some may be naturally dropped if the obsessions are deemed not worthy of attention or irrelevant. Others may need to be stopped intentionally, even if they “feel” necessary or helpful, so that the cycle of reinforcement is interrupted.

In summary, compulsions are often not unpleasant or involuntary. It is important to uncover all compulsions, even the subtle ones, and to understand what maintains them. It is only then that recovery from obsessional doubting and sticky overanxious thinking can be robust and resilient.

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