What's a ritual in OCD?
Obsessive–compulsive disorder
Obsessive–compulsive disorder (OCD) is a mental disorder where people feel the need to check things repeatedly, perform certain routines repeatedly (called "rituals"), or have certain thoughts repeatedly (called "obsessions"). People are unable to control either the thoughts or the activities for more than a short period of time. Common activities include hand washing, counting of things, and checking to see if a door is locked. Some may have difficulty throwing things out. These activities occur to such a degree that the person's daily life is negatively affected. This often takes up more than an hour a day. Most adults realize that the behaviors do not make sense. The condition is associated with tics, anxiety disorder, and an increased risk of suicide.
The cause is unknown. There appear to be some genetic components with both identical twins more often affected than both non-identical twins. Risk factors include a history of child abuse or other stress-inducing event. Some cases have been documented to occur following infections. The diagnosis is based on the symptoms and requires ruling out other drug related or medical causes. Rating scales such as the Yale–Brown Obsessive Compulsive Scale (Y-BOCS) can be used to assess the severity. Other disorders with similar symptoms include anxiety disorder, major depressive disorder, eating disorders, tic disorders, and obsessive–compulsive personality disorder.
Treatment involves counseling, such as cognitive behavioral therapy (CBT), and sometimes antidepressants such as selective serotonin reuptake inhibitors (SSRIs) or clomipramine. CBT for OCD involves increasing exposure to what causes the problems while not allowing the repetitive behavior to occur. While clomipramine appears to work as well as SSRIs, it has greater side effects so is typically reserved as a second line treatment. Atypical antipsychotics may be useful when used in addition to an SSRI in treatment-resistant cases but are also associated with an increased risk of side effects. Without treatment, the condition often lasts decades.
Obsessive–compulsive disorder affects about 2.3% of people at some point in their life. Rates during a given year are about 1.2%, and it occurs worldwide. It is unusual for symptoms to begin after the age of 35, and half of people develop problems before 20. Males and females are affected about equally. In English, the phrase "obsessive–compulsive" is often used in an informal manner unrelated to OCD to describe someone who is excessively meticulous, perfectionistic, absorbed, or otherwise fixated.
OCD can present with a wide variety of symptoms. Certain groups of symptoms usually occur together. These groups are sometimes viewed as dimensions or clusters that may reflect an underlying process. The standard assessment tool for OCD, the Yale–Brown Obsessive Compulsive Scale (Y-BOCS), has 13 predefined categories of symptoms. These symptoms fit into three to five groupings. A meta analytic review of symptom structures found a four factor structure (grouping) to be most reliable. The observed groups included a "symmetry factor", a "forbidden thoughts factor", a "cleaning factor", and a "hoarding factor". The "symmetry factor" correlated highly with obsessions related to ordering, counting, and symmetry, as well as repeating compulsions. The "forbidden thoughts factor" correlated highly with intrusive and distressing thoughts of a violent, religious, or sexual nature. The "cleaning factor" correlated highly with obsessions about contamination and compulsions related to cleaning. The "hoarding factor" only involved hoarding-related obsessions and compulsions, and was identified as being distinct from other symptom groupings.
Obsessive–compulsive disorder
The specific technique used in CBT is called exposure and response prevention (ERP) which involves teaching the person to deliberately come into contact with the situations that trigger the obsessive thoughts and fears ("exposure"), without carrying out the usual compulsive acts associated with the obsession ("response prevention"), thus gradually learning to tolerate the discomfort and anxiety associated with not performing the ritualistic behavior. At first, for example, someone might touch something only very mildly "contaminated" (such as a tissue that has been touched by another tissue that has been touched by the end of a toothpick that has touched a book that came from a "contaminated" location, such as a school.) That is the "exposure". The "ritual prevention" is not washing. Another example might be leaving the house and checking the lock only once (exposure) without going back and checking again (ritual prevention). The person fairly quickly habituates to the anxiety-producing situation and discovers that their anxiety level drops considerably; they can then progress to touching something more "contaminated" or not checking the lock at all—again, without performing the ritual behavior of washing or checking.
Estrogen
Compulsions in male lab mice, such as those in obsessive-compulsive disorder (OCD), may be caused by low estrogen levels. When estrogen levels were raised through the increased activity of the enzyme aromatase in male lab mice, OCD rituals were dramatically decreased. Hypothalamic protein levels in the gene COMT are enhanced by increasing estrogen levels which are believed to return mice that displayed OCD rituals to normal activity. Aromatase deficiency is ultimately suspected which is involved in the synthesis of estrogen in humans and has therapeutic implications in humans having obsessive-compulsive disorder.
