How to treat OCD without rituals with the systemic approach?

An interactional reading involves a more personalized understanding of OCD , recognizing that individuals may experience and manifest their symptoms in unique ways. This approach promotes personalization of treatment, with a more in-depth exploration of underlying dynamics which helps to improve therapeutic engagement. While the DSM provides a structured framework for classifying disorders, interactional reading enriches clinical understanding by highlighting the diversity of OCD experiences and informing therapeutic approaches tailored to each individual.

Determining the nature of OCD

The treatment will be oriented according to the nature of the OCD observed: OCD with rituals , OCD without rituals or pathological doubt, pathological doubt.

What is OCD without rituals or pathological doubt?

In the analysis of obsessive disorder without rituals or pathological doubt , the excessive search for control to the point of loss of control is a central paradox. This disorder, primarily driven by fear of error, results in a paradoxical failure to control thoughts that are supposed to help maintain order and predictability. The person suffering from this disorder frequently engages in excessive planning and pervasive control, characteristic of an obsessive perception-reaction system. This hyper-control manifests itself in a vicious circle where defense against phobic perceptions leads to an increased need for control, culminating in a total loss of it.

Affected individuals often enter into crisis when confronted with uncontrollable elements, highlighting the limits and fragility of their rigid control system. This disorder can sometimes be accompanied by an “obsessive-paranoid” type perception-reaction, where distrust of others and a rigid perception of the world predominate. To combat intrusive thoughts, the individual may seek distraction, seek comfort or assurance from others, or engage in compulsive behaviors.

How to identify OCD without rituals or pathological doubt?

In the therapeutic approach, it is essential to understand whether the individual is using their mind more or performing physical actions to maintain control. It is also crucial to determine whether these actions are preventative or reactive, and whether the mental controls are aimed at avoiding certain thoughts or engaging in rumination. Understanding whether the concerns are focused on oneself, on others, or on broader external elements, allows the intervention to be adapted to the specific situation of the individual.

Strategic questions make it possible to identify the nature of obsessions and compulsions without rituals or pathological doubt, their impact on the individual's daily life, and the underlying mechanisms that maintain the disorder. Examples of strategic questions that could be asked in such cases include:

Questioning the nature of obsessions:

• What is the specific nature of your obsessions?
• How do these thoughts manifest and how often?

Question the impact on daily life:

• How do these obsessions affect your daily life?
• Are there specific situations or times when they are more intense or disruptive?

Identify current management strategies:

• What strategies do you currently use to manage your obsessions?
• Are these strategies effective or do they provide temporary relief?

Identify emotional and physical reactions:

• What emotional and physical reactions do you experience in response to these obsessions?
• How do these reactions influence your behavior and ability to function 

Trace the history of the disorder:

• When did you start noticing these obsessions?
• Have they evolved or changed over time?

Understand the influence on relationships and activities:

• How do these obsessions affect your personal relationships, professional relationships, or other important activities?
• Are there any avoidances or behavioral changes related to these obsessions?

Questioning awareness of obsessions:

• Are you aware of the irrationality or exaggeration of these obsessions?
• How do you perceive these thoughts and their validity or importance?

Ask for support and resources:

• What type of support or resources have you sought or found helpful in the past?
• Are there any interventions or approaches that you have not yet explored but that interest you?