Prevalence and clinical characteristics of mental rituals in a longitudinal clinical sample of obsessive-compulsive disorder

Abstract

Background Obsessive-compulsive disorder (OCD) is a chronic and debilitating anxiety disorder associated with significant impairment in quality of life and functioning. Research examining the differences in clinical correlates and treatment response associated with different obsessions in OCD has yielded important findings underscoring the heterogeneous nature of this disorder. To date, most of this research has focused on differences associated with primary obsessions, and little attention has been paid to the clinical utility of studying how compulsive symptoms affect clinical course. Virtually no systematic research has explored the clinical characteristics of one understudied symptom presentation, mental rituals, and what impact this primary symptom has on severity and course of illness. Mental rituals, or compulsions without overt signs, represent unique clinical challenges but often go understudied for numerous methodological and clinical reasons. Methods In the present study, we explored the impact of primary mental rituals on clinical severity and chronicity in a large, longitudinal sample of OCD patients (N = 225) over 4 years. Results Mental rituals were a primary presenting symptom for a sizable percentage of the sample (12.9%). Primary mental rituals were associated with greater clinical severity and lower functioning at intake, as well as a more chronic course of illness, as participants with primary mental rituals spent nearly 1 year longer in full DSM-IV criteria episodes over the 4-year follow-up interval than OCD patients without mental rituals. Conclusions These results suggest that mental rituals are uniquely impairing and highlight the need for further empirical exploration and consideration in treatment.

A multi‐method examination of the link between obsessive‐compulsive symptomatology and emotion‐related impulsivity

“…Instead, it was linked to urge to ritualize. Mental rituals like undoing a ‘bad’ thought, praying, or repeating certain words/phrases are often associated with the type of obsessions this task was designed to provoke (Sibrava, Boisseau, Mancebo, Eisen, & Rasmussen, 2011). These rituals can be performed quickly and covertly such that the experience of fear might be short‐lived if the automatic use of mental rituals leads to immediate short‐term fear reduction.…”

Quality of Web-based information on obsessive compulsive disorder

“…Obsessive compulsive disorder (OCD) is an anxiety disorder associated with considerable impairment in quality of life and functioning 1. The disorder, classified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Revision (DSM-V), Obsessive-Compulsive and Related Disorders, is known for a high percentage of severe cases 2.…”

“…Obsessive compulsive disorder (OCD) is an anxiety disorder associated with considerable impairment in quality of life and functioning. 1 The disorder, classified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Revision (DSM-V), Obsessive-Compulsive and Related Disorders, is known for a high percentage of severe cases. 2 Available treatments include pharmacological management and cognitive and behavior therapy, 3 , 4 with treatment sometimes requiring a combination of multiple strategies.…”

Best practices for CBT treatment of taboo and unacceptable thoughts in OCD

“…On the other hand, covert compulsions are internal, meaning they are not visible to the naked eye and may include behaviours such as internal dialogue, mental review, somatic checking, internal neutralization techniques, such as saying a prayer, or attempting to reverse intrusive thoughts by thinking the opposite (also known as mental 'undoing'), and a number of behaviours that largely fall under efforts at thought control including thought suppression and distraction . Due to the undetectable nature of mental rituals, covert compulsions remain understudied and there is ample reason to suspect prevalence rates may be under-estimated due to reluctance to disclose information within this subgroup (Sibrava et al, 2011). For this reason, it has also been mistakenly suggested that OCD patients who primarily engage in mental rituals may be less amenable to treatment (Whittal et al, 2010b).…”