AND COVERT COMPULSIONS
Padmal de Silva
This chapter deals with a specific presentation of obsessive-compulsive disorder (OCD). In Chapter 2 it was noted that some patients with OCD report obsessions only, or obsessions occurring with cognitive, or covert, compulsions. For many years, work on the understanding and treatment of these patients lagged behind the developments in work on patients with overt compulsions. Indeed, in major, pioneering research programmes investigating OCD, the researchers gave priority to overt compulsions. Rachman (1971) stated:
During the course of a research programme which is directed at the modi-
fication of obsessional neuroses …it was considered best to concentrate on
overt compulsive behaviour during the early stages of our investigations.
Obsessional patients who suffered from ruminations but displayed little or
no compulsive behaviour were not included in the formal systematic studies
The emphasis on studying the clinical features and treatment of OCD patients whose difficulties included prominent overt compulsions led to a relative neglect of the exploration of the problems of those who lacked such compulsions. To make matters worse, many clinicians also took the view that compulsions were necessarily overt (see Chapter 2). The recognition of the covert compulsions (e.g. Rachman, 1976b) was a major impetus to the study of those who lacked overt rituals and to the development of treatment strategies for them.
In this chapter, the focus will be on obsessions, covert compulsions and ruminations. There are OCD patients who present with pure obsessions, i.e. with no compulsions, overt or covert. There is a large sub-group of
Obsessive-Compulsive Disorder: Theory, Research and Treatment.
Edited by Ross G. Menzies and Padmal de Silva. © 2003 John Wiley & Sons, Ltd.