What are compulsions?

Compulsive Behavior

Compulsions are repetitive behaviors or mental acts to prevent or reduce anxiety rather than to provide pleasure or gratification. The most common compulsive behaviors include washing and cleaning, hoarding, checking, requesting or demanding assurance, and ordering. The acts can last a few minutes or an entire day, often disrupting the compulsive person’s work, family, or social roles. Some compulsive acts also can cause physical harm. For example, harm can occur when a person repetitively washes his or her hands so that they become raw or when a person repetitively bites his or her fingernails.

Compulsions Versus Habits

Although people normally perform tasks repetitively, these tasks are not necessarily compulsive. Daily routines and practices are not compulsions; instead, they are normal habits. The difference between compulsions and habits can be recognized contextually. Habits bring efficiency to one’s life and compulsions tend to disrupt one’s life.

Researchers sometimes distinguish between habits and compulsions as normal compulsions and abnormal compulsions; habits are considered normal compulsions. As such, normal and abnormal compulsions are often similarly diagnosed as compulsive behavior and are distinguished only contextually. That is, if the behavior is detrimental, it is considered an abnormal compulsion.

Compulsion Versus Addiction

The use of both compulsion and
addiction
in everyday language is the most likely cause of confusion between the terms. Common and analogous use has led to the terms compulsion and addiction being both misused and misunderstood. A history of the change in the use of the word addiction can also be to blame, as compulsion was sometimes substituted for addiction to add legitimacy to the treatment of addiction.

Since the 1990s, research by scientists and clinicians has looked into differentiating and disentangling these behaviors. The American Psychological Association, for example, substitutes the term dependency for addiction to reflect the change in the definition of addiction to include behavioral addiction. Nevertheless, the difference between compulsion and addiction can be simplified. Compulsion is the repetitive behavior or mental act that prevents or reduces anxiety; addiction is a repetitive compulsive condition. Compulsion, or repetitive behavior, is a part of addiction, or repetitive compulsion. Although new research is expanding the definition of the two terms, the complexity of these disorders makes it difficult to propose a single model that could account for all their characteristic features.

Compulsive Disorders

The basic mechanisms underlying compulsive and addictive disorders overlap in their phenomenology, their genetics and family history, and in their co-morbidity and pathophysiology. Compulsion is most often coupled with obsession to form obsessive-compulsive disorder
(OCD).

OCD is characterized by obsessions and compulsions. Obsessions are unwanted persistent thoughts that produce distress and compulsions are repetitive behaviors that prevent or reduce distressing situations. Persons with OCD often use compulsive behaviors to rid themselves of obsessive thoughts; however, the relief is often temporary.

Symptoms of OCD include excessive washing or cleaning, extreme hoarding, repetitive checking, and preoccupation with limited but specific thoughts, such as sex or violence. According to the Anxiety and Depression Association of America in 2014, approximately 1 percent, or 2.2 million adults, in the United States have the disorder. Many people with OCD often remain undiagnosed because of their ability to cope with and function with the disorder.

There is considerable overlap in the co-occurrence of compulsion and addiction. Addiction is a recurring and persistent compulsive condition in which a person engages in a specific activity or uses a substance despite its negative or dangerous effects. Moreover, compulsion is the behavioral aspect of addiction, while further characterization of addiction includes dependency and changes in brain chemistry. A person becomes initially addicted to a substance or behavior as it provides pleasure. Through continued use of the substance or performance of the behavior, the person develops a dependency. Soon after, involvement with the substance or procedure is necessary for the person to provide relief, thereby developing a compulsion. Studies have found that 27 percent of people under treatment for OCD also met the criteria for substance abuse disorder.

Multiple studies have linked compulsive behavior to dysregulation of frontostriatal neurocircuitry in the brain and the associated monoamine systems. The pathological neurochemistry underlying these disorders is caused by dysfunction in serotonin-, dopamine-, and glutamate-dependent neurotransmission. Therefore, first-line pharmacologic treatment involves the use of selective serotonin reuptake inhibitors and clomipramine. Cognitive behavioral therapy is another popular approach. It is being extensively investigated for dealing with different aspects of this disorder. However, the clinical picture for persons with compulsive disorder is complex, as it is marked with wide heterogeneity of the presenting symptoms.

Bibliography

Abramowitz, Jonathan S., Dean McKay, and Steven Taylor, eds. Obsessive-Compulsive Disorder: Subtypes and Spectrum Conditions. Boston: Elsevier, 2008. Print.

“Facts & Statistics.” Anxiety and Depression Association of America. ADAA, Sept. 2014. Web. 28 Oct. 2015.

Fontenelle, Leonardo F., et al. “Obsessive-Compulsive Disorder, Impulse Control Disorders, and Drug Addiction.” Drugs 71 (2011): 827–40. Print.

Franklin, Martin E., and Edna B. Foa. “Treatment of Obsessive Compulsive Disorder.” Annual Review of Clinical Psychology 7 (2011): 229–43. Print.

Hyman, Steven E., and Robert C. Malenka. “Addiction and the Brain: The Neurobiology of Compulsion and Its Persistence.” Nature Reviews Neuroscience 2 (2001): 695–703. Print.

Markarian, Yeraz, Michael J. Larson, and Mirela A. Alde. “Multiple Pathways to Functional Impairment in Obsessive-Compulsive Disorder.” Clinical Psychology Review 30 (2010): 78–88. Print.