Why Are Compulsive Behaviors Difficult To Stop?

Medically reviewed by Laura Angers Maddox, NCC, LPC
Updated October 25, 2024by BetterHelp Editorial Team

According to a study in the Neuropsychology Review, compulsive behavior is defined as repetitive acts prompted by the feeling that an individual must perform them but a knowingness that they aren't in line with the individual's overall goals, values, or morals. 

Compulsive behavior might include bodily-related actions like skin picking or hair pulling or can be related to psychological urges like frequently reaching out for reassurance from a partner when you want to stop. Often, compulsions are challenging to cope with and may feel out of control. Knowing why these behaviors are hard to stop and how to get help might help you learn how to stop them in the future.

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Are you having trouble stopping certain compulsions?

Debunking the myths behind obsessive-compulsive disorder (OCD)

People may jokingly state that they "can't stop" partaking in a pleasant activity when talking to friends. This common phrase may confuse the public perception of compulsive behavior or a repetition compulsion. When individuals hear people referring to their behaviors as "obsessive" or "compulsive" when they don't fit the clinical definitions, it can normalize the misconception that obsessive and compulsive behavior is not a "real" or complex diagnostic phenomenon.

Compulsive behaviors are distressing

Compulsive behavior is not a fun, easy, or casual type of behavior to live with. Compulsions are often distressing and unwanted. Therefore, it may be beneficial to learn more about the reality of compulsive behavior and cultivate a more nuanced understanding of this experience. When society understands compulsive behavior, it may contribute to destigmatizing it and avoiding spreading misinformation.

Obsessive-compulsive disorder (OCD) is not the only one that causes compulsions

It can also be beneficial to note that compulsive behavior is not a disease in and of itself. Compulsions can be a symptom of a mental illness but may also occur on their own. Although obsessive-compulsive disorder (OCD) is the most common mental health condition associated with compulsive behavior, it is not the only one. Compulsive behavior can be a symptom of many other conditions and may be a sign of neurodivergence for some people.

What is obsessive-compulsive disorder (OCD)?

It is estimated that 2% of the general population has OCD. Although many myths surround the meaning of "OCD," obsessive-compulsive disorder is a real mental illness in the DSM-5. It is not "quirky," "convenient," or "obsessive cleaning disease." It's not a term for someone who likes to keep a tidy home or color-coordinate their closet. OCD is an often debilitating mental health condition characterized by upsetting, unwanted, and vivid intrusive thoughts, compulsive behavior, and anxiety. 

Behaviors associated with OCD can include

  • Avoidance of people, places, objects, or situations that cause fear or compulsion urges  

  • Frequent reassurance seeking

  • Internal rituals, such as mental counting, checking of body parts, blinking, etc. 

  • Fears related to intrusive thoughts 

  • Fear of breaking one's own moral code or going against one's values

  • Fear of having participated in an immoral activity without knowing 

  • A preoccupation with self-control and potentially controlling the actions of others to avoid fear or intrusive thoughts

Compulsions may bring temporary relief to the distress caused by obsessions. However, the urge to complete a compulsion can return each time a person's obsessive thought or fear is incited. In some cases, compulsions may become a habit, where the original obsessive fear and worry have been forgotten, but compulsions are completed to maintain a ritual. 

There may sometimes be an obvious correlation and logic between obsession and compulsion. However, many times, there is no connection between the two. For example, a person might tap their hand three times if they have a distressing thought about traffic accidents. Although the thought and the ritual are not connected, the ritual is done to relieve anxiety. 

Getty/Vadym Pastuk

What are the symptoms of obsessive-compulsive disorder?

In addition to the symptoms mentioned above, people who live with OCD may experience the following:

  • A distressing and persistent urge to have "certainty" 

  • Intense doubts, distress, and anxiety about values 

  • Fear of having said an offensive statement or acted in an offensive way

  • Fear of repressing a memory 

  • Constant mental review of thoughts, actions, and memories 

  • Intrusive mental images of disturbing or immoral activities— harming a loved one, unwanted sexual thoughts, driving a car into a crowd, etc.

