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.

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...