Compulsive behaviors are any repetitive behavior that you feel compelled to do. Everyone exhibits these behaviors occasionally, but if you’re spending an inordinate amount of time and mental energy on them, you may be dealing with a larger mental health condition.
If you’ve ever felt an overwhelming urge to do something—regardless of the consequence—you’ve likely engaged in a compulsive behavior. Maybe you’ve felt a sudden need to pick at a pimple, even though you knew it would bleed. Or, you’ve found yourself reaching for another cigarette, despite telling yourself that you’d quit. These urges come and go, and acting on them doesn’t always mean anything serious. After all, we’re only human.
However, if compulsive behaviors begin to take over your life—consuming so much time that you’re constantly late, or interfering with your ability to complete daily tasks—it’s worth investigating the potential root cause. You could be dealing with a mental health condition, like obsessive-compulsive disorder (OCD), hoarding disorder, or substance use disorder. Read on to understand what a compulsive behavior is, and how to get help for your mental health.
What is a compulsive behavior?
A compulsive behavior is an action that stems from a seemingly uncontrollable urge. It is usually performed out of a desire to relieve stress, alleviate uncomfortable physical sensations, cope with difficult emotions, or gain control. “People will describe a compulsion as something they feel they have to do—or are drawn to,” says Dr. Patrick McGrath, PhD, Chief Clinical Officer at NOCD.
Compulsions can be physical or mental, but physical compulsions are often easier to spot. For example, you may find yourself excessively cleaning your home, or arranging and re-arranging objects until they feel “just right.” Mental compulsions can be harder to identify since they happen internally, but can include excessive praying, ruminating, or repeating words (or phrases) in your head.
Which conditions include compulsive symptoms?
There are a variety of mental health conditions that can trigger compulsive behaviors—from OCD to eating disorders and more. Let’s explore some of the potential causes behind this common symptom.
Obsessive-compulsiver disorder (OCD)
Compulsive behavior is a primary symptom of OCD, a chronic mental health condition in which you experience obsessions (unwanted, intrusive thoughts, sensations, images, feelings, or urges) that trigger compulsions. If you have OCD, you feel compelled to engage in compulsive behaviors, because you want to avoid distress, or because you believe that something bad will happen if you don’t.
For example, you may excessively wash your hands in a ritualistic fashion because you’re afraid of contracting an illness. Or, you may engage in a more unexpected compulsion related to an underlying fear—like tapping your foot a certain number of times whenever you begin to worry about your family’s safety.
With OCD, compulsions only provide temporary relief; the obsessions, distress, and anxiety always re-emerges.
The act of performing compulsions also reinforces the idea that you need these behaviors to handle your fears, worsening those fears, and exacerbating a cycle of obsessions and compulsions.
Body-focused repetitive behaviors, or BFRBs
Not all compulsive behavior is driven by a need to alleviate discomfort, or try to prevent a feared outcome. Take compulsive skin-picking for example. You might find it satisfying to persistently scratch at or pick your face. While BFRBs can feel good, they can be detrimental to your health. For example, you pick enough skin to cause bleeding or scarring.
Compulsive skin-picking is just one example of a body-focused repetitive behavior, (BFRB)—an umbrella term for conditions characterized by repetitive behaviors on the body, including hair-pulling, nail-biting, or cheek-biting. The condition impacts about two percent of adults in the United States. BFRBs often occur alongside OCD, but they are a distinct condition.
Eating disorders
Common eating disorders include anorexia, bulimia, binge-eating disorder, avoidant restrictive food intake disorder (ARFID), and orthorexia. The American Psychiatric Association describes these mental health conditions, which affect 1 in 20 people, as a “severe and persistent disturbance in eating behaviors, and associated distressing thoughts and emotions.”
People with eating disorders feel compelled to engage in disordered behaviors. For example, if you have bulimia, you may feel as if you have to binge. When the binge is over, you may experience a similar, if not stronger, urge to neutralize that action with purging.
While eating disorders often occur alongside OCD, depression, and anxiety, they are their own mental health condition.
