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 herself.

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 Obsessive-Compulsive Disorders (1991, Warner Books).