Compulsion or Addiction?

Is it a habit, an obsession, a compulsion or an addiction?

Compulsion and addiction each involve a perceived lack of control by the individual facing them. However, there are some key differences.

Most all of us exhibit habitual behavior, for instance looking both ways before crossing the road, but compulsions and addictions refer to those instances where these behaviors disrupt an individual’s ability to function.

We’ve all avoided stepping on the cracks between paving stones on the way to school: that was no mere habit, but a compulsion, since we thought there would be an undesirable outcome if we didn’t perform the ritual. Likewise, common compulsions include repeatedly making sure the gas is turned off when leaving the house and making sure the lights are ‘properly’ out by switching them on and off again.

Compulsive actions and behaviors offer temporary relief from anxiety — in turn, the need to reduce this anxiety is what drives the compulsive behavior. Sometimes an obsessive thought relates to the compulsive behavior (such as fear of germs and hand-washing), but often the compulsive behavior has no clear relation to anything in particular, like performing a superstitious ritual of walking all the way around one’s car before getting in.

The term addiction is used to describe a recurring compulsion by an individual to engage in some specific pleasure-seeking activity, despite harmful consequences to the individual’s health, mental state or social life. Like when one reaches for a cup of coffee, the pleasure center of the brain receives stimulation so the action is repeated. Not all doctors agree on what addiction or dependency is. The term is often reserved for drug addictions to psychoactive substances that alter the natural chemical behavior of the brain, defined by tolerance to the drug, withdrawal symptoms and inability to decrease the amount consumed, but it is sometimes applied to other compulsions such as problem gambling and compulsive overeating. Many people, both psychology professionals and laypersons, now feel that the term addiction should be made to include psychological dependency on such things as gambling, food, sex, pornography, computers, work, exercise, shopping, and religion. Although these are things or tasks which, when used or performed, do not fit into the traditional view of addiction and may be better defined as an obsessive-compulsive disorder, withdrawal symptoms may occur with abatement of such behavior.

Obsessions are persistent ideas, thoughts, impulses, or images that cause anxiety or distress. Repeated doubts and the need to have things in a particular order are some of the more common obsessions. The individual with obsessions usually attempts to suppress such thoughts or impulses or to neutralize them with some other thought or action (i.e., a compulsion). A compulsion, then, is a feeling that you have to do something to relieve the obsessive thought or doubt. A compulsion is a physical or mental act that you perform over and over–the act of an obsession. Common compulsions include counting, washing, arranging and checking things again and again. When these tendencies are exaggerated, like when having to perform a ritual of making sure the front door is locked 10 or 20 times every time you go out, the behavior has escalated to an obsessive-compulsive disorder (OCD). Such behavior then becomes time-consuming and interferes with normal daily routine.

Perhaps the most famous of all OCD sufferers was the billionaire entrepreneur Howard Hughes (’The Aviator’), who spent his later life mentally and physically incarcerated by his own fears of contamination and elaborate cleaning rituals.

No one is sure why people have OCD. New research suggests that OCD may be related to atypical functioning of the circuitry in a part of the brain called the striatum. Whatever the reason, there seems to be an inappropriate response to anxiety in the deeper, primitive part of the brain that is not involved in reasoning. The cause of OCD is probably a mix of many factors including neurobiological, environmental influences and the way we think.

A link between addiction and OCD was illustrated when an assessment of 50 alcoholic patients revealed that 12% had OCD, 5 or 6 times greater than in the general population. Addictions are often refractory to treatment, but patients treated for substance abuse and OCD showed greatly reduced OCD symptoms and higher overall abstinence rates.

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