Obsessive–compulsive disorder
Obsessions are thoughts that recur and persist, despite efforts to ignore or confront them. People with OCD frequently perform tasks, or compulsions, to seek relief from obsession-related anxiety. Within and among individuals, the initial obsessions, or intrusive thoughts, vary in their clarity and vividness. A relatively vague obsession could involve a general sense of disarray or tension accompanied by a belief that life cannot proceed as normal while the imbalance remains. A more intense obsession could be a preoccupation with the thought or image of someone close to them dying or intrusions related to "relationship rightness". Other obsessions concern the possibility that someone or something other than oneself—such as God, the Devil, or disease—will harm either the person with OCD or the people or things that the person cares about. Other individuals with OCD may experience the sensation of invisible protrusions emanating from their bodies, or have the feeling that inanimate objects are ensouled.
Obsessive–compulsive disorder
As a result, people with OCD are often aware that their behavior is not rational, are unhappy about their obsessions but nevertheless feel compelled by them. By contrast people with OCPD are not aware of anything abnormal; they will readily explain why their actions are rational, it is usually impossible to convince them otherwise, and they tend to derive pleasure from their obsessions or compulsions.
Anxiety disorder
A person with OCD knows that the symptoms are unreasonable and struggles against both the thoughts and the behavior. Their symptoms could be related to external events they fear (such as their home burning down because they forget to turn off the stove) or worry that they will behave inappropriately.
Compulsive hoarding
In 2008, a study was conducted to determine if there is a significant link between hoarding and interference in occupational and social functioning. Hoarding behavior is often severe because hoarders do not recognize it as a problem. It is much harder for behavioral therapy to successfully treat compulsive hoarders with poor insight about their disorder. Results show that hoarders were significantly less likely to see a problem in a hoarding situation than a friend or a relative might. This is independent of OCD symptoms, as people with OCD are often very aware of their disorder, which suggests a possible association with obsessive–compulsive personality disorder (OCPD) where the behavior are ego-syntonic. The opposite condition is compulsive decluttering.
Biology of obsessive–compulsive disorder
Abnormal affect in OCD has been hypothesized to result from dysfunction in the OFC, ventral striatum, and amygdala. OCD is characterized by high levels of anxiety, high rates of comorbidity with major depressive disorder, and blunted response to reward. This is reflected by reduced amygdala and ventral striatum response to positive stimuli, and elevated amygdala response to fearful stimuli. Furthermore, deep brain stimulation of the nucleus accumbens is an effective treatment of OCD, and symptom improvement correlates with reduced binding of dopamine receptors. The reduced binding, due to the ability of the radioligand tracers to be displaced by endogenous dopamine, is taken to reflect increased basal dopamine release. Affective dysregulation due to blunted reward, and elevated fear sensitivity may promote compulsivity by assigning excessive motivational salience to avoidance behavior.
Obsessive–compulsive disorder
Some people with OCD exhibit what is known as "overvalued ideas". In such cases, the person with OCD will truly be uncertain whether the fears that cause them to perform their compulsions are irrational or not. After some discussion, it is possible to convince the individual that their fears may be unfounded. It may be more difficult to do ERP therapy on such people because they may be unwilling to cooperate, at least initially. There are severe cases in which the person has an unshakeable belief in the context of OCD that is difficult to differentiate from psychotic disorders.
Intrusive thought
Exposure therapy is the treatment of choice for intrusive thoughts. According to Deborah Osgood-Hynes, Psy.D. Director of Psychological Services and Training at the MGH/McLean OCD Institute, "In order to reduce a fear, you have to face a fear. This is true of all types of anxiety and fear reactions, not just OCD." Because it is uncomfortable to experience bad thoughts and urges, shame, doubt or fear, the initial reaction is usually to do something to make the feelings diminish. By engaging in a ritual or compulsion to diminish the anxiety or bad feeling, the action is strengthened via a process called negative reinforcement—the mind learns that the way to avoid the bad feeling is by engaging in a ritual or compulsions. When OCD becomes severe, this leads to more interference in life and continues the frequency and severity of the thoughts the person sought to avoid.
Exposure therapy
In the exposure and response prevention (ERP or EX/RP) variation of exposure therapy, the resolution to refrain from the escape response is to be maintained at all times and not just during specific practice sessions. Thus, not only does the subject experience habituation to the feared stimulus, they also practice a fear-incompatible behavioral response to the stimulus. The distinctive feature is that individuals confront their fears and discontinue their escape response. The American Psychiatric Association recommends ERP for the treatment of OCD, citing that ERP has the richest empirical support.
