Danielle Einstein and Ross G. Menzies
Obsessive-compulsive disorder (OCD) is remarkable in that there are seemingly an infinite number of presentations of the disorder. Intrusive thoughts about virtually any topic can become the subject of obsessions and rituals and these may arise in the most unusual circumstances. For example, one woman watched a movie in which a young girl fell pregnant to the devil. She then experienced intrusive thoughts (which subsequently required neutralising) about whether she, herself, had fallen pregnant to the devil. There are an unlimited number of topics that can be perceived to be threatening to an individual. Intrusive thoughts as diverse as killing a loved one with an axe to wondering whether a cough ‘sounds right’ can become the subject of obsessive thoughts and rituals.
The present chapter will focus on atypical presentations that frequently accompany washing and checking. The effectiveness of exposure and response prevention (ERP) for the treatment of these behaviours has not been extensively documented (Ball, Baer & Otto, 1996). Despite the dominance of studies focused on cleaning and checking rituals, estimates of atypical compulsions reach as high as 56% in clinical samples (Summerfeldt et al., 1997; see further, Table 12.1).
The chapter will examine atypical obsessions and compulsions, including aggressive, sexual and religious obsessions, repeating and counting compulsions, obsessions with a need for symmetry or exactness and associated ordering/arranging compulsions, and symptoms referred to as miscellaneous on the Yale–Brown Obsessive-Compulsive Scale (Y-BOCS; Goodman et al., 1989a, 1989b). The characteristics of these obsessions and compulsions will be reviewed, and case examples will be provided. This will be followed by a brief description of treatment strategies.
Obsessive-Compulsive Disorder: Theory, Research and Treatment.
Edited by Ross G. Menzies and Padmal de Silva. © 2003 John Wiley & Sons, Ltd.