Compulsive Behaviour (Compulsions)

1) What it is

Compulsive behaviour is when you feel driven to do something repeatedly, even if you don’t really want to, because it temporarily reduces anxiety, fear, discomfort, or a “not right” feeling.

Compulsions often happen to try to:

• prevent something bad from happening
• feel certain or safe
• reduce anxiety or disgust
• get rid of intrusive thoughts
• neutralise guilt or fear

Compulsions are very common in Obsessive Compulsive Disorder (OCD), where obsessions (intrusive thoughts) trigger compulsions (repetitive behaviours).

The NHS explains that OCD is treated using talking therapy that helps you face fears and obsessive thoughts without doing compulsions, often using Exposure and Response Prevention (ERP).

2) What it feels like (real-life examples)

People often describe compulsions as:

• “I know it’s irrational, but I can’t stop.”
• “If I don’t do it, I feel panicked.”
• “I don’t feel safe until it’s done.”
• “I keep checking even though I already checked.”
• “It’s like my brain won’t let it go.”
• “I’m exhausted, but the urge is too strong.”

Compulsions can feel like:

• intense pressure to act immediately
• rising anxiety that only drops after the behaviour
• brief relief followed by doubt
• shame and frustration afterwards

3) Common signs & symptoms

Compulsive behaviour can be physical or mental.

Common compulsions (behavioural)

• checking locks, switches, or appliances
• repeated washing or cleaning
• repeatedly seeking reassurance
• repeating actions until they feel “right”
• counting, tapping, arranging, or symmetry behaviours
• rereading or rewriting
• hoarding behaviours (sometimes OCD-related)
• compulsive Googling or online searching for certainty
• avoiding triggers and using safety behaviours

Mental compulsions (hidden)

• repeating prayers or phrases mentally
• replaying conversations repeatedly
• trying to cancel out thoughts
• analysing or ruminating for certainty
• mentally checking body sensations

Effects on daily life

• takes up large amounts of time
• causes exhaustion and stress
• impacts work, study, and relationships
• creates secrecy, shame, or frustration
• anxiety quickly returns after relief

4) What causes it / risk factors

Compulsions usually begin as coping strategies that become stuck.

Common drivers include:

• OCD (most common link)
• anxiety disorders
• trauma responses (control and safety seeking)
• perfectionism and fear of mistakes
• strong responsibility beliefs (“If I don’t check, it’s my fault”)
• intolerance of uncertainty
• sensitivity to disgust or contamination fears
• stress, burnout, or major life changes

Compulsions are reinforced by a learning loop:

• anxiety → compulsion → short relief → compulsion feels necessary → repeats

5) Triggers (what can make it worse)

Triggers vary, but often include:

Internal triggers

• intrusive thoughts or images
• “what if” thoughts
• bodily sensations
• “not right” feelings
• guilt, doubt, or responsibility fears

External triggers

• germs or contamination fears
• health or news content
• uncertainty
• making mistakes or feeling judged
• stressful environments
• being rushed
• conflict or lack of sleep

Compulsions usually increase when you are:

• tired
• stressed
• burnt out
• emotionally overloaded

6) What helps right now (fast relief tools)

The aim is to reduce urges without feeding the cycle.

Label the urge

• “This is a compulsion urge. It will peak and fall.”

Delay the compulsion

• “I’ll wait 10 minutes first.”

Reduce reassurance

• “I’m choosing to accept uncertainty.”

Breathing reset

• inhale for 4
• exhale for 6–8
• repeat 6 times

One-and-done rule

• check once
• stop
• accept discomfort

Gradual reduction is progress.

7) Longer-term self-help strategies

Compulsions reduce most effectively using ERP principles.

Gradual response prevention

• reduce how often
• reduce how long
• reduce intensity

Example:

• wash hands for 10 minutes → reduce to 8 → 5 → 2

Exposure ladder

• list triggers from easiest to hardest
• practise exposure without compulsions
• repeat until anxiety drops

Avoid swapping compulsions

• notice replacement rituals
• gently interrupt them

Practise uncertainty tolerance

• “Maybe yes, maybe no.”
• “I can live with not knowing.”

Reduce overall stress

• regular meals
• stable sleep
• movement
• boundaries
• reduced caffeine

8) Treatment options (what usually helps)

Compulsive behaviour linked to OCD is very treatable.

Common treatments include:

• CBT with Exposure and Response Prevention (ERP)
• guided self-help CBT programmes
• specialist OCD therapy (especially for complex or mental rituals)

9) Medication overview (plain-English)

Medication can reduce symptom intensity for some people.

• often antidepressant medication
• usually combined with ERP-based therapy

Medication works best alongside behavioural change rather than alone.

10) Work, relationships & daily life tips

Work

• use one-and-done checking rules
• write tasks down instead of re-checking
• schedule short breaks
• use grounding instead of reassurance

Relationships

Compulsions often pull others into reassurance cycles.

Helpful request:

• “Please don’t reassure me repeatedly. Help me sit with uncertainty.”

Daily life

• set time limits on checking
• reduce Googling and reassurance-seeking
• track small wins (“I resisted one compulsion today”)

11) When to seek urgent help

Seek urgent support if:

• compulsions take hours each day
• you can’t work, eat, sleep, or function
• you feel trapped or hopeless
• self-harm thoughts appear
• compulsions cause physical harm (e.g. skin damage)

12) Trusted help & resources

NHS support

• NHS: OCD overview
• NHS: OCD treatment (CBT + ERP)

Self-help guides

• NHS Inform: OCD self-help guide
• CNTW NHS: obsessions and compulsions guidance

Specialist charities

• OCD-UK
• OCD Action

Mental health support

• Mind: OCD information and self-care
• Rethink: OCD symptoms and treatment

Crisis support

• Samaritans: 116 123
• Shout: text SHOUT to 85258

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