OCD often revolves around thoughts and fears. With that in mind, it can be beneficial to note that people living with OCD are not dangerous and do not act on intrusive thoughts. Instead, people with OCD often have rigid moral codes and live in terror that they have violated their principles or inner rules. 

Intrusive thoughts often attach themselves to the most profound aspects of a person's beliefs or identity. For example, someone with OCD might volunteer with an animal shelter and eat a vegan diet. Being kind to animals is essential to this person— so vital that they have altered their life choices to align with and reflect their values. On an average day, this person might help abused and abandoned animals by feeding them, comforting them, and doing everything in their power to make those animals feel safe and supported.

If that person also lives with OCD, they might experience intrusive thoughts about harming animals that horrify them. For example, they might have images of their mind of animal suffering or believe they've repressed a memory of hurting an animal. These thoughts can be highly distressing to someone who cares deeply about being kind to animals. While these thoughts are not indicative of their character or morals, the nature of these thoughts can indicate OCD and may make the individual believe that they are "immoral." However, there are ways that individuals can learn how to stop intrusive thoughts. In addition, professional support may be beneficial. 

Themes of obsessive-compulsive disorder

Intrusive thoughts are one example of the effect that OCD can have on someone's mental health. However, not everyone lives with intrusive thoughts. OCD can center around different themes, and someone focused on one theme might not have the same fears or compulsions as someone fixated on another theme. 

The previous example exemplifies a subset of OCD called "harm OCD." Harm OCD is one of the "obsession themes" someone with OCD may experience. Although all OCD themes have common hallmark symptoms, the types of obsessions and compulsions that someone engages in can differ from theme to theme.

For example, when people think about OCD, they may imagine someone worried about germs. These themes are referred to as "contamination OCD." However, although contamination OCD is common and often shown in media, other subtypes can occur, including the following: 

  • Moral scrupulosity

  • Relationship OCD

  • False memory OCD

  • Unwanted sexual thoughts

  • Religious OCD

  • Mental health OCD

  • Perfectionism OCD

  • Health OCD

As a result of these themes, someone might live in fear that they have done something wrong, violated the moral code of their religion, harmed someone, or created a problem in their relationship with their significant other. Likewise, many people with OCD have experienced intrusive thoughts suggesting that their OCD is not real— even after being diagnosed by a licensed mental health professional— or they may struggle with unwanted sexual thoughts that repulse them.

All types of OCD can be harmful and distressing or adversely impact all areas of life. If thoughts and images like these emerge in your mind, you may feel distressed and hope to prevent these thoughts from occurring. As a result, many people with OCD engage in compulsive behavior because they feel a sense of desperate hope that these compulsions may prevent the thoughts. 

Compulsions can also look like "normal" behavior and might include silent rituals that others can't easily pick up on. Some people have compulsions where they try to control the actions of others, and others might have compulsions related to checking. Checking behavior can include checking that a door has been locked, checking with a person that they're feeling okay, or repeatedly checking that an Uber is arriving, even when the app says they haven't arrived yet. There are many types of compulsions associated with OCD. 

ADHD and compulsive behaviors 

OCD is not the only mental health condition that may cause compulsive behavior. People who live with ADHD or identify as neurodivergent also frequently experience compulsive behavior. There are several similarities between OCD and ADHD, and researchers at the International OCD Foundation have observed that both conditions regularly get mistaken for one another, which might lead to misdiagnosis.

Although these conditions have many symptoms in common, they are different, and the treatment approaches that work best for each are unique. To understand how to cope with symptoms of ADHD, it can be beneficial to understand what symptoms are commonly associated with it. 

What is ADHD?

