Reference
Guide | Reference

38  Compulsivity and Perseveration

38.1 Summary

  • A dimensional construct describing repetitive thoughts, urges, or behaviors that are hard to inhibit and consume time or function.

38.2 Core Construct

  • Difficulty disengaging from repetitive cognitive or behavioral loops despite distress or low utility.

38.3 Subdimensions

  • Obsessional intrusions and doubt.
  • Behavioral rituals or checking.
  • Perseverative rumination or mental rituals.

38.4 Severity Anchors (0-4)

  • 0: No clinically meaningful compulsivity.
  • 1: Mild, occasional, manageable.
  • 2: Moderate, recurring, interferes with focus or time use.
  • 3: Severe, time-consuming or impairing.
  • 4: Extreme, disabling or unsafe.

38.5 Time-Course Patterns

  • Chronic with fluctuating intensity.
  • Trigger-linked spikes.

38.6 Functional Impact

  • Work/school: time loss, reduced concentration.
  • Relationships: reassurance seeking or conflict.
  • Self-care: avoidance or ritual delays.

38.7 Developmental Expression

  • Childhood: rituals or checking under stress.
  • Adolescence: increased rumination or perfectionism.
  • Late life: health-focused checking or safety rituals.

38.8 Cultural / Context Notes

  • Differentiate culturally normative rituals from distressing compulsions.

38.9 Differential and Rule-Outs

  • Anxiety threat responses without rituals.
  • Trauma intrusions without compulsions.
  • Psychosis with fixed beliefs.
  • Substance effects or neurologic contributors.

38.10 Measurement Prompts

  • Brief obsession/compulsion measure.
  • Time spent on rituals or rumination.

38.11 Treatment-Relevant Correlates (non-prescriptive)

  • High compulsivity often predicts avoidance and functional restriction.

38.13 Documentation Snippet (1-2 lines)

  • “Compulsivity elevated with checking and rumination; Compulsivity 3; chronic course.”