Jessica Gross | Longreads | February 2017 | 15 minutes (3,932 words)

Checking our smartphones every few minutes. Making sure every spice jar is in the exact right place in the rack. Shopping. Stealing. Working nonstop. Hoarding. “Compulsions come from a need so desperate, burning, and tortured it makes us feel like a vessel filling with steam, saturating us with a hot urgency that demands relief,” Sharon Begley writes in her new book, Can’t Just Stop. “Suffused and overwhelmed by anxiety, we grab hold of any behavior that offers relief by providing even an illusion of control.”

In a time of extreme anxiety for many of us, Begley’s book feels particularly relevant. In chapters that run the gamut from obsessive-compulsive disorder to compulsive do-gooding, Begley—a senior science writer for STAT, whose previous books include The Emotional Life of Your Brain and Train Your Mind, Change Your Brain—explores how behaviors that range widely in both character and extremity can come from a common root. “Venturing inside the heads and the worlds of people who behave compulsively not only shatters the smug superiority many of us feel when confronted with others’ extreme behavior,” she writes. “It also reveals elements of our shared humanity.” Begley and I spoke by phone about what anxiety is, exactly; her own compulsions; and whether it’s possible to have no compulsions (not likely).

What is the definition of “compulsion,” as compared to addiction and impulsive behaviors?

This was the first thing that I had to grapple with. The first thing I did was go around to psychologists and psychiatrists and start asking, “What is the difference between these three things?” To make a long story as short as possible, they really didn’t have a clue, or at least they were not very good at explaining it—to the extent that the same disorder would be described in the DSM, the Diagnostic and Statistical Manual of Mental Disorders from the American Psychiatric Association, using “compulsive” one time and “impulsive” the next.

So where I finally came down, after finding people who had really thought about this, is as follows. Impulsive behaviors are ones that go from some unconscious part of your brain right to a motor action. There is very little emotion except for that feeling of impulsivity. There’s certainly little to no thought involved.

Behavioral addictions—and this is where I thought it started to get interesting—are born in something pleasurable. If you’re addicted to gambling, it probably is because, at least when you started, it was a whole lot of fun. You loved it. You got a hedonic hit, a pulse of enjoyment. And certainly as things go along, a behavioral addiction like gambling can cause you all sorts of distress and destroy your life. But at least at the beginning, it brings you extreme pleasure.

Compulsions are very different. They come from this desperate, desperate need to alleviate anxiety. They’re an outlet valve. The anxiety makes you want to jump out of your skin, or it makes you feel like your skin is crawling with fire ants. And what compulsions do is bring relief only after you have executed the compulsion, whether it is to exercise, or to check your texts, or to shop, or to keep something if you’re a hoarder. And crucially, compulsions, although they bring relief, bring almost no enjoyment except in the sense that if you stop banging your head against a wall, then it feels good to stop.