OCD: The logic of compulsions and rituals

One of the most easily recognizable characteristics of OCD is the seemingly illogical nature of the actions taken by people who suffer from it. However, although these rituals may seem illogical to the casual observer, our work has demonstrated that they have an intelligible underlying logic of their own. It is also important to emphasize that successful treatment of OCD relies on the ability to identify the underlying logic and use interventions based on that same logic.

Compulsions, what are they?

We can distinguish obsessive compulsions based on fear (such as hand washing to avoid contamination) from those based on pleasure (such as compulsive buying, vomiting syndrome or pathological gambling, etc.). A difficulty for humans is that pleasure-based compulsions are greatly facilitated by the structure of the brain and its ability to find pleasure in repetition. However, not all rituals are the same in their structure or even their purpose, or what we might call "logic." While some rituals must be done a certain number of times, others are done in a specific sequence, and still others can be done to feel a certain way or to achieve a specific sensation. The logic behind these rituals is important, because if the clinician does not recognize the logic behind the compulsion, he or she will not be able to know what type of intervention will be necessary to treat the problems quickly and effectively. Below is a general description of the structure and type of most compulsive rituals, seen from our point of view.

Description of compulsive rituals

Rational and preventive rituals

These compulsive rituals are specific actions that arise from the patient's belief that by doing so he can prevent a certain feared situation from occurring. For example, being contaminated or infected, losing control, losing bodily energy, etc.

Repair rituals 

Performing these ritualized actions or thoughts gives the illusion of protecting the person from something that might have already happened. These include washing your hands to try to remove dirt left on them, checking to see if a job has been done multiple times for fear that it is not good, or repeating the name of a certain person. no one to exorcise his negative outlook or his bad luck. These rituals are performed to intervene and repair damage after a feared event has occurred, so that the patient does not feel unsafe. They are therefore oriented towards the past.

Propitiatory rituals 

Performing these (apparently magical) rituals or thoughts appears to cause something positive to happen, or has the illusion of helping the patient avoid something negative. This may involve, for example, arranging objects in a particular position in order to bring good fortune or avoid misfortune. These rituals are a form of magical thinking, linked to highly fatalistic religious beliefs, superstitious convictions and/or reliance on extraordinary powers or faith, etc.