Compulsive hoarding
For many years, hoarding has been listed as a symptom or a subtype of obsessive-compulsive disorder (OCD) and obsessive–compulsive personality disorder (OCPD). Obsessive-compulsive disorder is a type of anxiety disorder. People with OCD experience unwanted thoughts that incline them to do something repetitively. Some of these behaviors are excessive cleanliness and excessive toothbrushing. The current DSM says that an OCD diagnosis should be considered when:
Impulse control disorder
Dysfunction of the striatum may prove to be the link between OCD, ICD and SUD. According to research, the 'impulsiveness' that occurs in the later stages of OCD is caused by progressive dysfunction of the ventral striatal circuit. Whereas in case of ICD and SUD, the increased dysfunction of dorsal striatal circuit increases the "ICD and SUD behaviours that are driven by the compulsive processes". OCD and ICD have traditionally been viewed as two very different disorders, the former one is generally driven by the desire to avoid harm whereas the later one driven "by reward-seeking behaviour". Still there are certain behaviours similar in both, for example the compulsiveness of skin pickings in ICD patients and the behaviour of reward-seeking (for example hoarding) in OCD patients.
Blood ritual
Some blood rituals involve two or more parties cutting themselves or each other followed by consumption of blood. The participants may regard the release or consumption of blood as producing energy useful as a sexual, healing, or mental stimulus. In other cases, blood is a primary component as the sacrifice, or material component for a spell. 
Blood rituals are practiced by various groups of people, including those with religious or political affiliations. Some of the rituals involving blood have been practiced for many centuries, and are still being practiced in the 21st century (Baker 1, Copeman 2, Malik 2). The Shi’ite Muslims practiced a ritual called Matam in 2002 in Britain (Malik 2). However, the Aztecs participated in blood rituals around 500 years ago (Pendragon 1). The blood in the rituals has a symbolic meaning, depending on the group and ritual being performed. 
Around 1376 to 1521 AD, Aztecs used blood and sacrifice frequently as an offering to the Sun God (Pendragon 2). The Aztecs saw death as part of life, just like birth (Pendragron 2). They believed the gods sacrificed their own blood to create the universe, so in turn, the Aztecs offered blood to the Gods as a sort of reciprocal exchange and gift for their creations (Pendragon 2). Furthermore, the supply of ritual blood was believed to maintain plentiful fertile crops and aid in the continuation of the Aztec world. The author Jasmyne Pendragon, who has a bachelor of archaeology, stated in her Article The Purpose of Aztec Blood Rituals Part 1, that “The Aztecs lifestyles were governed by a need to supply fresh-blooded sacrificial victims to the sun god who required the hearts of men to give life to the world and assist the souls of dead warriors to the Aztecs version of heaven” (2). The rituals maintained a relationship between Aztecs and their gods (Pendragon 2). The Aztecs believed the gods would provide plentiful crops and healthy long lives as long as blood was ritually given (Pendragon 2). If blood was not sacrificed to the gods, the humans believed they would be punished and endure excessive pain “more violent than any man could ever do” (Pendragon 3).
Intrusive thought
The prevalence of OCD in every culture studied is at least 2% of the population, and the majority of those have obsessions, or bad thoughts, only; this results in a conservative estimate of more than 2 million sufferers in the United States alone (as of 2000). One author estimates that one in 50 adults have OCD and about 10–20% of these have sexual obsessions. A recent study found that 25% of 293 patients with a primary diagnosis of OCD had a history of sexual obsessions.
Delayed- Maturation Theory of Obsessive Compulsive Disorder
The results of this test show the baseline brain pattern compared to the first scan they took. The first scan provides data about the activation in the frontal-striatal neural circuit, which is the area involving OCD. The difference in the brain patterns depict information regarding biological mechanisms, which underlie heterogeneity in OCD.
Compulsive hoarding
Recent findings suggest that there may be three types of hoarding: pure hoarding, hoarding plus OCD (i.e., co-morbid OCD), and OCD-based hoarding Given the aforementioned distinction, it was proposed to increase coverage of compulsive hoarding in the forthcoming Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V), both by creating a distinct category for compulsive hoarding, provisionally named, Hoarding Disorder (either in the main manual under "obsessive-compulsive spectrum disorders" or in the appendix), and by including hoarding as a potential symptom of OCD.
House clearance
Some house clearances can take more than a day if there is a large amount of household furniture and effects, sometimes when the occupant has been suffering from OCD or compulsive hoarding syndrome.
