Obsession Versus Compulsion

IF YOU'RE ONE OF THE millions of people in the U.S. who cope with obsessive thoughts, there's a good chance you also struggle with compulsive behavior.

Obsessions and compulsive behaviors are different, but they're often connected in the context of obsessive-compulsive disorder, says Elizabeth McIngvale, an assistant professor at the Baylor College of Medicine in Houston. She's with the Menninger Department of Psychiatry and Behavioral Sciences.

She's also the founder of the Peace of Mind Foundation, a nonprofit organization that aims to improve the quality of life for people with OCD through advocacy, education, research and support. "If we're talking about OCD, they're absolutely connected," McIngvale says. Overall, about 1.2% of adults in the U.S. are living with OCD, according to the Anxiety and Depression Association of America. That works out to more than 3 million people.

Obsessions Can Lead to Compulsive Behavior

For people with OCD, the connection between obsessions and compulsive behavior is straightforward, McIngvale says. For example, a man with OCD who's driving to work and is several miles from his home may obsessively worry about not having turned off his stove – even though he's pretty sure he didn't leave the stove on, she says. That's the obsession, which could lead to the man driving back to his home repeatedly to check on the stove. For someone with OCD, obsessive thoughts cause severe mental discomfort, which individuals feel can only be alleviated by compulsive behavior (before treatment).

"In OCD, there's never, ever enjoyment," McIngvale says. "The person with OCD is simply engaging in compulsive behavior to alleviate (his or her) anxiety. Someone with OCD behaves compulsively because (he or she) believes that something terrible might happen if they don't or it will not feel right," she says.

Obsessions can occur in a variety of ways, says Mayra Mendez, a licensed psychotherapist and program coordinator for intellectual and developmental disabilities and mental health services at Providence Saint John's Child and Family Development Center in Santa Monica, California. "Obsessions are thoughts, a mental process, governed by cognitions, beliefs and mental images," Mendez says. "Obsessions are repetitive, involuntary, unwanted and intrusive thoughts that occur frequently and cause interruptions in fluid thinking. While everyone can have moments of obsessing about a song, eating a certain food, replaying scenes and words in their minds, such repetitive thoughts only become problematic and clinically impactful when they occur persistently and are experienced as intrusively promoting extremely high levels of anxiety."

People can become obsessed in different ways, she says. For example, someone might read about a health condition and think constantly and rigidly about how it might affect his or her own health. Someone with tendencies toward perfectionism could obsess about doing a work task perfectly,

Typical obsessions can involve a wide array of topics, Mendez says. They include:

Fear of germs.Rigid beliefs about rules, regulations, morality and gender.Narrow and restrictive ideas about completing tasks or inaccuracies.Anxieties about health, death, disease and mortality.

These obsessions can fuel compulsions, which are "actions, behaviors, activities and physical deeds enacted to manage, contain and minimize the intrusive and unwanted thoughts," Mendez says. "Compulsions typically involve repetitive actions, routines, or movements that are ritualistic and redundant."

Examples of compulsive behaviors include pacing, counting steps to get from one point to another and repeating the action several times. "The compulsion is ritualistic in that it's done in response to controlling the thought of forgetfulness," Mendez says. "For example, if a person is worried about having turned off the lights in a room, (he or she) might walk five paces back to the door to look at the room, see that the light is turned off, then try to move on, but the nagging doubt continues and the five paces are undertaken again with the process repeating several more times.

" Cleaning or washing is another common compulsion in response to fears of germs or uncleanliness. "This may be seen when a person washes hands numerous times persistently in response to fear of germs or worry of being dirty and getting other objects dirty by touching with unclean hands," Mendez says.

External and Internal Compulsions

As there are an array of obsessions, there are also a range of compulsive behaviors, McIngvale says. Broadly, compulsive behaviors can be put into one of two buckets: external compulsions, which involve overt actions, and mental ones; that is, "compulsions we do in our mind," she says.

Examples of external compulsions include:

Repetitive hand-washing.Walking in and out of doorways.Moving objects back and forth.Touching or tapping items or rearranging them.

Mental compulsions may include rituals such as:

Counting items, such as cars on the road or ceiling tiles.Thinking of a neutral color, like beige.Saying a prayer.Mentally repeating or replaying scenarios.

Obsessive-compulsive behavior can disrupt a person's life in a variety of ways, says Pamela Wiegartz, associate director of psychology clinical services in the Department of Psychiatry at Brigham and Women's Hospital in Boston. Here are examples of how OCD can disrupt a person's life:

A new mother avoids being alone with her child because of intrusive (and unfounded) thoughts that she might harm the baby.Someone is chronically late for work because he or she keeps rechecking the lock on the apartment or house door.A person creates a fire hazard at home because he or she compulsively hoards items that other people would throw away.

Non-Disruptive Compulsions

It's important to keep in mind that obsessions and compulsive behavior are on a spectrum, says Dan Foti, an associate professor in the Department of Psychological Sciences at Purdue University in West Lafayette, Indiana. "We're all probably a little obsessive-compulsive about something," Foti says. For example, some people may insist on always putting on a sock, then a shoe, in that sequence, while others only put on both socks then both shoes. Some athletes have specific rituals they go through while competing. For instance, before every pitch, some baseball players go through a routine of adjusting their batting glove and taking the same number of practice swings when they're up to bat. Such behaviors could be considered compulsive or superstitious, but such habits are typically nothing to worry about, he says. "These are harmless behaviors that follow some kind of rule we feel compelled to follow, and the rule is not rational if you stop and think about it," Foti says.

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