Compulsive behaviours — repetitive actions performed despite a desire to stop, often in response to anxiety, intrusive thoughts or emotional distress — significantly affect quality of life and can be debilitating when severe. They are central features of OCD but also occur in BDD, hoarding disorder, skin picking, hair pulling and other presentations. Specialist psychological therapy, particularly ERP-based CBT, produces reliable and often significant improvement.
See therapies that may helpCompulsive behaviour involves repetitive actions that are performed to reduce anxiety or distress, or in response to obsessional thoughts, urges or rigid rules. The relief is temporary — anxiety returns, driving further compulsion in a self-maintaining cycle. Compulsions can be behavioural (checking, washing, ordering, touching) or mental (reviewing, reassuring oneself, neutralising thoughts).
While compulsions are the defining feature of OCD, they also feature in body dysmorphic disorder (reassurance-seeking, checking), hoarding disorder, trichotillomania (hair pulling), dermatillomania (skin picking), and as features of anxiety disorders more broadly.
Compulsive behaviours may present as:
Compulsive behaviours respond well to specific psychological approaches:
OCD Action, OCD UK and the BDD Foundation can help find appropriate specialist therapists. It is important to work with a therapist trained specifically in ERP — general CBT without the ERP component is significantly less effective for compulsive presentations. NHS specialist OCD services exist in most regions.
Showing 11 therapies linked to Compulsive behaviours.
| Therapy | Evidence | Notes |
|---|---|---|
| Cognitive Behavioural Therapist |
strong
|
CBT, often with exposure and response prevention, helps you resist compulsive urges and challenge the thoughts that drive them. |
| EMDR Practitioner |
strong
|
EMDR can target distressing memories or triggers that feed compulsive urges, helping reduce the drive to repeat the behaviour. |
| ISTDP Practitioner |
strong
|
ISTDP works with the buried emotions and anxiety that can fuel compulsive behaviours, easing the pressure that triggers them. |
| Psychotherapist |
strong
|
Longer-term psychotherapy explores the underlying feelings and patterns behind compulsions, supporting lasting change in the behaviour. |
| Arts Therapist |
moderate
|
Arts therapy offers a non-verbal way to express the tension and anxiety behind compulsions, which some find helps loosen their grip. |
| EFT Practitioner |
moderate
|
EFT pairs tapping with focus on compulsive urges to ease the anxiety that drives them; evidence is limited and it complements, not replaces, proper care. |
| Hypnotherapist |
moderate
|
Hypnotherapy aims to calm the anxiety and reinforce control around compulsive urges; evidence is limited, so treat it as a complement to professional care. |
| Mindfulness Practitioner |
moderate
|
Mindfulness helps you notice compulsive urges without acting on them, building tolerance of the discomfort that usually triggers the behaviour. |
| NLP Practitioner |
moderate
|
NLP techniques aim to interrupt the thought patterns linked to compulsive urges; evidence is limited, so use it alongside appropriate professional care. |
| Regression Therapist |
moderate
|
Regression therapy looks at early experiences thought to underlie compulsions; evidence is limited and it should support, not replace, professional care. |
| Tension and Trauma Practitioner |
moderate
|
TRE uses gentle shaking to discharge built-up tension that can feed compulsive urges; evidence is limited, so treat it as a complement to proper care. |
No — OCD takes many forms. Common themes include contamination fears, harm OCD (fear of harming self or others), pure O (intrusive thoughts without visible compulsions), relationship OCD, scrupulosity (religious or moral obsessions), and symmetry or ordering. Compulsions can be visible behaviours or entirely mental rituals.
Compulsions relieve anxiety rapidly and reliably, making them powerfully reinforcing even when unwanted. Willpower alone attempts to suppress behaviour without addressing the anxiety-relief cycle maintaining it. ERP specifically addresses this cycle by allowing anxiety to arise and naturally reduce without the compulsion — the mechanism through which lasting change occurs.
Exposure and Response Prevention (ERP) involves systematically facing feared triggers while refraining from the compulsive response. This allows the anxiety associated with the trigger to naturally reduce (habituation) and teaches the brain that the feared consequence does not materialise without the compulsion. It is the most evidence-based treatment for OCD and related presentations.
No — mental compulsions (reviewing events for reassurance, mentally neutralising thoughts, reassuring oneself) are common and often unrecognised. People with predominantly mental compulsions may believe they have 'pure O' (obsessions without compulsions) when in fact the compulsions are internal. ERP can target mental compulsions as well as behavioural ones.
Yes — SSRIs (selective serotonin reuptake inhibitors) have good evidence for OCD and are often used alongside ERP-based CBT. Combined treatment produces better outcomes than either alone in many cases. Medication decisions should be made with a GP or psychiatrist.