An in vivo study of compulsions

Abstract

Leading models of obsessive-compulsive disorder (OCD) assume that compulsions are enacted to neutralize distress over obsessions. However, lab-based research suggests that once a compulsion starts factors other than distress cause it to persist. There have been few studies of the persistence of compulsions as conducted in people's own environments. The purpose of this study was to replicate and extend existing findings by having participants with OCD (N = 36) keep diary records of their target compulsion once a day for six days, using a tablet app based on Bucarelli and Purdon’s (2015) Repeated Actions Diary. Key findings were: beliefs about obsessions had a modest association with distress over the obsession, but neither beliefs nor distress were strongly associated with compulsion duration or repetitions. Compulsion goals were often framed in ways that rendered them impossible and unverifiable (“get rid of all the germs”) rather than harm avoidance or distress reduction. Compulsions were not repeated often, particularly washing compulsions. One of the most important compulsion goals was to avoid being held responsible for harm by others, and this may warrant further study. It may be helpful in treatment to identify and address compulsion goals. Continued study of compulsions is warranted.