Substance use disorder
The American Psychiatric Association defines a substance use disorder as a compulsive need to drink alcohol, or use tobacco or drugs to the point where it impacts your functioning. Your behaviors may feel out of your control, and you may feel powerless in response.
While it is not uncommon for people with OCD to use substances in order to cope with the distress of having OCD, substance use disorder is its own diagnosis. Compared to OCD compulsions, people with substance use disorder usually feel a sense of pleasure engaging in compulsive behavior, which in turn reinforces the desire to misuse substances.
Hoarding disorder
If you collect and keep items of little use or value, and struggle with your living space as a result—or experience distress at your level of clutter—you may be dealing with a hoarding disorder. While hoarding can be a feature of OCD (there is even an OCD subtype known as hoarding OCD), hoarding disorder differs from OCD because the compulsions are not related to intrusive thoughts or fears.
If you have hoarding disorder, there are many reasons why you might hoard, including a heightened sense of emotional attachment to objects, or concern that you may need all the things you’ve collected someday. Some people hoard because they feel guilty about waste. Whatever the reason for your hoarding, this compulsion can be hard to address on your own, and can lead to isolation from friends and family.
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How is compulsive behavior treated?
The first step is understanding the root cause of your compulsive behavior. A psychiatrist or licensed therapist can help diagnose any mental health condition(s) you may be experiencing, and figure out whether any are occurring together.
Be aware that OCD misdiagnoses can be common—so while you can seek a diagnosis from a variety of providers, it’s often best to reach out to a therapist that specializes in OCD and exposure and response prevention (ERP) therapy.
Find the right OCD therapist for you
All our therapists are licensed and trained in exposure and response prevention therapy (ERP), the gold standard treatment for OCD.
After you have been properly diagnosed, you can dive into treatment. Let’s take a look at how therapeutic approaches differ for each of the above mental health conditions.
ERP for OCD
The most effective treatment for OCD is ERP therapy, a specialized and highly effective form of cognitive behavioral therapy (CBT) designed for OCD. This form of therapy tackles compulsions by purposefully triggering an obsession, and helping you learn new ways to react. For example, if you have an OCD-related fear of needles, your therapist might ask you to look at pictures of needles. When you feel a surge of anxiety and that urge to perform a compulsion, you’d instead focus on response prevention.
Response prevention involves learning strategies to resist engaging in compulsions. This might look like delaying the compulsion, or practicing tolerating the uncertainty that arises during these moments. In time, by learning new responses, you can teach your brain that it can withstand your fears, without resorting to compulsions—reducing your overall OCD symptoms.
Habit reversal training (HRT) for BFRBs
BFRBs are best treated using habit reversal training (HRT), another form of CBT therapy, which teaches you to replace compulsive behaviors with new actions. A therapist will help you track your compulsive behavior, so you understand when you’re most likely to engage in it, and why. Then, they’ll help you find a healthier habit to replace it with.
Let’s imagine you deal with nail-biting. The first step to HRT would be becoming aware of your nail-biting, so you can be on the lookout for triggering moments. Maybe you bite your nails while watching TV, for example. Going forward, your therapist might encourage you to sit on your hands while watching TV, to avoid defaulting to nail-biting. In time, you might feel you need to rely on the habit less.
Treatment for eating disorders
The first line of treatment for eating disorders is often focused on stabilizing a person’s health. This may mean medical attention, or hospitalization. From there, different types of therapy will be introduced depending on the specific eating disorder. For example, people with body dysmorphic disorder (BDD) generally respond well to a varied range of CBT modalities and techniques. Medication can also help supplement therapy.
Treatment for substance use disorders
Medication, group therapy, and individualized treatment can all be helpful for substance use disorder. Alcoholics Anonymous’ 12-step program is a community group that has helped many people enter recovery for substance use disorders.
Key takeaways
- Everyone exhibits compulsive behaviors from time to time, but if they feel persistent and uncontrollable it’s time to get help from a mental health professional.
- Compulsive behaviors show up in mental health conditions such as OCD, BFRBs, hoarding disorder, eating disorders, and substance use disorder.
- OCD compulsions can be most effectively treated with ERP therapy—which teaches you to resist engaging in these behaviors entirely.