What are Compulsive Disorders?

Compulsive disorders, or as they are referred to in the DSM-V, Obsessive-Compulsive and Related Disorders, are a grouping of disorders classified by compulsive behaviors persisting beyond developmentally appropriate periods. Compulsions specifically, are repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to individual rules that must be applied rigidly (American Psychiatric Association, 2013).

These compulsions can also include preoccupations and mental acts in response to these preoccupations. The obsessional component that compulsions exist in response to are defined as recurrent and persistent thoughts, urges, and images that are experienced as intrusive and unwanted (American Psychiatric Association, 2013). Put together, an intrusive urge, for example, is followed by a ritualistic behavior, thus linking the obsession and compulsion together.

Why do they matter?

In the case for developmental normativity, preoccupations and ritualistic behaviors can occur for individuals and phase out naturally. When considering compulsive disorders however, such behaviors and accompanying cognitive processes lead to clinically significant impairment in functioning, which can interfere with social, occupational, and day-to-day living. If you or someone you know is dealing with obsessive thoughts and/or compulsive behaviors, reach out to one of our New York Behavioral Health therapists for a free consultation to help understand what your options are for treatment.

Types of Compulsive Disorders

There are several classified compulsive disorders listed in the most recent version of the DSM. Of those include obsessive-compulsive disorder (OCD), body dysmorphic disorder, hoarding disorder, trichotillomania (hair-pulling disorder), excoriation (skin-picking) disorder, and other specified obsessive-compulsive and related disorders (i.e. nail, lip, or cheek biting, and obsessional jealousy).

It is important to note that the presence of compulsions and compulsive rituals is most often associated with and preceded by obsessions, or obsessional thoughts, that lead to the compulsive behavior. In the case of body dysmorphic disorder for example, the obsession involves extreme concern about one or more personally perceived physical flaws that are unnoticeable to others; the obsessional preoccupation of the flawed physicality can lead to significant anxiety, which then pairs with compulsive acts such as mirror checking, grooming, and hiding the perceived defect.

Compulsive Disorder Signs and Symptoms

Compulsive rituals are the apparent features within compulsive disorders and often account for their functional impairment (Castonguay et al., 2021). These rituals can be both overt behaviors or covert mental acts aimed at preventing a perceived negative outcome, and/or an attempt to reduce distress and anxiety about a particular feared consequence. It is important to note that compulsions are both intentional and motivated. This contrasts to mechanical behaviors that can be listed as criteria for non-compulsive diagnoses that are unintentional in nature.

In the case of OCD, some of the most common compulsive rituals include washing and cleaning (decontamination), checking (locks, appliances, etc.), ordering and arranging, repeating, and counting. Avoidance is often also present to some degree in compulsive disorders, particularly in OCD, which is intended to prevent exposure to situations that provoke obsessional thoughts and urges to ritualize (Abramowitz & Jacoby, 2014). NYBH clinicians can help you get a better understanding of the signs and symptoms associated with compulsive disorders, and build out a treatment plan together to help meet your mental health needs.

Course and Clinical Implications

Though precipitants to symptom onset can sometimes be difficult to identify, individuals with OCD have identified stressful and/or traumatic events and experiences as a possible contributing factor (Gershuny et al., 2003). The content of obsessional thoughts leading to compulsive behaviors are also influenced, at least in part, by environmental and sociological factors. Compulsive disorders are often associated with impaired social and role functioning, with additional negative impact to platonic, familial, and romantic relationships, school or occupational difficulty, and sleep and sexual difficulties, depending on the type and severity of the compulsive disorder (Koran, 2000).

In contrast, individuals with compulsive disorders in the U.S. do not differ substantially from the general population with alcohol use, suicide, or marriage (Castonguay et al., 2021). Family members and close personal relationships of individuals with compulsive disorders also typically experience some degree of suffering, as the compulsive behaviors can often interfere with time spent together, and place restrictions on activities they can engage in together.

Treatment for Compulsive Disorders

Cognitive-behavioral models hold the greatest promise for understanding and treating OCD and associated compulsive disorders, as they are the only approaches that are empirically supported and provide a logically consistent basis for treatment (Castonguay et al., 2021). Exposure and Response Prevention (ERP) is a treatment modality designed to help individuals confront stimuli that provoke obsessional fear, and is a top form of treatment for obsessive compulsive and related disorders.

The treatment can be done using situational exposure, which is confronting the actual fear, or imaginal exposure, which is confronting an imagined form of the fear. The response prevention component of treatment entails refraining from compulsive rituals and other strategies that serve as an escape from obsessional fear (Castonguay et al., 2021). Another treatment is Acceptance and Commitment Therapy (ACT) which can help foster willingness to experience their obsessional thoughts, uncertainty, anxiety, flexible responding, and live in alignment with a values-based life (Twohig et al., 2015). 

Cultural Considerations for Compulsive Disorders

There are some factors to consider that can contribute to distinctive identifiers in compulsive disorders. It is important to keep in mind that sociocultural and religious and/or spiritual factors can inform and shape the content of specific obsessions and compulsions. For OCD specifically, there is substantial similarity across cultures in the gender distribution, age of onset, and comorbidity factors (describing the other disorders that commonly occur in people with the disorder) (American Psychiatric Association, 2013). It is also important to note that temperamental, environmental, physiological, and genetic factors can all play a part in the development and influence of compulsive disorders.

Final Thoughts

Compulsive disorders can pose a significant impact to your relational connections, social functioning, occupational and career performance, and your overall mental health and well-being. Though the road to recovery can often feel overwhelming, help to mitigate and even relieve symptoms is possible, and finding the appropriate treatment for your needs is what the clinicians at New York Behavioral Health are here to do. Whether you or someone you love are experiencing signs consistent with obsessive-compulsive disorder, body dysmorphic disorder, or another pattern of obsessional thoughts yielding compulsive behaviors, NYBH is here to help you and your loved ones meet your mental health needs.

References

Abramowitz, J. S., & Jacoby, R. J. ( 2014). Obsessive‐compulsive disorder in the DSM‐5. 

Clinical Psychology: Science and Practice, 21(3), 221–235. 

https://doi.org/10.1111/cpsp.12076

American Psychiatric Association. (2013). Obsessive-compulsive and related disorders. In 

Diagnostic and statistical manual of mental disorders (5th ed.). 

https://doi.org/10.1176/appi.books.9780890425596

Castonguay, L. G., Oltmanns, T. F., & Powers Lott, A. (2021). Psychopathology: From science to 

clinical practice (2nd ed.). New York, New York: The Guilford Press.

Gershuny, B. S., Baer, L., Radomsky, A. S., Wilson, K. A., & Jenike, M. A. (2003). Connections 

among symptoms of obsessive-compulsive disorder and posttraumatic stress disorder: A 

case series. Behaviour Research and Therapy, 41, 1029-1041. 

https://doi.org/10.1016/S0005-7967(02)00178-X

Koran, L. M. (2000). Quality of life in obsessive-compulsive disorder. Psychiatric Clinics of North 

America, 23, 509-517. https://doi.org/10.1016/S0193-953X(05)70177-5 

Twohig, M. P., Abramowitz, J. S., Bluett, E. J., Fabricant, L. E., Jacoby, R. J., Morrison, K. L., & 

Smith, B. M. (2015). Exposure therapy for OCD from an acceptance and commitment 

therapy (ACT) framework. Journal of Obsessive-Compulsive and Related Disorders, 6, 167-173. https://doi.org/10.1016/j.jocrd.2014.12.007