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.
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).
Many such rituals are done in a 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 effectively.
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.
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.
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.
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.
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