217: Compulsions and how to manage them

What are compulsions? Why do compulsive behaviours happen? And can you learn how to stop compulsions and take back control?

That’s what I’m talking about this week here on Let’s Talk About Mental Health — the weekly podcast that makes mental health simple. So, get comfortable, and let’s talk!

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This podcast episode was originally released on 4 February, 2024.

Hello and welcome to Episode 217 of Let’s Talk About Mental Health, and thanks so much for joining me as I talk about compulsions and mental health!

I’m Jeremy Godwin and I teach you how to look after your mental wellbeing, with practical tips you can apply immediately based on quality research and my own experience of learning to live with anxiety and depression after a breakdown in 2011 that changed my life. Each week I teach you simple ways to improve one specific aspect of your wellbeing. 

In this episode I’ll be talking about what compulsions are, why we need to manage compulsive behaviours, and how to deal with compulsions in a thoughtful and considered way. 

So, let’s talk about compulsions!

Introduction

I don’t know about you, but I often find myself distracted by random thoughts. Sometimes I’ll have the urge to check that the back door is locked before I leave the house (even though it hasn’t been opened since the last time I checked it!), or I might randomly find myself fixated on a particular bit of information that I have to check on before I can proceed with anything else; I’m notorious for pausing a TV show so I can figure out what other show I know an actor from… which I’m sure drives my partner nuts! And what makes it worse is that I try to drag it out of my memory before I give in and check IMDb, so I can’t imagine that’s terribly fun for anyone who has to sit and wait while I struggle to pull some random bit of information out of my head (all the while pulling a face like I’m squinting to read the chart of letters at the optometrist’s office). 

Compulsions come in all shapes and sizes, from the harmless through to the more serious (such as those associated with obsessive-compulsive disorder, which I’ll discuss more later). Regardless of your situation, learning how to manage these types of compulsive thoughts and behaviours can make an enormous difference in your life; the more ‘in control’ you feel, the more you’ll be able to find peace of mind.

So, let’s get ourselves on the same page with some definitions and let’s talk about…

What are compulsions?

The Oxford Dictionary (which is a handy book to have, but a bit dull if you read it cover to cover…) defines compulsions as, “the action or state of forcing or being forced to do something” or “an irresistible urge to behave in a certain way.” It’s the second definition we’re focusing on today (since the first one is more about controlling). 

In a general sense, when we talk about compulsion, it’s like having an internal nagging voice that just will not shut up. Imagine you’re sitting down, trying to relax, and then suddenly there’s this little voice inside your head saying, “Hey, don’t you think you should really check if the door is locked again? Not so sure if it was!” That’s compulsion in a nutshell. It’s this irresistible urge or force that drives you to do something repeatedly, often against your better judgement.

Now, when we talk about compulsive behaviour, specifically in the mental health context, it’s like taking that nagging voice and putting it on loudspeaker. It’s not just about checking the door once or twice; it’s the feeling that you must do it, perhaps a dozen times, even though you know it’s definitely locked. This type of behaviour can range from relatively harmless habits, like needing to organise your desk a certain way, to more impactful ones that can really disrupt your daily life.

In terms of mental health, compulsive behaviour often ties in with conditions like Obsessive-Compulsive Disorder (OCD) or Obsessive-Compulsive Personality Disorder (OCPD). Here, the compulsions are like uninvited guests at a party in your brain, absolutely insisting on certain actions or rituals, or in the case of OCPD, perfectionism and an urge to be in control. These aren’t just whims or preferences; they’re driven by intense anxiety or fear, like a mental itch you just can’t scratch enough, and they can also be a way that the brain is trying to regain control in order to cope with stress or danger. 

