Obsessive-Compulsive Disorder (OCD) is a complex and often misunderstood mental health condition that affects millions of people worldwide. Obsessions are defined as intrusive, persistent and unwanted thoughts, images and/or urges that cause distress. Compulsions, which we will focus on in this post, are physical or mental acts that negatively reinforce the OCD cycle. Exposure and response prevention (ERP) targets the compulsions to break the cycle, so proper understanding of compulsions is key to successful treatment. If you need a refresher, check out this blog post.

What Are Compulsions?

Compulsions are physical or mental acts that a person performs in response to the distress caused by the obsessions. The function of these behaviors is to reduce the distress/discomfort, ward off harm or prevent something bad from happening. After one performs a compulsion, there tends to be temporary relief, and this reinforces the need to do compulsions again in the future.

Just like the content of obsessions, the types of compulsions are wide and varied. Though this is the case, and compulsions don’t come in a one-size-fits all bucket, there are types of compulsions that tend to be common across subtypes. 

Common Types of Compulsions

Some of the most frequently observed compulsions in OCD appear here. This is by no means an exhaustive list, and when in doubt about if a behavior is compulsive or not, ask your client what function the behavior serves. If it serves to take away distress, prevent something bad from happening or ward off something bad/harmful, it likely fits the bill for a compulsion.

1. Checking

Checking is one of the more common compulsions in OCD. Individuals may feel compelled to repeatedly check things like locks, appliances, doors or light switches to ensure they are secure or turned off. Fears of harm or danger, such as the fear of causing a fire by leaving the stove on, often drive this behavior.

Examples include:

• Repeatedly checking that doors are locked
• Checking the stove or oven multiple times to ensure it’s off
• Reviewing emails or texts to make sure they don’t contain any mistakes
• Checking to make sure all of the pets are accounted for before leaving the house

2. Washing and Cleaning

Fears of contamination, germs, or disgust-based obsessions typically drive washing and cleaning compulsions. Individuals may feel the need to wash their hands excessively, clean their living space frequently, or avoid touching certain objects or surfaces to prevent contamination.

Examples of washing and cleaning compulsions include:

• Washing hands or using sanitizer repeatedly or for excessive lengths of time
• Cleaning household items or areas repeatedly
• Excessive or lengthy shower routines

3. Counting and Repeating

Some people with OCD feel compelled to count or repeat actions a certain number of times. A belief that certain numbers are “safe” or “unlucky,” or that repeating an action will prevent something bad from happening, may drive this behavior.

Examples of counting and repeating compulsions include:

• Counting steps while walking or stairs while climbing
• Repeating phrases, words, or actions a specific number of times
• Needing to perform tasks, like turning on and off a light switch, multiple times until it “feels right”

4. Ordering and Arranging

Ordering and arranging compulsions involve the need to arrange items in a specific order, including based on size, color, or symmetry. This compulsion is typically driven by a desire for things to feel “just right” or by a fear that something bad will happen if items are not arranged correctly.

Examples of ordering and arranging compulsions include:

• Arranging items on a desk or shelf until they are perfectly aligned
• Organizing clothes or other belongings by color or size 
• Rearranging items in a room repeatedly until they “feel right”

5. Mental Compulsions

Not all compulsions are visible and some occur exclusively in the mind. Mental compulsions involve repetitive mental acts such as praying, counting, or mentally reviewing events. People often perform these compulsions to neutralize obsessive thoughts or reduce anxiety.

Examples of mental compulsions include:

• Repeating specific prayers or mantras in response to unwanted thoughts
• Mentally reviewing past actions to ensure nothing was done wrong
• Ruminating; in other words mental efforts to fix, solve, prevent or prepare for the worst case scenario
• Telling oneself that everything is fine, okay or that nothing bad will happen (also known as self-reassurance)

6. Reassurance-Seeking

Reassurance-seeking involves repeatedly asking others for confirmation or reassurance about one’s fears or concerns. It falls outside of the realm of information seeking and the reassurance doesn’t provide lasting relief. Here’s a great fact sheet on information seeking vs. reassurance-seeking. 

Examples of reassurance-seeking include:

• Constantly asking loved ones if everything is okay
• Seeking reassurance from others that no harm was caused
• Asking for repeated validation about decisions or actions
• Using the internet, social media or AI tools to find answers or seek reassurance

7. Avoidance

Avoidance compulsions involve an individual going to great lengths to not have to come into contact with a trigger. Individuals may avoid people, places, situations and things that bring about obsessions and distress.

Examples of avoidance include:

• Avoiding going to places where there might be children or family functions with children
• Staying off of social media to avoid being triggered
• Avoiding going out unless one can wear a mask
• Avoiding taking medication or drinking alcohol for fear of losing control

The Impact of Compulsions

While compulsions may provide temporary relief from distress, they often lead to significant distress and disruption in daily life. Compulsions can be incredibly time-consuming, sometimes taking up most of the day and causing significant impairment in different aspects of life and overall well-being.

Conclusion

Compulsions are at the core of OCD and play a pivotal role in maintaining the disorder. Recognizing and understanding these behaviors is essential for accurate diagnosis and effective treatment. While compulsions vary greatly from person to person, they often fit into common patterns that can guide intervention strategies. By focusing on the function of the behavior and conducting a thorough functional assessment, clinicians can confidently implement response prevention and help clients take meaningful steps toward breaking the OCD cycle.