A diary study of the phenomenology and persistence of compulsions

• Compulsive episodes yielded a sense of certainty over 50% of the time.
• Negative beliefs about obsessions were not associated with distress over obsessions.
• Stronger negative beliefs about obsessions were associated with less chance of achieving certainty.
• Episodes ending without certainty had more repetitions and sensory/cognitive doubt.
• Treatment should identify and address factors that influence compulsion persistence.

Background and objectivesResearch on the persistence of compulsions has found that, when making the decision to stop a compulsion, people with OCD weigh sensory and memory information as more important than external criteria. At the same time, research has also found that repetition of behaviour has a deleterious effect on memory, sensory and cognitive confidence. These findings have important treatment implications but they are almost exclusively laboratory based. This study sought to examine compulsions as they occur in vivo using a structured diary format.Methods22 People with a principal diagnosis of OCD completed measures of memory, sensory and cognitive confidence and used a structured diary to report on three compulsive episodes a day for three days.ResultsDespite repetition, a sense of certainty or the “right” feeling was achieved in over half of the compulsive episodes. The outcome of compulsive episodes was not influenced by distress over the obsession, nor was distress associated with negative beliefs about obsessions. Episodes in which certainly was not achieved were characterized by greater repetitions, greater memory, cognitive and sensory doubt and less certainty that the compulsion had been done properly.LimitationsThe sample size was modest, checking compulsions were over-represented and data were based on retrospective self-report, albeit 2-h on average.ConclusionsConsistent with laboratory studies, repetition has insidious effects on the persistence of compulsions. However, compulsions yielded a sense of certainty half the time, despite repetitions.