What are compulsions
From an etymological point of view the term compulsionreferring to human behavior, derives from the Latin verb compellAndking which means “to push forcefully”. Today the adjective compulsiveaccording to the literal meaning, is equivalent to the term “constricting” or “uncontrollable”.
It is precisely this literal meaning of the adjective that is often used, in common language but also in the psychological technical one, to indicate the tendency to implement behavior in a little regulated or forced way.
The same Vocabulary Treccani recites: compulsive adj. (der. of compulsion). – In psychiatry, impulse, behavior, act and similar, which is performed by a subject in a machine and unstable way, as a symptom of a variety of behavior and neurological disorders.
In fact, the term compulsionIn psychology and psychiatry, it is often associated with all problems of dependence and impulses control. In these psychopathological paintings, the subject is unable to resist an impulse and gives in to the urgent temptation to implement dangerous or dysfunctional behaviors. The act is usually preceded by an increasing sensation of excitement which follows gratification and/or relief.
Let’s take the example of the compulsive shopping. In this disorder the subject, starting from mental states characterized by unpleasant emotions (boredom, sadness, emptiness, etc.), is caught by the irrepressible sense of urgency with respect to the purchase (compulsions). The actual act ofcompulsive purchase Instead, it is accompanied by emotions of arousal, pleasure and gratification. For a behavioral mechanism of positive (given by the gratification) and negative reinforcement (reduction of previous unpleasant feelings) the behavior is fueled and the problem is self-manifested over time generating harmful effects even serious on personal functioning (economic and social problems, for example) but also a profound subjective suffering (e.g., feelings of guilt and shame with themes of scornful self-critical).
In the case of compulsive shoppingthe compulsion to the purchase, it turns out to be an impulsive act (the person cannot fail to give in to temptation) but also compulsive (repeated and perceived as not controllable). And this also applies to other substances use disorders or for impulses control disorder.
Compulsions in obsessive-compulsive disorder
In the field of psychopathology, the term compulsion It is also central in the phenomenology of obsessive-compulsive disorder (DOC). The DOC is in fact characterized by the intrusive and recurring presence of thoughts, doubts, impulses and mental images (obsessions) which generate intense discomfort, which is then reduced or temporarily eliminated by the subject, through actions with reassurance value (compulsions).
By definition, the compulsions In the DOC they are: “repetitive behaviors (e.g., wash your hands, tidy up, check) or mental actions (e.g. pray, count, repeat words mentally) that the subject feels obliged to implement in response to an obsession or according to rules that must be applied rigidly. The behaviors or mental actions are aimed at preventing or reducing anxiety or discomfort or preventing some feared events or situations; mental actions are not connected in a realistic way with what they are designated to neutralize or prevent, or are clearly excessive “(taken from DSM-5; APA, 2013).
Too often the compulsions of the Doc are confused with other Afinal and finalistic behaviors within various kinds disorders. Just think of certain behavioral symptoms inside neurological syndromes or in pervasive development disorders: in these cases, stereotyped motor manorisms, tics or ritualized actions are all behaviors without a motivational purpose below that characterizes the compulsions.
If this were not enough, there are finalistic behaviors, ritualized and forced to relate to other disorders that have underlying purposes very different from compulsions of the doc. For example, we think of repeated checks that patients with eating disorders put in place with respect to weight and body shape or the controls aimed at the behavior of others of paranoid subjects or with persecutory delusions. Then there are behaviors of continuous search for closeness in separation anxiety disorders and already described research behaviors of pleasure typical of pathological addictions.
In the doc, the compulsion Instead, it fulfills a very precise end which is that of the reduction of the discomfort associated with feared mental events (obsessions). In particular, thanks to the research in the cognitive-behavioral field, it has been possible to understand that the purpose below the compulsions It can be placed within 3 large motivational areas:
- Avoid damage feared for themselves or for others (what British colleagues call Harm Avoidance): all the compulsions Sometimes to reduce anxiety or fear related to the event that, by its inattention or lightness, terrible events can happen, such as, for example, diseases, accidents, economic damage, unfortunate events of a superstitious character.
- Avoid or reduce emotions of disgust (disgus avoidance): the acts aimed at reducing or canceling the discomfort connected to the alleged contamination with waste substances (e.g. feces, urine, sperm, saliva, hair) or with organic residues deemed disgusting by the subject (e.g., bums, drug addicts, prostitutes, people considered morally deplorable) are
- Avoid or reduce sensations of “not be fine” (Not Just Right Experience Avoidance): all actions include in this category compulsive which reduce or eliminate the subjective sensation that everything is not completely “right” and that something in themselves or in the surrounding world is not “how it should be”.
From what has just been said, we therefore understand as the same behavior compulsive may have completely different underlying motivations. We think, for example, at compulsions of reorganization and symmetry. Only asking us – and asking the patient! – What is the fear below, we can understand if the aim is to cancel a superstitious fear (“Doctor, if my documents are not all stacky on each other perfectly could a misfortune happen to my loved ones”) or rather to contain a fear of bewilderment (“only by keeping my aligned documents I am absolutely sure that they are all in their place. If I lost it would be a disaster, to avoid the unpleasant feeling of not being in place (“I feel uncomfortable if the documents are not all arranged in that way. I can’t stand it and I can’t do anything if I don’t feel” okay “!)
On the other hand, the same obsessive fear can be canceled or reduced through strategies compulsive Different: a hypothetical patient with DOC, for example, could pursue the purpose of reducing fear of contagion both with rituals compulsive of washing both with repeated checks and their clothes do not present hypothetical spots attributable to infected blood.
In conclusion, too often in psychiatry and psychology, we are faced with diagnostic framing purely based on symptoms, especially behavioral. This could lead us to leave out a question that is fundamental in our profession. What function does that behavior have?
From what has been said, in fact, the need to understand the specific motivation underlying to the compulsion In order not only to correctly frame the problem of the person, but also spread individualized psychotherapeutic interventions and dropped on the meanings underlying the behavioral symptom.
Recommended readings
- First chapter of the volume win the obsessions of Gabriele Melli
- Information booklet of the International OCD Foundation (in Italian)
