There is no universal definition of compulsive behaviour, but the most all-encompassing one available in research is “repetitive acts that are characterized by the feeling that one ‘has to’ perform them while one is aware that these acts are not in line with one’s overall goal”1. Sufferers of Obsessive Compulsive Disorder (OCD) may find themselves washing their hands twenty times a day, despite knowing that it serves them no purpose. Alcoholics and drug addicts all-too-often may feel an irresistible urge to use their substance of choice, even though they are aware of the harmful effects it will have on them. Other conditions which are characterised by compulsive behaviour include anorexia, bulimia, gambling addiction, shopping addiction, sex addiction, hoarding, and self-harm. This article will seek to understand compulsive behaviour and its causes further, and to explore how it can potentially be treated.
It is important to note that whilst the mechanism of action is similar for many compulsive behaviours, the driving force and reasoning is not always the same. It is theorised that the behaviours of an OCD sufferer are motivated primarily to relieve the symptom of the illness, which is characterised by an uncontrollable urge to do an action even though there is no logical explanation for it. In other words, it is not a pleasure-based experience. On the other hand, addicts commonly believe that engaging in their behaviour of choice (or no choice, depending on how one looks at it) will be pleasurablei2. It should be acknowledged that OCD and addiction are not mutually exclusive, with young-onset OCD being associated with increased risk of addiction problems3.
What causes compulsive behaviours?
In OCD sufferers it is thought that prolonged exposure to stress or trauma can cause these symptoms; in one study of Vietnam war veterans, those with a higher exposure to intense firefights were much more likely to suffer with the condition4. It is thought that addiction can be caused by a multitude of factors such as genetics and childhood trauma5. During this addiction, it is thought that the dopamine system is culpable for the characteristic behaviours. Dopamine is our “feel good” chemical, and is released when we do pleasurable activities, such as exercise, have sex, and eat. Drugs and other addictive behaviours cause a massive release of dopamine in our bodies. It has been said that over time the amount of dopamine the brain can absorb decreases through the amount of receptors declining, which leads to the subject increasing their drug intake to counteract this as the brain now expects this massive dopamine release. Decreasing one’s own dopamine receptors through drug use has been shown to disrupt the parts of the brain responsible for inhibitions and emotional control, leading to increased impulsivity and lack of control6. It is thought that these parts of the brain are also responsible for the behaviours in OCD 7.
It has been theorised that the brain has learned to recognise certain patterns in usage, which can explain why some addicts relapse when faced with people, places, or things which they connect with using drugs. This ingrained coping mechanism can last for years; in the aforementioned study with Vietnam veterans it was shown that exposing the subjects to these triggers had the effect of making them want to take drugs. This can happen subconsciously, which may help to clarify why some cannot explain why they relapsed.
How can compulsive behaviours be treated?
The previously mentioned Vietnam veterans also provide some clues as to how addicts can recover. It is estimated that between 10% and 25% of all soldiers in Vietnam were addicted to heroin but were forced to detox before they could take the plane home at the end of the war. Out of the entire addict population, only 12% of all addicts went on to relapse on heroin when they got home, showing that environmental triggers play a massive role in the brain’s response to compulsive behaviours. Whilst avoiding all potential triggers may be an unreasonable request for an addict, the malleable nature of our brains means that slowly, and with the right support one can learn to cope with these situations without using destructive coping mechanisms8
As with most psychological disorders, there is no “one size fits all treatment”, so we offer a range of treatments at our private rehab. Cognitive behavioural therapy has been shown to be effective in some patients 9, whilst interestingly the application of Naloxone has been shown to be effective for both OCD and addiction in terms of compulsive behaviour 10. Other options available for treatment are counselling, complete abstinence and medication. Whilst the thought of making a change to one’s brain through addiction is a daunting one, it is not a future without hope. The brain’s neuroplasticity (ability to change) means that it is absolutely possible for one’s brain to restore itself to the levels it was at previously 11.
2 Hartney, Elizabeth. “The Difference Between An Addiction And A Compulsion”. Verywell Mind, 2020, https://www.verywellmind.com/the-difference-between-an-addiction-and-a-compulsion-22240.
3 Mancebo, Maria C. et al. “Substance Use Disorders In An Obsessive Compulsive Disorder Clinical Sample”. Journal Of Anxiety Disorders, vol 23, no. 4, 2009, pp. 429-435. Elsevier BV, doi:10.1016/j.janxdis.2008.08.008. Accessed 14 July 2020.
4 de Silva, Padmal, and Melanie Marks. “The Role Of Traumatic Experiences In The Genesis Of Obsessive–Compulsive Disorder”. Behaviour Research And Therapy, vol 37, no. 10, 1999, pp. 941-951. Elsevier BV, doi:10.1016/s0005-7967(98)00185-5. Accessed 14 July 2020.
5 Miller, Dusty. Psychiatric Quarterly, vol 73, no. 2, 2002, pp. 157-170. Springer Science And Business Media LLC, doi:10.1023/a:1015011929171. Accessed 14 July 2020.
6 Volkow, N. D. et al. “Addiction: Beyond Dopamine Reward Circuitry”. Proceedings Of The National Academy Of Sciences, vol 108, no. 37, 2011, pp. 15037-15042. Proceedings Of The National Academy Of Sciences, doi:10.1073/pnas.1010654108. Accessed 14 July 2020.
7 Lubman, Dan I. et al. “Addiction, A Condition Of Compulsive Behaviour? Neuroimaging And Neuropsychological Evidence Of Inhibitory Dysregulation”. Addiction, vol 99, no. 12, 2004, pp. 1491-1502. Wiley, doi:10.1111/j.1360-0443.2004.00808.x. Accessed 14 July 2020.
8 Snoek, Anke. “How To Recover From A Brain Disease: Is Addiction A Disease, Or Is There A Disease-Like Stage In Addiction?”. Neuroethics, vol 10, no. 1, 2017, pp. 185-194. Springer Science And Business Media LLC, doi:10.1007/s12152-017-9312-0.
9 McGovern, Mark P. et al. “A Cognitive Behavioral Therapy For Co-Occurring Substance Use And Posttraumatic Stress Disorders”. Addictive Behaviors, vol 34, no. 10, 2009, pp. 892-897. Elsevier BV, doi:10.1016/j.addbeh.2009.03.009. Accessed 14 July 2020.
10 Amiaz, Revital et al. “Naltrexone Augmentation In OCD: A Double-Blind Placebo-Controlled Cross-Over Study”. European Neuropsychopharmacology, vol 18, no. 6, 2008, pp. 455-461. Elsevier BV, doi:10.1016/j.euroneuro.2008.01.006. Accessed 14 July 2020.
11 Field, Matt. “The Biology Of Desire: Why Addiction Is Not A Disease. M.Lewis Publicaffairs, New York, USA, 2015. ISBN: 978 1 61039 437 6 (Hardback).”. Addiction, vol 110, no. 12, 2015, pp. 2039-2039. Wiley, doi:10.1111/add.13141. Accessed 14 July 2020.