Compulsions

DEFINITION: Compulsions are strong, irresistible, and often persistent impulses to perform an act that can be irrational or that can conflict with self-will. Compulsions are distinct from habits and addictions.

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, cleaning, hoarding, checking, counting, ordering, and arranging. Mental compulsions, reassurance seeking, and avoidance are also considered common compulsions. 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 can also cause physical harm. For example, harm can occur when a person repetitively washes their hands to become raw or when they repetitively bite their fingernails.

Compulsions Versus Habits

Although people normally perform repetitive tasks, 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. 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, intrusive thoughts, such as sex or violence. According to the Anxiety and Depression Association of America in 2022, approximately 1.2 percent, or 2.5 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 adverse 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 between 10 and 40 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 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. Other treatments include exposure and response prevention, Transcranial Magnetic Stimulation (TMS), and support groups. However, the clinical picture for persons with compulsive disorder is complex, as it is marked with wide heterogeneity of the presenting symptoms.

Bibliography

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