In the past 30 years considerable progress has been made in improving our understanding of the bewilderingly repetitive and self-defeating nature of compulsive checking. Why do they do it, over and over again? The first advance was accomplished when the compulsions were subjected to detailed behavioural analyses in the early 1970s, and the results of these experiments helped to consolidate the growing ability to modify this abnormal behaviour. The second advance came with the infusion of cognitive concepts and analyses, beginning with Salkovskis' remarkable paper in 1985. The second part of this chapter will trace the chronology of these advances.
Compulsions are the most common and most prominent feature of obsessive-compulsive disorders and in many cases they constitute the major problem. Two main compulsions have been identified: checking compulsions and cleaning compulsions. Clinical descriptions of these two types of compulsions were subsequently confirmed by factor-analytic studies (Hodgson & Rachman, 1977; Rachman & Hodgson, 1980). A psychometric scale, the Maudsley Obsessional Compulsive Inventory (MOCI), was developed to determine the structure of OCD and yielded two stable major factors, checking and cleaning (Hodgson & Rachman, 1977). Constructed in the behavioural era, the scale had good service (Taylor, 1998) but has been replaced by scales that are fuller and include more cognitive items (e.g. Foa et al., 1998b). These measures will be discussed more fully in Chapter 14.
As discussed in Chapter 2, compulsions are repetitive, stereotyped, intentional acts. The necessary and sufficient conditions for describing repetitive behaviour as compulsive are an experienced sense of pressure to act and the attribution of this pressure to internal sources. The occurrence of resistance is an important confirmatory feature, but it is not necessary or sufficient. The compulsions may be wholly unacceptable or, more often,
Obsessive-Compulsive Disorder: Theory, Research and Treatment.
Edited by Ross G. Menzies and Padmal de Silva. © 2003 John Wiley & Sons, Ltd.