What is the Difference between Compulsive and Addictive Behaviour?
This is a question which is often asked in class, so it is worth exploring in a bit more detail. Please remember though that the distinction can be a fine one, which sometimes changes as new research becomes available. ‘Compulsion’ and ‘Addiction’ are terms which are also used differently and interchangeably, even by the medical profession, so this distinction becomes confused at times. We have all heard of ‘compulsive gambling’, for example, but this may also be referred to in terms of ‘addictive behaviour’. So, where does the distinction lie?
Firstly, it is useful to define what we mean by these types of behaviour:
Compulsive Behaviours - an article from the Neuropsychology Review of 2019, suggested the following definition:
‘Compulsive behaviour consists of repetitive acts that are characterised by the feeling that one has to perform them while also being aware that these acts are not in line with one's overall goal.’
So, people with compulsions will repetitively engage in behaviours which are disruptive for themselves and their environment. In OCD, for example, clients will often report that they fully realise that their compulsions are not rational and they recognise the disruptive effects they have on their life, but still cannot give always give a reason for why they continue to do them. Consider the compulsion of having to wash your hands 25 times, for example. This has a considerable effect on your daily routine. No real pleasure is gained from the act, although there will be a reduction of anxiety when the act is performed. This will be temporary, however, and the person will need to repeat this again and again to achieve anxiety reduction.
Addictive behaviours, on the other hand, involve an element of pleasure at least initially, which we explore later in this article. There is no real pleasure as such in the previous example of hand washing, for example, (apart from the feeling of relief from anxiety). Addictive behaviours refers to the abusive use of any substance despite the harmful effects and negative consequences that may arise. These substances can include: illegal drugs, over the counter and prescription medication, food, coffee, sugar, and legal drugs such as nicotine and alcohol.
In a similar way, process addictions are defined as self-sabotaging and recurrent behaviours which are repeated to the extent of causing adverse consequences to an individual’s health and wellbeing, both physical and mental. Examples include addictive gambling, sex addiction, working out, playing video games repetitively and so on.
The word ‘compulsive’ is often used in the definition of addictions, so this can muddy the waters somewhat. So what are the differences between the two? We can pinpoint two major distinctions:
• Pleasure is the first major difference, as mentioned above.
Addictions usually start with the expectation of pleasure, whereas compulsions, certainly in the case of disorders such as OCD don’t. While people with addictions suffer all manner of discomfort to pursue their goal, their behaviour is still rooted in the expectation of some degree of pleasure or positive outcome. Many addictions also begin as a coping strategy – the glass of wine at the end of a busy day, which creates a relaxing, positive feeling of being able to ‘wind down’, for example.
Obviously this aspect of ‘pleasure seeking’ can be confusing to consider, because there comes a point where people don’t really enjoy the addictive behaviours at all and are simply seeking relief from the urge to continue. There may be recognition of their addiction and experiences of withdrawal, which can cause intense emotional and physical pain. At this stage, the pleasure is gone and their behaviour does have compulsive elements.
However, the original motivation was pleasure and herein lies the distinction.
• Another significant distinction is the individual’s awareness of their actions and of reality.
When we consider OCD again, often people are frustrated by their inability to control compulsions which they know are irrational and often non-nonsensical. Although the actions they repeat may temporarily assuage the anxiety, there can also be a sense of increasingly anxiety about their compulsive behaviours, as they question their need to act in this way (In effect, an anxiety about their anxieties).
Conversely, at least in the earlier stages of addictions, people may simply feel that they are having a good time and may well ignore any signs that their behaviour is spiralling out of control. They may well argue against the concerns of others who can see that they are on the path to addiction. This denial is part of the addiction cycle and often will continue until something major happens, such as a drink driving incident, which forces a person to confront the reality of their addiction.
Actually, there are considered to be two different types of addiction denial – Type A and Type B. Type A individuals usually know and understand they have a problem but will deny it when confronted, by being dishonest and manipulative, whereas Type B are usually partially or completely blind to their illness.
One of the problems we have in defining different types of disorder or issue is that many words which belong in the mental health arena are now used in common vernacular. ‘Depressing’ is used to describe a bad day; ‘OCD’ is used as a joke to describe someone’s love of cleaning or tidying their home. It’s up to us as therapists to use words properly and judicially.