When I was going through my breakdown back in late 2011 and early 2012, I felt compelled to wipe down the shower glass (with one of those squeegee things) a specific number of times, and I would count random things as well as my footsteps… oh, and I also found myself picking random words out of a conversation and writing them in the air with my finger. It was all completely random and I had no idea I was even doing it half the time, but if I tried to resist the urge then I felt fear rising — actually, terror — until I eventually gave in and did the random thing. Now, obviously that’s a more extreme example and in hindsight I know those actions were fear-based attempts by my brain to create a sense of control when I felt like I had none, which eventually faded over time as my treatment and therapy began to work, but regardless of whether or not you ever find yourself dealing with mild compulsions, or something more serious, it helps to be aware of these types of thoughts and behaviours so you can manage them. 

But, look, let’s not paint too gloomy of a picture here. It’s important to remember that compulsions are kind of like overzealous security guards in your mind; they think they’re helping, bless their hearts, but sometimes they just don’t know when to take a break, so it’s up to us to take the reins and regain control. 

Let’s briefly discuss the difference between Obsessive Compulsive Disorder (or OCD) and having compulsions or compulsive behaviour, because it’s something that often trips people up a bit (I mean, how many times have you heard someone say, “Oh, I’m a bit OCD!”?).

The easiest way to look at it is to remember that OCD is an actual diagnosable disorder, with a very specific set of criteria that need to be met; just liking your kitchen to be tidy doesn’t make you OCD (it makes you tidy). OCD is a complex mental health condition that’s characterised by two main ingredients: obsessions and compulsions. 

Obsessions are those persistent, unwanted thoughts, images, or impulses that pop up uninvited, kind-of like a song stuck in your head (but far less catchy and definitely more distressing). These are not just your everyday worries about real-life problems; they’re more intense, and often irrational. 

Compulsions, on the other hand, are the repetitive behaviours or mental acts that someone feels driven to perform in response to an obsession. It’s like if you had a fear of germs (which is an obsession), you might wash your hands excessively (which is a compulsion). In OCD, these compulsions are often performed to relieve the distress caused by the obsessions, even though it’s usually only a temporary fix.

Now, having compulsions or compulsive behaviour, outside of OCD, is perfectly natural… but it doesn’t automatically equate to being or having OCD. People might experience compulsive behaviours without the presence of these nagging obsessions. These behaviours can range from mild to severe, and might not meet the full criteria for OCD.

For instance, someone might habitually check their email every few minutes, driven by a compulsion, but not necessarily have the intrusive, obsessive thoughts characteristic of OCD. Or, a person might compulsively shop, not because of an obsession per se, but due to other factors like emotional distress.

In short, while all people with OCD have compulsions, not everyone with compulsive behaviours has OCD. Obsessive-Compulsive Disorder is a specific diagnosis with a defined set of criteria, whereas compulsive behaviours can occur in various contexts, not always linked to those pesky obsessions. And, while I think of it, a quick note to say I covered intrusive thoughts back in Episode 201 in case that’s relevant to your situation.

So, compulsions come in various shapes and sizes, and they can be as unique as the individuals who experience them. But there are a few common types that many people might encounter in their daily lives, such as:

• Checking: This is a big one. It’s like the mental equivalent of patting your pockets to make sure you’ve got your keys, but on overdrive. People might repeatedly check things like locks, appliances, or emails. It’s the “Did I turn the oven off?” thought that pops up not just once, but maybe ten times before you can leave the house. Next…
• Counting: Some people find themselves compulsively counting steps, tiles on the floor, or even the number of times they chew; it’s a bit like having an internal abacus that just won’t quit (in case you’re old enough to know what an abacus is!). Next…
• Ordering and Arranging: This is for the symmetry lovers and the ‘everything in its right place’ crowd. It involves arranging objects in a particular way, like making sure all the labels in the pantry face forward. It’s the compulsion’s way of saying, “A place for everything, and everything in its place… or else!” Next…
• Cleaning and Washing: So, this goes beyond the regular concern for cleanliness. It’s more about excessive hand-washing, showering, or cleaning of objects, driven by fear of contamination. It’s like your brain’s stuck on a loop of ‘clean, rinse, repeat’. Next…
• Hoarding: And this is about holding onto items that most people would consider worthless or expendable, like old newspapers, packaging, or broken objects. It’s the “But what if I need this someday?” mindset taken to an extreme, and any attempts to get rid of a hoarder’s stuff can result in real pain because they tend to form attachments with things. Next… 
• Ruminating: This is a mental compulsion, where a person gets stuck on a thought or idea, often negative or distressing, and can’t seem to move past it (and I covered this topic back in Episode 116). Next… 
• Repeating: Performing the same action or ritual multiple times, like touching a doorknob a certain number of times before opening it. It’s the brain’s way of saying, “Third time’s the charm… or maybe the fourth time, just to be really sure.” And next…
• Mental Rituals: These can include silently repeating phrases, affirmations, or counting numbers in your head. It’s like having an invisible, mental security blanket.

