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One of the most easily recognised features of OCD is the seemingly illogical actions people initiate while suffering from the condition. However, even though these rituals may seem illogical to the casual observer, our work has demonstrated that these rituals have an intelligible underlying logic of their own. It is also important to point out that successful treatment of OCD is based on being able to identify the underlying logic and use interventions based on the exact same logic.
Fear or Pleasure?
We can distinguish obsessive compulsions based on fear (such as hand washing enacted to prevent contamination) from those based on pleasure (such as compulsive shopping, vomiting syndrome or pathological gambling). One difficulty for humans is that pleasure based compulsions are aided greatly by the structure of the brain and its ability to find pleasure in repetition. However, not all rituals are the same in structure or even in their purpose, or what we might call ‘logic.’ While some rituals have to be done a number of times, some are done in specific sequence and others can be done to feel a certain way or to achieve a specific sensation. The logic underlying these rituals is important, because if the clinician doesn’t recognise the logic supporting the compulsion, they won’t be in a position to know what kind of intervention will be necessary to treat the problems rapidly and effectively.
Below is a general description of the structure and type of most compulsive rituals when viewed from our perspective.
A Strategic Description of Rituals
Rational and preventive rituals: These rituals are specific actions that arise from the patient’s belief that doing so can prevent a certain feared situation from happening. For example, getting contaminated or infected, losing control, losing body energy and so forth.
Reparative rituals: The performance of these ritualised actions or thoughts hold the illusion of protection for the person from something that could have happened already. This includes washing hands as an attempt to eliminate dirt left on them, or checking whether a job has been done several times for fear that it is wrong, or repeating the name of a certain person to exorcize their negative gaze or bad luck. These rituals are carried out to intervene in and repair the damage after a feared event has taken place, so that the patient will not feel that they are in danger. Therefore, it is oriented toward the past.
Propitiatory rituals: The performance of these rituals or thoughts (seemingly magical) appear to make something positive happen, or have the illusion of helping the patient avoid something negative. An example may be arranging objects in a particular position to bring good fortune or to avoid misfortune. These rituals are a form of magical thinking, like highly fatalistic religious beliefs, superstitious convictions, and confidence in extraordinary powers or faith.
The compulsions described above constitute the failed attempts made by the patient to control their fear or to achieve a sensation. Other failed solutions below also create and maintain the disorder.
Failed Attempts at a Solution
- Avoidance of any anxiety provoking places, people or objects. This is essentially an attempted solution which feeds the problem.
- A continual search for reassurance or help from family members, friends or partners, who can eventually become entangled in the pathological mechanisms.
Family and Friends
We cannot forget about the impact family members and loved ones can have on the patient with OCD. Family members are very often involved in these dysfunctional rituals or control. Patients who suffer from OCD can become more anxious and aggressive over time towards friends and family if they refuse to cooperate and this must be managed effectively so as to avoid worsening the situation. It is very important that others participate in the treatment to increase its effectiveness. It is important that family members step aside from this pathological and vicious circle and allow for the restoration of the patient’s responsibility for their problem.
