5 Types of OCD Compulsions | Ep. 399

There are five crucial types of OCD compulsions, and today, we will go through each one and provide actionable strategies for recognizing and reducing them, paving the way for a more balanced life.

What you will learn:

• Discover the most common physical compulsions and learn simple tactics to manage them effectively.
• Understand mental compulsions and how to break free from repetitive thought patterns.
• Learn how avoidant behaviors might be silently fueling your OCD and what you can do about it.
• Explore the subtle yet powerful reassurance-seeking compulsion and how to resist the urge to seek constant confirmation.
• Uncover the hidden impact of self-punishment compulsions and strategies to replace them with self-compassion.

Welcome back. My name is Kimberley Quinlan. I’m an anxiety specialist and an OCD specialist, and today, we are talking about the five types of OCD compulsions you must know and understand. 

Why is this so important? Let me explain. 

Having OCD is an incredibly confusing experience. It often feels like the whole experience is so overwhelming. It takes you away from the things that you value, the people you value, and the things you love to do. Often, the way in which we can start to overcome OCD is to actually work backwards, reducing the symptoms by working backwards. 

I have an online course called ERP School. You can go over to CBTSchool.com to learn more about it. We do go deep into this, way deeper than we will today. But for today, I want to explain to you how we can identify those five compulsions so that you can be aware of them when they come up.

Often, when we’re aware of the compulsions we’re doing, we can actually catch them a little earlier and then reduce how much we’re doing them by engaging in other, more helpful skills. We’ve talked a lot about helpful skills here on the podcast. Again, you can go to the course if you’re wanting to get a full step-by-step process on those. But this is going to be one of the first things we do—to identify specifically what are the compulsions you are doing. Because even though you might know someone with OCD, you guys might have completely different compulsions, or maybe you have multiple subtypes of OCD, and in one subtype, you do this set of compulsions, but in another subtype, you do a completely different set of compulsions. You will need to be able to identify those in order to be able to resist doing those compulsions. We call it response prevention. 

Let’s get going. Let’s talk about the five compulsions or types of compulsions that you absolutely should know about, so you can start to work on that reduction of compulsion. 

Number one is the one that everybody knows about. Hollywood talks about it all the time. It’s physical compulsions. This is a lot of the compulsions that we used to talk about a lot because that’s what they used to think OCD contained—just this type of compulsion. We have come so far since then, and we know that there are other types of compulsions, but let’s go through physical compulsions first. 

These are just examples. I will not include all of them, but the number one very well-known physical compulsion we do is checking. Checking the stove, checking the door, checking the hair dryer, checking, checking, checking. Often, and with any compulsion, compulsions are behaviors we do to reduce or remove an intrusive thought, feeling, sensation, urge, or image. We call these obsessions. We have an obsession. The obsession makes us uncomfortable. We do a compulsion to reduce or remove that obsession. That gives us some relief, but before we know it, the obsession comes right back because we’ve reinforced it by doing that compulsion. That was a very quick rundown. Again, if you want a deeper understanding, you can head over to ERP School. But for the sake of us being clear, checking compulsions is a very, very common one. 

An additional very common type of checking compulsion is moving or arranging things either before symmetry or so that they “feel right.” 

Another very common checking behavior that people do is washing their hands, cleaning, or decontaminating things. This was big and got a lot of promotion over COVID. But again, it also shows up a lot in Hollywood, a very common physical compulsion. 

We also have touching things, repeating things, counting things, or any physical behavior can become a physical compulsion. It’s important for us to remember that while we are just covering a few here, your physical compulsions could be anything. It could be a movement of the body that you repetitively do. It might be a physical action, like some people with sexual obsessions might engage in sexual intercourse as a compulsion. People might engage in being people pleasers as a compulsion. Again, there are many ways in which this can show up. 

The second type of OCD compulsion is mental compulsions. We did a whole series on mental compulsions with some of the best OCD therapists in the world. I started off the series by going through and doing an introduction to mental compulsions. It’s Episode 282. If you’re interested in going deep into the specific types of mental compulsions, head on over to the podcast. Listen to Episode 282. It is a completely free series about mental compulsions. We talk about mindfulness, we talk about strategies, and we talk about scripting—all of the ways in which you can manage these mental compulsions.

The third type of OCD compulsion is avoidant compulsions. Now, a lot of the time, people who have OCD can hide this compulsion because they can’t really see what they’re avoiding. Now, there always will be situations where you are walking into an elevator and all of a sudden you have an intrusive thought and you have to avoid it, so you have to step out of the elevator. Yes, people can see that, but there are often other times where people are avoiding things and no one would know. Maybe they’re avoiding a person, a place, or a thing. Maybe it’s cleaning products or taking medication. Maybe they’re avoiding a certain exchange between people. Maybe they’re avoiding topics. Maybe they’re avoiding shows on TV. Maybe they’re avoiding certain topics that show up on their laptop, computer, or internet search.

Avoidance, in my opinion, is one of the most important that we target because it gives us an opportunity, once we’ve identified it, of great exposures. We can do ways to practice facing that fear in a planned way so that you can practice willingly experiencing anxiety, distress, and whatever intrusive experience you’re having. 

