Rituals are behaviors thatOCDsufferers engage in to try to reduce anxiety, distress, or prevent some feared outcome related to their obsessive thoughts. Common rituals include excessive washing or cleaning, repeating actions, checking things repeatedly, ordering items, counting, seeking reassurance, etc.
Rituals are time-consuming and interfere significantly with daily activities or functioning. People may spend hours each day engaged in rituals. People with OCD typically recognize the irrational or excessive nature of the rituals but feel unable to control or resist the intense urge to perform them.
Rituals provide temporary relief from anxiety, but the obsessions and distress soon return. This drives the vicious cycle of ongoing ritualizing behavior.
Rituals prevent new learning and reinforce OCD beliefs. Avoiding triggers maintains fears rather than allowing opportunities to disconfirm them.
Rationale
Prior research demonstrates that compulsions are functionally distinct from obsessions in OCD and drive much of the impairment associated with the disorder (Abramowitz et al., 2003; Storch et al., 2008).
However, common assessment measures often combine obsessions and compulsions into overarching content dimensions (e.g.,contamination,religious; Storch et al., 2010).
This conflation provides a limited understanding of the heterogeneous nature of rituals, their patterns of co-occurrence, and their ability to predict outcomes (Leckman et al., 2010; Subira et al., 2015) differentially.
Cluster analysis allows the examination of interrelationships among rituals that may better inform treatment planning compared to a singular focus on content (Rufer et al., 2005).
Further, identifying poor prognostic factors upfront, such as certain hard-to-treat ritual subgroups, can lead to improved care delivery and outcomes for those patients (Jakubovski et al., 2013).
Method
Sample
Statistical Analysis
Results
Insight
Strengths
Limitations
Implications
Using mixed methods identifies more nuanced compulsions
Tailoring treatment for ritual profiles
Assessing linked uncertainty
Keep Learning
References
Primary paper
Pinciotti, C. M., Bulkes, N. Z., Bailey, B. E., Storch, E. A., Abramowitz, J. S., Fontenelle, L. F., & Riemann, B. C. (2023). Common rituals in obsessive–compulsive disorder and implications for treatment: A mixed-methods study.Psychological Assessment, 35(9), 763–777.https://doi.org/10.1037/pas0001254
Other references
Abramowitz, J. S., Franklin, M. E., Schwartz, S. A., & Furr, J. M. (2003). Symptom presentation and outcome of cognitive-behavioral therapy for obsessive-compulsive disorder.Journal of Consulting and Clinical Psychology, 71(6), 1049–1057.https://doi.org/10.1037/0022-006X.71.6.1049
Jakubovski, E., Diniz, J. B., Valerio, C., Fossaluza, V., Belotto-Silva, C., Gorenstein, C., Shavitt, R. G., & Miguel, E. C. (2013). Clinical predictors of long-term outcome in obsessive-compulsive disorder.Depression and Anxiety, 30(8), 763–772.https://doi.org/10.1002/da.22129
Leckman, J. F., Rauch, S. L., & Mataix-Cols, D. (2010). Symptom dimensions in obsessive-compulsive disorder.CNS Spectrums, 12(5), 376–387.https://doi.org/10.1017/S1092852900023904
Rufer, M., Fricke, S., Moritz, S., Kloss, M., & Hand, I. (2006). Symptom dimensions in obsessive-compulsive disorder: Prediction of cognitive-behavior therapy outcome.Acta Psychiatrica Scandinavica, 113(5), 440–446.https://doi.org/10.1111/j.1600-0447.2005.00682.x
Storch, E. A., Abramowitz, J. S., & Goodman, W. K. (2008). Where does obsessive-compulsive disorder belong in DSM-V?Depression and Anxiety, 25(4), 336–347.https://doi.org/10.1002/da.20488
Storch, E. A., Merlo, L. J., Larson, M. J., Marien, W. E., Geffken, G. R., Jacob, M. L., Murphy, T. K., & Goodman, W. K. (2010). Clinical features associated with treatment-resistant pediatric obsessive-compulsive disorder.Comprehensive Psychiatry, 51(1), 35–42.https://doi.org/10.1016/j.comppsych.2009.02.004
Subira, M., Alonso, P., Segalàs, C., Real, E., López-Solà, C., Mas, S., Jiménez-Murcia, S., Bueno, B., Fernández-Aranda, F., & Menchón, J. M. (2015). A cluster analysis to find clinical phenotypes in obsessive-compulsive disorder: Results from a large family study.The Canadian Journal of Psychiatry, 60(9), 387–396.https://doi.org/10.1177/070674371506000904
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
