The abundance of irrelevant or unnecessary acts in OCD motor rituals represents reduced functionality in terms of task completion, typifying OCD rituals as pessimal behavior (antonym of optimal behavior).
A concept and methodology derived from an animal model provided the framework for a study of rituals in obsessive compulsive disorder (OCD) patients and yielded objective and observable criteria applicable for compulsive rituals across patients. The employed ethological approach should be able to reveal and identify a common structure underlying OCD rituals, pointing to shared psychopathology. Eleven OCD rituals performed by patients in their own home were videotaped and compared with the behaviour of healthy individuals instructed to perform the same rituals. The videotaped rituals were deconstructed into visits to specific locations or objects (ritual space), and to the acts performed at each location/object (ritual basic components). Quantitative analyses revealed that compulsiveness emanates from the expansion of repeats for some acts and visits, and from the addition of superfluous act types. Best discrimination between OCD and control rituals (90.9% success) was provided by the parameter "maximum of act repeats in a ritual" (R(2)=0.77). It is suggested that the identified properties of compulsive behaviour are consistent with a recent hypothesis that ritualized behaviour shifts the individual's attention from a normal focus on structured actions to a pathological attraction onto the processing of basic acts, a shift that invariably overtaxes memory. Characteristics and mechanisms of compulsive rituals may prove useful in objective assessment of psychiatric disorders, behavioural therapy, and OCD nosology.
BackgroundThis study focused on hypotheses regarding the source of incompleteness in obsessive-compulsive disorder (OCD). For this, we had to document the behavioral manifestation of incompleteness in compulsive rituals, predicting that an exaggerated focus on acts that are appropriate for the task will support the hypothesis on heightened responsibility/perfectionism. In contrast, activity past the expected terminal act for the motor task would support the “stop signal deficiency” hypothesis.Methodology and Principal FindingsWe employed video-telemetry to analyze 39 motor OCD rituals and compared each with a similar task performed by a non-OCD individual, in order to objectively and explicitly determine the functional end of the activity. We found that 75% of OCD rituals comprised a “tail,” which is a section that follows the functional end of the task that the patients ascribed to their activity. The other 25% tailless rituals comprised a relatively high number and higher rate of repetition of non-functional acts. Thus, in rituals with tail, incompleteness was manifested by the mere presence of the tail whereas in tailless rituals, incompleteness was manifested by the reduced functionality of the task due to an inflated execution and repetition of non-functional acts.ConclusionsThe prevalence of activity after the functional end (“tail”) and the elevated non-functionality in OCD motor rituals support the “lack of stop signal” theories as the underlying mechanism in OCD. Furthermore, the presence and content of the tail might have a therapeutic potential in cognitive-behavior therapy.
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