Unlike anorexia nervosa and
self-mutilation, OCD has always had a legitimacy about it in that the
non-afflicted, meaning those of us who do not suffer from it, as in the
cases of anxiety and depression, can see ourselves as having a bit of
"personal superstition". Nonetheless, most of us have difficulty
understanding how someone could be nightmarishly crippled by it. Yet
until the last decade, OCD has been viewed by many as purely chemical
with nearly no psychological components to it.
There have traditionally been two
forms of treatment recommended for OCD. The first has been
"desensitization" - having the person afflicted with OCD repeatedly
perform the behavior that they dread and avoid. For example, if one has
a fear of contamination, demand that they handle dirty objects. If a
person has a need to repeatedly check stove knobs, door locks, etc, far
beyond what is reasonable, have them walk away from these objects with a
maximum of one check. The second treatment has been solely medication.
OCD involves a highly complex set
of ideas that are no doubt based on many factors: trauma, heredity,
chemistry, and family life. Individuals will fall into varying clusters
of these categories. The intensity and frequency of their need to
perform these behaviors will vary as well. Some persons will be able to
contain doing these behaviors so that they are not seen by anyone else.
Others will be embarrassed and humiliated at being compelled to do these
inappropriate behaviors within plain sight of others. These behaviors
are "fear - avoiding" and "dread - avoiding" behaviors which produce
familiar discomfort while they are performed. This is preferable to the
more intense level of fear or dread if they are not performed for the
number of repetitions each individual has prescribed for himself or
Treatment may need to involve a)
medications, and there are several b) a behavioral component, and c) I
believe, long-term psychotherapy that is designed to produce an alliance
with another person (the therapist) who will, to a large degree, replace
the rituals. In other words, "relationship vs. rituals".
Many of these rituals and the
theory behind their origins, as well as the psychotherapeutic style of
treatment I recommend, are discussed in
(1991, Warner Books).