So, it’s important to remember that while we all might experience mild forms of these behaviours at some point, they cross into the realm of compulsions when they become excessive, time-consuming, and interfere with daily life. It’s like the difference between a light drizzle and a downpour; a bit of rain is manageable, but a storm can really disrupt your plans. 

OK, now let’s talk about…

Why we need to manage compulsive behaviours

And this is one of those, ‘Jeremy feels compelled to state the obvious’ moments: if you don’t learn how to control and manage compulsions, then they’re very likely to control you… and that can cause all manner of issues. It’s a bit like keeping your garden well-tended and under control; if you let the weeds take over, they wreak havoc and turn your lovely, serene garden into a total mess.

In the broadest sense, managing compulsions is about regaining control over your daily life. When compulsions are running the show, they can take up a lot of your time and energy; by managing them, you can take back your precious time and energy to invest in activities that are much more fulfilling and enjoyable, rather than spending hours locked in repetitive, often unproductive behaviours.

From a mental health perspective, the stakes are a bit higher. Compulsions, especially when they’re part of a condition like OCD, can be incredibly distressing. They’re not just ‘quirky little habits’; they’re driven by underlying anxiety or distress. If they’re left unmanaged, they can lead to a significant decrease in the quality of life, impacting everything from personal relationships to work performance.

Compulsions can also lead to a vicious cycle. The more you give in to them, the stronger they become. It’s as if every time you perform a compulsive behaviour, you’re telling your brain, “Yes, this is important, go ahead and keep worrying about it.” So, managing these behaviours is crucial in breaking that cycle and reducing the overall level of anxiety and distress.

In more severe cases, unmanaged compulsions can lead to isolation, depression, or even physical health issues, depending on the nature of the compulsion. For example, excessive hand-washing can lead to skin problems, while compulsive eating can lead to health complications.

So, managing compulsions, whether they’re part of a diagnosed condition like OCD or not, is vital for maintaining your mental well-being, personal freedom, and overall quality of life. It’s about taking back the reins and ensuring that your daily routine and mental space aren’t overrun by these demanding, uninvited guests. It’s not just about getting rid of the weeds; it’s about nurturing a garden where you can thrive.

So, how do you do that? Well, let’s first take a quick break to hear from the brands who help me create this show each week…

AD BREAK

And welcome back! Now let’s get into the how-to part of today’s episode and let’s talk about… 

How to deal with compulsions in a thoughtful way

First, take stock of your situation — if anything I’ve talked about in this episode has struck a nerve with you, or if you’re concerned you may be dealing with compulsive behaviours of your own, it’s worthwhile sitting down and making some notes for yourself about any observations you might have in terms of potential compulsive behaviours. This isn’t about judgement; it’s about being self-aware, and to do that you need to have an honest conversation with yourself (you can do that in your head; maybe don’t walk around Ikea having a one-person chat that results in you being carted off in a padded van!). Next…

Monitor your situation — if you’re aware of specific compulsions that you have, observe them over the course of a week or two and make yourself some notes about how they manifest and what’s happening when they do; for example, do they appear more frequently during times of stress, anxiety, or fear? Taking a little time to understand what’s happening, and why, can then be really helpful for your own knowledge and for when you do my next suggestion…

