You've probably heard a friend describe themselves as "a little OCD." Perhaps you know someone who always cleans the shared kitchen at work and leaves notes for those who mess it up. Maybe your cousin can't put their smartphone down when you go to dinner. All of these are manifestations of compulsion. Compulsion can be an irresistible force, one that surfaces as a response to our own anxieties. It can drive you to shoplift, to count the number of red doors, or to hoard every copy of the New York Times you can get your hands on. Or it can be as innocuous as your need to wipe down your computer keyboard before you start work each morning.
In her book Can't Just Stop: An Investigation of Compulsion, Sharon Begley, who is the senior science writer at the Boston Globe, probes exactly what compels us. Begley searches for the line between acceptable, even helpful, compulsions and diagnosable disorders, following the latest changes in thinking from the American Psychiatric Association. She looks at hoarding, when a person can't stop letting things into their lives until they are fully taken over by their possessions; video games, whose intermittent rewards structure pings our pleasure centers; and compulsive do-gooders, who will put themselves and their families in danger in order to be perceived as a good person.
In conversation with Begley, she breaks down why we try not to "step on cracks" when we know it won't "break our mother's back," how your social-media use is not a mental disorder, and psychiatry's history of over-labeling relatively normal behavior.
Courtney E. Smith: We often throw the terms around interchangeably, but what are the differences between compulsive behavior, obsessive-compulsive disorder (OCD), and obsessive-compulsive personality disorder (OCPD)?
Sharon Begley: I started out with the same question, wondering what counts as compulsive behavior and how you can tell the difference between that and an impulse-control problem or an addictive behavior. The American Psychiatric Association, in its current Diagnostic Manual ( DSM-5 ), for the first time allowed a behavior to be considered an addiction with gambling. That means that suddenly behavior can be either addictive, impulsive, or compulsive. My first round of interviews for this book was asking psychologists, psychiatrists, and experts to explain to me the difference. Long story short: they struggled to explain it.
A compulsive behavior is one that is born in anxiety; in other words, we feel anxious about doing or not doing something and then engage in that behavior to make the anxiety go away. That connects with OCD, which is a well-recognized disorder. It is characterized by obsessions and compulsions. The obsession is an idea in your head, usually an incorrect idea, about the world, like thinking your hands are covered in germs or that you've left the front door unlocked. The compulsion is the behavior that you do to diffuse your anxiety. A person with OCD will wash their hands all the time or get up countless times during the night to check the door lock. It can be completely and totally debilitating. OCPD is a recognized disorder, in the DSM-5, that is characterized by obsessive thoughts that aren't quite as severe as OCD. It is an extreme form of consciousness.
CES: An idea you put forward in the book that caught my attention, because I hadn't previously given much thought to the difference between compulsion and diagnosed disorders, is that we should think of compulsion on a spectrum, in the same way we talk about autism.