The CDC defines ADHD as one of childhood's most common neurodevelopmental disorders. It is often first diagnosed in childhood and can last into adulthood. Children with ADHD may experience difficulties paying attention, controlling impulsive behaviors, or reducing hyperactivity. Common symptoms of ADHD include:

  • Daydreaming

  • Forgetfulness

  • The loss of personal items 

  • Squirming, fidgeting, or struggling to sit still 

  • Rapid talking in social situations 

  • Risk-taking 

  • Frequent mistakes 

  • Impulsive behavior 

  • Hyperactivity 

  • Difficulties with emotional control

  • Difficulty understanding one's emotions 

  • Disorganization 

  • Difficulty with time management

  • Poor impulse control

  • Difficulty with executive functioning

Because ADHD is commonly diagnosed in childhood, many people assume that ADHD primarily affects children. However, ADHD is a lifelong neurobehavioral disorder and a form of neurodivergence. Contrary to popular misconceptions, children do not "grow out of" ADHD. Instead, children who have ADHD grow up to be adults with ADHD. 

Many ADHD symptoms can feel disruptive. Without support and accommodation, people with ADHD may experience substantial difficulties in their careers, relationships, and health. These difficulties can lead to the development of compulsive behavior similar to compulsions seen in OCD. 

Someone with ADHD may engage in compulsive behavior for different reasons. People with ADHD are often highly aware of the disruptive nature of their symptoms, so they may attempt to find a creative way to cope with them. These coping mechanisms may involve unique strategies to minimize clutter and disorganization in their lives or cope with racing thoughts and hyperactivity. 

The difference between OCD and ADHD compulsions is their motivations. For someone with OCD, compulsions can harm mental health. By contrast, someone with ADHD may engage in compulsive behavior as a coping mechanism rather than a ritual. They may still feel they must complete these rituals, but fear or intrusive thoughts might not drive these compulsions. 

Why is it difficult to stop compulsive behaviors? 

If you experience behaviors motivated by fear or a desire to cope with distress, you might be experiencing compulsions. This behavior may also be unhealthy if you feel dependent on a certain system or routine. Having a healthy routine can be beneficial, but routines are set schedules created to benefit you and not motivated by fear or personal rituals. If your routine controls you, you might consider reaching out for support. 

Compulsions are often difficult to stop because they are a symptom of a mental illness. Although OCD doesn't have a cure, it can often be managed with therapy and potential medications. However, consult a doctor before changing, starting, or stopping a medication or medical treatment. In addition, if you believe you may be living with ADHD, therapy might help you cope with distressing symptoms or ways you'd like to manage your life. ADHD is a neurological difference and cannot be "treated," but many people find support by talking to a medical or mental health professional. 

Compulsive behaviors not necessarily motivated by mental illness, such as skin picking, nail biting, smoking, or substance use, may also be treated through therapy. If you're experiencing compulsive behaviors due to substance use, you might be experiencing addiction, which is a psychological and physical response that changes brain chemistry. This compulsive behavior is often difficult to control and might require withdrawal, detox, or counseling alongside a professional. 

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

Although many people believe that addiction or compulsive behavior is "a choice," it is a medical issue and not your fault. 

The benefits of therapy for compulsive behaviors and your mental health 

Therapists are qualified to treat mental health conditions like OCD. Discussing your symptoms with your therapist may help you identify the condition or symptom that could be causing compulsive behavior.  

It may also be beneficial to note that OCD and ADHD often require different treatment approaches. ADHD is often managed through a combination of medication and cognitive-behavioral therapy (CBT). By contrast, OCD is commonly treated with a therapeutic technique called exposure and response prevention therapy (ERP). 

What is exposure therapy for OCD? 

ERP may be considered the gold standard of OCD therapy because studies prove it is one of the most effective methods for treating OCD. 

ERP can be beneficial because OCD cannot be cured. Medication may temporarily relieve symptoms, but long-term treatment may require therapeutic intervention. Anxiety medication might be used with a course of ERP if the individual feels nervous about treatment. However, unlike many medications, ERP works to help clients manage the underlying cause of OCD (fear) and help them reclaim control of compulsions. 

