This article discusses the neural systems thought to be involved with some of the processes implicated in the repetition compulsion: drives, wishes, and impulses; emotional and reward learning; and self- and affect-regulation. The author looks at the neurobiological underpinnings of these processes and finds that the compulsion to repeat may represent a variety of ways that we try to approach pleasure and avoid unpleasure—which would place it within, rather than beyond, the pleasure principle. The author then suggests some possible mechanisms by which reflecting on the repetition compulsion from a neurobiological and psychodynamic framework may facilitate change.