Compulsions and Avoidance
It makes sense to try to avoid, suppress, or somehow neutralize unwanted thoughts that trigger anxiety and distress. If intrusive thoughts seem especially frightening or disgusting, it seems logical that you wouldn’t want to have them and would want to avoid them. If they seem especially important, it’s natural that you would desperately want to resolve your fears about them. The problem is, the more you try not to have a thought or to control your thoughts, the less in control you feel. The troubling thought intrudes even more. If you’re afraid of a thought or the meaning of a thought, you’ll experience distress when you have it, try harder to get rid of it, and then experience it more frequently, creating a vicious cycle.
Compulsions are attempts to escape the vicious cycle and feel better. They’re fueled by thoughts along these lines: If I go back and check to see if the stove is off, I’ll feel better. If I wash my hands again and do it in a certain way, I’ll feel better. If I can convince myself that I would never harm my spouse or child, I’ll feel better. Make sense? It would if we could ever know anything for certain. That’s the problem in OCD; you can never achieve the 100 percent certainty that you seek. In spite of your best efforts to obtain certainty, to achieve that “just right” feeling, to decrease a sense of threat or responsibility, or to try to control your thoughts, the underlying OCD themes don’t go away just because you use a compulsion to gain some immediate relief.
Compulsions are defined as repetitive behaviors or mental acts that are performed either in response to obsessions or that are based on rigid rules that you feel the need to follow (American Psychiatric Association 2013). When you have OCD, you may engage in repetitive behaviors, or rituals, such as hand washing or checking, usually with rigid rules about exactly how to do them. You may engage in mental rituals, such as repeating certain phrases or numbers in your head with the hope of decreasing your anxiety or the likelihood of something bad happening. You may mentally review your actions to be certain that you’ve done everything correctly. Compulsions are attempts to reduce anxiety or distress or prevent negative events, yet they aren’t realistic solutions and are often quite excessive. They are time-consuming and become additional sources of distress.
Like obsessions, compulsions generally fall into categories, and certain compulsions are often paired with certain obsessions. For example, washing compulsions frequently are used in response to contamination obsessions and checking compulsions are used to alleviate doubts about responsibility for harm or mistakes. However, there can be a lot of cross-over, and it’s also common to perform compulsions from more than one category.
Yet even when compulsive behaviors look quite different on the outside, they all serve a common function: attempting to decrease anxiety and distress in response to the activation of underlying OCD themes.
Seeking reassurance is another behavior used in the quest for certainty.
Avoiding thoughts and situations that trigger them is a strategy used to minimize the likelihood of feeling anxious and engaging in rituals.
Why Compulsions and Avoidance Strategies Don’t Work
Compulsions and avoidance can provide a temporary fix. Initially, they may offer some relief, but unfortunately, that relief is fleeting. You can go home and check to be sure the door is locked. You can drive back to where you think you felt a bump and check to see if a pedestrian is lying on the road. You can wash your hands ten times. You can seek reassurance that you aren’t the type of person who commits murder. You can try to avoid triggers of obsessions. If you do these things, you might feel better. You might feel reassured, at least for a while. But what happens when problematic thoughts, urges, or images return? You’re likely to think, Am I sure that the door is locked? Could I have missed seeing someone on the road? Am I certain that I’m not contaminated? How can I know for sure that I won’t harm someone someday?
Compulsions and avoidance never relieve all doubt. You can never achieve absolute certainty.