The fourth type of OCD compulsion is reassurance-seeking. This one is important, specifically if your OCD is showing up in relationships, specifically relationship obsessions or relationship OCD. However, reassurance-seeking happens in many, many subtypes of OCD. The first type of reassurance is simply asking questions. Do you think I’ll get sick from this? Will this make me feel bad? Will this make me sick? Do you think I’m bad for having this thought? Do you ever have this thought? What if this happens? What if that happens? What if I feel this way? What if I did this thing? This is a very common part of reassurance-seeking. 

Another way in which you can do this, which again can be done on the silent down low, is by researching and Googling. This can be done on a web browser, looking up, what happens if I feel this feeling? Very common with health anxiety. What if I don’t love my partner? Very common with relationship obsessions. What if I harmed my baby? Very common with pedophilia obsessions or harm obsessions. What if I had a bad thought, or what does hell look like, if you’re having religious or scrupulosity obsessions. There are many ways in which people do research or Google searches to seek reassurance and certainty to reduce or remove their discomfort with their obsessions. This is one type of reassurance-seeking that we often are doing without even knowing. We’ve already gone down the Googling rabbit hole before we even know. 

Another one is just simply looking. If somebody is having anxiety and they want to know whether they harmed someone, let’s say, they might go into the room where that person is and look them up and down to see and get reassurance that they look fine. Or they might look at their partner and have, “Okay, I’m feeling the feelings I wanted to feel.” That’s giving them reassurance. These are other ways. Or maybe you look at the oven or the door to see if it’s been locked or so forth.

The last one is physical. There are physical ways in which we do seek reassurance, and this is where physical and reassurance mold together. As I mentioned before, some people engage in sexual intercourse to get reassurance of a certain feeling or an intrusive thought that they’re having. Some people act certain ways in public to get reassurance that they are good, didn’t do anything wrong, that who they are is acceptable, or that the thoughts that they’re having are acceptable. There are many ways in which physical behaviors can become reassurance-seeking behavior. 

Now I want to move over to the last, the fifth type of OCD compulsion, which is so important and one that we do not speak about enough. I speak about it often, but a lot of clinicians don’t even know to be assessing for this type of OCD compulsion, and this is self-punishment.

Self-punishment compulsions are incredibly painful. They actually create a lot of distress and depression for people with OCD, and they play out the same way that other compulsions do. In this case, they often will have an intrusive thought or a feeling or a sensation or an urge or image, have distress about it, and they will punish themselves to neutralize that thought or to punish them—to literally punish themselves for having it, even though it’s not their fault that they’re having this obsession, or they punish themselves in a way to try and prevent that obsession from coming true or to prove to themselves that they don’t believe and agree with that intrusive thought. Remember, intrusive thoughts are usually ego-dystonic, meaning they do not line up with your values. 

There are ways in which self-punishment compulsions can play out. Number one, it’s just simple criticism. Saying mean things to yourself, beating yourself up, judging yourself, berating yourself, mentally ruminating, and being so unkind to yourself—that can be a simple way that we engage in self-punishment. 

The second is actually physical punishment. Some people might hit themselves, hurt themselves, or push themselves to be in very uncomfortable situations, like running very, very fast or overexerting themselves in workouts, pushing themselves to work harder in their day job, just basically pushing themselves as a form of discipline. 

And then the last way that this plays out is they withhold pleasure. This is probably one of the most common that I see, which is, because I had my intrusive thought, I’m going to withhold joy, pleasure, and kindness from my life. That might be not giving yourself the nice things, not ordering the nice things off of the restaurant menu, only buying the cheap, really scratchy toilet paper, or not allowing yourself to have lovely, beautiful things, foods, clothes, beauty products, or cars. They just withhold kindness, joy, and loveliness from their lives. 

This is important because this is a very subtle and nuanced way that OCD can stay in our lives. Even though they’ve cut off these other, more common fourth compulsions, they’re still engaging in them. We’ve got to understand it. We’ve got to know about it, and we’ve got to catch it early. If you’re a clinician listening, please, please, please ask your clients about self-punishment compulsions, because you will probably find they’re doing these things all throughout the day. They won’t let themselves have hobbies. They won’t let themselves get new nice things, or they’re not really following up with their basic self-care because they’re punishing themselves for their intrusive thoughts. 

Now, that’s a lot to take on, but thank you for staying with me. 

Again, why is this important? You must know what are the compulsions you’re doing because compulsions keep the disorder going. Compulsions fuel the disorder. I want you to think about it like a fuel that keeps it generating and keeps it going. If we can identify these compulsions, then we can work to start reducing them. We can work at having a different reaction to the intrusive thoughts that we’re having or the discomfort we’re experiencing. And that is where we change your life. We change the way your brain works. 

There is a lot of this that is about the mechanics of the brain. When you have an intrusive thought and you respond as if it’s real, your brain keeps thinking it’s real, and it’s going to keep sending out all of the anxiety hormones, which means you are going to keep suffering. When we can reduce those compulsions, we’re changing the way your brain is experiencing these obsessions and intrusive thoughts. From there, we start to reverse-engineer the disorder. That is where the gold is. With repetitive practice, we can then move towards recovery from OCD and overcoming it so that you can go live your big, beautiful life. That’s how we do it in sessions with my clients. That’s how we do it in ERP School as well. 

If this has been helpful, I hope that that is the case. You can always leave us a review. You can always come back next week. I’ll be here, same place, same time, and I cannot wait to see you there. 

Thank you again for being here, and please do not forget, today is a beautiful day to do hard things.