Talk with a professional (especially if you’re dealing with more serious compulsions) — so, find a psychologist or psychiatrist who you feel comfortable with and work through things with them. While a counsellor can be helpful for most talking therapy, they probably won’t have the level of skill or training that more advanced mental health professionals have; psychologists and psychiatrists are usually able to apply proven therapeutic techniques like Acceptance and Commitment Therapy (or ACT), which teaches you how to live with your compulsions in a much-less disruptive way. Now, even if you’re not dealing with serious compulsive thoughts or behaviours you’ll still find it beneficial to work with a professional; there are lots of things you can do to self-manage (which I’ll talk about in a moment) but it’s aways worthwhile taking a ‘prevention is better than cure’ approach to your mental health if you can (especially if you notice that the compulsions are happening more frequently)… at the very least be aware of this option and keep it up your sleeve for if and when you need it. 

OK, now let’s talk through a list of things you can do to manage your compulsions yourself (let me just preface this by saying that none of these replace therapy, especially for more challenging situations). Let’s start with…

Set compulsion-free zones or times — designate certain times of the day or areas in your home where you won’t engage in compulsive behaviours. You could start by declaring your dining table a compulsion-free zone, for example. Doing this creates a physical or temporal boundary, giving you a clear framework to practice control. Next…

Try habit reversal training — this involves replacing a compulsive behaviour with a more positive or neutral action, and it’s useful because it provides your brain with an alternative response. If you feel the urge to check something repeatedly, you could instead clench your fists for a moment or write down your concern. Next…

Delay and distract — when you feel the urge to perform a compulsion, delay acting on it for a set period, say 5 or 10 minutes. During this time, engage in a distracting activity. This technique helps weaken the compulsion over time. Next…

Write down compulsive thoughts — look, either your thoughts go somewhere or they just go round and round in your mind (usually picking up steam as they go); so, write it out to get it out. Each time a compulsive urge arises, write it down in detail; this helps externalise the thought, making it easier to analyse and resist. OK, next…

Try preventing your response — deliberately expose yourself to the trigger of your compulsion, and then consciously prevent yourself from performing the compulsive act. This can be quite challenging, but the more you do it you’ll find it’s highly effective in reducing the power of compulsions (just don’t push yourself too hard or too fast; take your time!). Next… 

Establish a ‘worry period’ — allocate a specific time of day for worrying or engaging in compulsions. Outside of this period, if you find yourself engaging in compulsive behaviour, remind yourself you need to wait until your designated worry time (you can write it down and come back to it at the assigned time if you really can’t let it go in the moment). OK, next… 

Practice imperfection — deliberately leave little things imperfect or unfinished, which can be especially helpful for perfectionism-driven compulsions. For example, try leaving a book slightly misaligned on the shelf or put a cushion back on the couch upside-down. Next…

Compulsion substitution — try replacing a harmful or disruptive compulsion with a less intrusive one; for example, if you feel the urge to wash your hands excessively then replace it with applying hand lotion instead. Next… 

Mindfully observe the compulsion — being more mindful can be incredibly helpful; when you feel a compulsion, instead of immediately acting on it, take a moment to observe it without judgement and just be aware of it. Note your feelings, the thoughts accompanying the urge, and the sensations in your body. This helps to connect you more with your body and it also helps you to be more objective about and detached from the compulsion. OK, next…

Try an incompatible activity — and by that I mean to engage in an activity that clashes with your compulsion; for example, if you have a compulsion to speak certain phrases, try singing instead. OK, next…

Label the irrationality — OK, so we know that some of these behaviours are random, unnecessary and completely irrational… so, label it as such! Say out loud why the compulsion is irrational or unnecessary; hearing it spoken can sometimes make it clearer in your mind. Next…

Limit your exposure to stress — so, stress can play a big role in making compulsive behaviours worse (not to mention the fact that many compulsions develop over time as a way of managing stress and anxiety), so it makes sense to try and reduce stress in your life as much as possible. I talked about how to do that all the way back in Episode 8 (about stress), plus I covered peace of mind more recently in Episode 174. OK, next… 