What is an example of ERP? 

ERP involves exposing yourself to your fears while preventing compulsive responses that you engage in. Many fears can be associated with OCD. However, one example is relationship OCD, where an individual fears that they might not truly love their partner and are lying to themselves about their connection. The individual might perform compulsions like frequently searching for relationship advice online, asking their partner for reassurance, or constantly looking at other relationships to notice their differences. 

In this case, a session of ERP may involve sitting with your anxiety and avoiding your compulsions. While obsessive thoughts occur, your course of ERP could teach you to refrain from engaging with them. The therapist may ask you to list your fears on a scale of one to 100. Then, you may list the supposed fear level you might experience if you didn't perform a compulsion urge. After rating your fears, you and your therapist can start with the lowest one and begin exposing yourself to it. In this example, you might fear that you want to break up with your partner and aren't being honest with yourself, even if you love them. 

Instead of telling yourself, "I don't want to break up with my partner; I love them," you can state the opposite to expose yourself to not seeking self-reassurance. You could say, "I might want to break up with my partner. Many people experience uncertainty in relationships." For someone with relationship OCD, stating that your thoughts might be true or that you cannot reassure yourself can feel terrifying. To expose yourself further, you might deny yourself the compulsion of searching online for articles about signs you want to break up with your partner. 

How does exposure work? 

As you expose yourself to not completing a compulsion, your therapist can help you track your fear levels. You might notice a significant spike in anxiety or fear in the middle of the practice. In some cases, this fear might cause you to want to avoid your therapist, run away, or complete a compulsion. Your therapist can guide you through the discomfort, reminding you that the fear will pass. As you learn that the fear of avoiding a compulsion doesn't last forever, you may feel more in control of your ability to control your actions.  

Note that exposure therapy is often terrifying and uncomfortable for clients. You may be asked to engage in thought exercises that are upsetting or unpleasant, and you might be asked to tell your therapist about intrusive thoughts that you feel shameful about. However, exposure therapy is meant to support you, so let your therapist know if you need to take it slow. You can also take breaks during sessions as you need. Often, the only intent needed for exposure therapy to work is a willingness to continue trying, even when it feels scary.  

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Are you having trouble stopping certain compulsions?

Alternative counseling options 

At times, reaching out for support from an in-person therapist can feel overwhelming. You might not feel ready to talk to someone face-to-face or prefer an environment where you feel safe to try exposure or another form of therapy. In these cases, online therapy through a platform like BetterHelp might be beneficial. 

Consider online therapy for mental health benefits

With advances in modern technology, many people have gravitated toward online therapy because this format is more convenient in a hectic, fast-paced world. Rather than amending your schedule to attend an in-person therapy appointment, you can talk to a therapist using phone, video, or messaging session options. Many platforms also offer 24/7 access to messaging which may allow you to check in with your therapist as you practice exposure therapy at home. 

Online therapy has also proven effective in treating people with symptoms of OCD and ADHD. One 2022 study utilized a video teletherapy treatment to reduce OCD symptoms and the symptoms of co-morbid conditions like ADHD. The intervention achieved significant results in less than half the total therapy time compared with standard once-weekly outpatient treatment, which could save time and money for online therapy participants. 

In a meta-analysis of online ADHD interventions, a different study identified six randomized controlled trials, including 261 patients with ADHD. A literature review indicated that online interventions were highly effective in supporting the study participants. 

Takeaway

Feeling consumed by obsessive thoughts and compulsive behaviors can feel frustrating, sad, and lonely. It is possible to significantly reduce the adverse effects that symptoms of OCD, ADHD, and other mental health conditions may have on one's life. Consider reaching out to a therapist to learn more about ERP or consider other treatment options as you work to reduce these behaviors and the distress they may cause.
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