When the Drive Repeats: OCD as Repetition Compulsion, Not Just Anxiety

Most clinicians are taught to treat OCD as a problem of fear:

Fear of germs.

Fear of harm.

Fear of something terrible happening if the ritual isn’t completed.

We respond accordingly — with exposure hierarchies, thought records, cognitive strategies.

And often, these work.

But sometimes… they don’t.

And what’s worse, we don’t know why.

We assume the treatment failed.

What if instead, we misunderstood the symptom?

This article explores a forgotten clinical truth:

Not all OCD is about avoidance.

Some of it is about repetition — not of behaviour, but of drive.

Not Everything Is About Anxiety

Freud’s early work on obsessional neurosis suggested something that still holds clinical weight:

The obsession is not a reaction to fear — it is a compromise formation.

A symbolic solution to a conflict between unconscious wishes and defences.

In modern terms:

The ritual is not just about preventing danger.

It is about acting out something that cannot be thought or tolerated.

That “something” is often unconscious guilt, desire, or aggression — a drive demand the ego cannot accept.

Repetition Compulsion in OCD

Let’s reframe the obsessional ritual as a kind of reenactment. Not just a compulsion to neutralise threat — but a repetition of an unresolved internal drama.

The young person who checks the locks 17 times each night is not simply afraid of burglary.

They may be repeating a gesture of failed protection — a fantasy of being the one who prevents harm they once felt helpless to stop.

Or the adolescent who washes until their hands bleed — not because they fear contamination…

But because they are attempting to punish the self.

A repetition of a superego-driven demand to atone for an internal transgression.

What Drives the Repetition?

In a Freudian formulation, there are three potential forces that may drive repetition in OCD:

1.Punishment for Unconscious Desire

The obsessional act functions as a self-imposed sentence for desires the ego cannot integrate:

• Aggression toward a sibling

• Sexualised phantasy

• Rivalry or envy toward a parent

The ritual cleanses the wish — but also keeps it alive.

2.Mastery of Helplessness

Some rituals recreate the conditions of helplessness to transform them:

• “If I control everything now, I won’t be the one caught off guard.”

• “If I recreate the scene internally, maybe I’ll win this time.”

What appears compulsive is actually an attempt to master trauma through repetition.

3. Avoidance of Psychic Contact

Paradoxically, repetition can serve to evacuate emotion. The ritual is repeated not to make something happen — but to prevent something from being felt.

This is where symbolisation fails, and action takes over. The symptom says:

“Don’t feel. Don’t think. Just do.”

Clinical Markers That Repetition, Not Fear, Is Driving the OCD

• The ritual provides no real relief, only momentary reset

• The content of the intrusive thought does not match the level of affect

• There is a moral tone to the ritual — often involving shame, punishment, or confession

• Exposure work elicits confusion or detachment, not just fear

• The young person struggles to describe what they fear will happen — or says, “I don’t know. I just have to.”

These are signs we’re not dealing with avoidance of catastrophe…

We’re dealing with a psychic ritual, replayed unconsciously.

Therapeutic Implications

Understanding OCD through the lens of repetition compulsion shifts our approach.

We move from:

• Stopping the behaviour

  
  

  To:

• Understanding what is being repeated — and why the mind needs it.

This doesn’t replace behavioural intervention. But it contextualises it.

Exposure without insight risks reinforcing the split.

But interpretation without containment risks overwhelming the ego.

The task is not to choose one — but to know when the mind is ready for each.

Final Thought

OCD is not always a symptom of fear.

Sometimes, it is a performance of internal conflict — rehearsed again and again, hoping this time the ending will be different.

To treat it effectively, we must stop asking only, “What are they afraid of?”

And start asking:

“What are they trying — again and again — to resolve?”