Build a structured daily routine — having a structured schedule reduces the amount of free time you have to engage in compulsions and provides a sense of order and control. You can do this by planning your day in advance, including work, leisure, and self-care activities. Next…

Do physical exercise — regular exercise can be a great way to manage compulsions because physical activity reduces stress and increases endorphins, making it easier to resist compulsive urges. You can incorporate exercise into your routine in any form you enjoy, such as walking, yoga, or dancing. Next…

Seek social support — talking about your experiences with trusted friends, family, or support groups can be incredibly helpful; it reduces the sense of isolation and provides a network of understanding and support. Even just catching up with a friend and discussing your challenges can be a great start. Next…

Limit stimulants — reducing your intake of stimulants like caffeine can help, as these can aggravate anxiety and compulsions. You can do this by gradually decreasing your consumption of coffee, tea, or energy drinks and observing any changes in your compulsion intensity. Next…

Use technology — there are many apps designed to help manage OCD and compulsions, and they can provide structured exercises and reminders to help you resist compulsive behaviours. There are some good ones that have been reviewed by the International OCD  Foundation and I’ll leave a link to that review in the transcript (available free at ltamh.com under the ‘Episodes’ tab; it’s linked in the episode description) [find it here: https://iocdf.org/ocd-apps/]. Next…  

Practice mindfulness — mindfulness involves staying present and fully engaging with the here and now; it trains your brain to focus on the current moment, rather than getting lost in compulsive thoughts or behaviours. You can practice mindfulness through meditation, focusing on your breath, or simply being aware of your senses in everyday activities. I talked about being more present recently in Episode 215, so check that out. OK, next…

Use positive reinforcement — reward yourself for resisting a compulsion; this could be something small like a treat or some personal time with a favourite activity. Bribing yourself can work wonders!

And a common type of compulsion is perfectionism, which is what I’m talking about in my latest video; it’s out now on YouTube and Spotify, and it’s linked in the episode description.

Summary and Close-out

Because when it comes to compulsions and mental health, what it all boils down to is this: Overcoming compulsions isn’t about perfection; it’s about making progress one step at a time. Learning to manage compulsions can lead to a newfound sense of empowerment and freedom, opening up a world where you are in control instead of your compulsions. Take your time, show yourself kindness, and take things one day at a time.

The choice is yours, as it is with all things related to your wellbeing… so, what choice will YOU make today? 

Each week I like to finish up by sharing a quote about the week’s topic, and I encourage you to take a few moments to really reflect on it and consider what it means to you. This week’s quote is by an unknown author, and it is:

“Compulsion is a prison we create for ourselves.”

Unknown

Alright… that’s nearly it for this week.

What are you taking away from this episode? If you’re on Spotify you can answer in the Q&A section below, otherwise you can let me know on Instagram @ltamentalhealth or by commenting on the transcript, which you can have delivered to your inbox each week, along with my newsletter Thursday Thoughts; sign up at ltamh.com or use the link in the episode description. And for more tips follow me on my other Instagram account @itsjeremygodwin, and support my work plus get early access to ad-free episodes on Patreon. 

Next week I’ll be talking about being intentional. Life can seem fairly random sometimes, but if you approach it in a more intentional way you’ll find that it’s a lot less random than it may seem; the trick is to find the right balance between ‘intentionality’ and ‘spontaneity’ so you don’t wind up over-planning things or boring yourself senseless! So how do you do that? Well, that’s what I’m talking about next week! I’ll be talking about what being intentional means, why it matters, and how to be more intentional.

I hope you’ll join me for that episode, which will be released on Sunday the 11th of February, 2024.

Thank you very much for joining me today. Look after yourself and make a conscious effort to share positivity and kindness in the world, because you get back what you put out. Take care and talk to you next time!

Jeremy 🙂

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