compulsions

Compulsions are repetitive, ritualized behaviors or mental acts that a person feels driven to perform in response to an obsession or according to rules that must be followed. They are typically intended to prevent or reduce distress or feared outcomes, but their connection to the feared event is often not realistic and the acts can become time-consuming and impairing.

Common examples include excessive washing or cleaning, checking, repeating actions, counting, ordering or arranging objects, and mental acts such as silently repeating phrases or mentally reviewing events. Compulsions may be automatic and may occur in public or private settings.

In obsessive-compulsive disorder, compulsions occur as part of the core symptoms alongside obsessions and are performed to relieve the anxiety triggered by these obsessions. They are typically time-consuming, taking more than an hour per day, or cause clinically significant impairment in everyday functioning. Compulsions can also appear in other anxiety disorders, tic disorders, and some medical conditions, or as part of medication withdrawal.

Diagnosis relies on clinical assessment of recurrent, intrusive compulsions that are difficult to resist, cause distress, and lead to impairment, and that are not attributable to substances or another medical condition.

Treatment options include cognitive-behavioral therapy with exposure and response prevention (ERP) and pharmacotherapy with selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, sertraline, fluvoxamine, or paroxetine; clomipramine is also effective. In severe or resistant cases, augmentation strategies or neuromodulation techniques such as deep brain stimulation or transcranial magnetic stimulation may be considered.

Prognosis varies; many individuals improve with treatment, though some experience persistent or relapsing symptoms. Early intervention can improve outcomes.