Intrusive thought
An intrusive thought is an unwelcome involuntary thought, image, or unpleasant idea that may become an obsession, is upsetting or distressing, and can feel difficult to manage or eliminate. When such thoughts are associated with obsessive-compulsive disorder (OCD), depression, body dysmorphic disorder (BDD), and sometimes attention-deficit hyperactivity disorder (ADHD), the thoughts may become paralyzing, anxiety-provoking, or persistent. Intrusive thoughts may also be associated with episodic memory, unwanted worries or memories from OCD, posttraumatic stress disorder, other anxiety disorders, eating disorders, or psychosis. Intrusive thoughts, urges, and images are of inappropriate things at inappropriate times, and generally have aggressive, sexual, or blasphemous themes.
Jonathan Abramowitz
Cognitive-behavioral factors and models of OCD and anxiety: The cognitive-behavioral model is the leading conceptual approach to understanding OCD and anxiety disorders. Abramowitz conducts cross-sectional, experimental, and prospective (longitudinal) research that has helped to clarify and advance this conceptual model. His work focuses on cognitive biases such as anxiety sensitivity, thought-action fusion, intolerance of uncertainty, and attentional biases that factor in the persistence of OCD and irrational fear. With his team at UNC, he has developed experimental paradigms for studying thought-action fusion and intolerance of uncertainty. His work has also demonstrated that cognitive factors prospectively predict the escalation of intrusive thoughts into obsessions.
Cause of obsessive-compulsive disorder
Data obtained from this research suggests that three brain areas are involved with OCD: the orbitofrontal cortex (OFC), the anterior cingulate cortex (ACC), and the head of the caudate nucleus. Several studies have found that in patients with OCD, these areas: (1) are hyperactive at rest relative to healthy control; (2) become increasingly active with symptom provocation; and (3) no longer exhibit hyperactivity following successful treatment with SRI pharmacotherapy or cognitive-based therapy. This understanding is frequently cited as evidence that abnormality in these neuroanatomical regions may cause OCD.
Obsessive–compulsive personality disorder
Obsessive-compulsive personality disorder (OCPD) is a personality disorder characterized by a general pattern of concern with orderliness, perfectionism, excessive attention to details, mental and interpersonal control, and a need for control over one's environment, at the expense of flexibility, openness to experience, and efficiency. Workaholism and miserliness are also seen often in those with this personality disorder. Persons affected with this disorder may find it hard to relax, always feeling that time is running out for their activities, and that more effort is needed to achieve their goals. They may plan their activities down to the minute—a manifestation of the compulsive tendency to keep control over their environment and to dislike unpredictable events as elements beyond their control.
Procedural memory
Neuroimaging studies show that OCD patients perform considerably better on procedural memory tasks because of noticeable over-activation of the striatum brain structures, specifically the frontostriatal circuit. These studies suggest that procedural memory in OCD patients is unusually improved in the early learning stages of procedural memory. Individuals with OCD do not perform significantly different on procedural working memory tasks than healthy controls.
Antisocial personality disorder
Conduct disorder (CD) is a disorder diagnosed in childhood that parallels the characteristics found in ASPD and is characterized by a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate norms are violated. Children with the disorder often display impulsive and aggressive behavior, may be callous and deceitful, and may repeatedly engage in petty crime such as stealing or vandalism or get into fights with other children and adults. This behavior is typically persistent and may be difficult to deter with threat or punishment. Attention deficit hyperactivity disorder (ADHD) is common in this population, and children with the disorder may also engage in substance abuse." CD is differentiated from oppositional defiant disorder (ODD) in that children with ODD do not commit aggressive or antisocial acts against other people, animals, and property, though many children diagnosed with ODD are subsequently rediagnosed with CD.
Jeffrey M. Schwartz
Brain lock is a term coined by Schwartz to describe obsessive-compulsive behavior and to describe a treatment plan he published in his 1997 book "Brain Lock: Free Yourself from Obsessive-Compulsive Behavior". In the book Schwartz claims that obsessive-compulsive disorders (OCD) are a result of a bio-chemical imbalance where brain functions will get "locked" in an obsessive-compulsive pattern and that OCD can be self-treated by following four steps, which are listed as follows:
Obsessive–compulsive disorder
In the United States, psychosurgery for OCD is a treatment of last resort and will not be performed until the person has failed several attempts at medication (at the full dosage) with augmentation, and many months of intensive cognitive–behavioral therapy with exposure and ritual/response prevention. Likewise, in the United Kingdom, psychosurgery cannot be performed unless a course of treatment from a suitably qualified cognitive–behavioral therapist has been carried out.
Delayed- Maturation Theory of Obsessive Compulsive Disorder
Cognitive behavioral therapy, which involves exposure and response prevention (ERP), is the psychosocial treatment of choice for obsessive‐compulsive disorder. Despite this, ERP is not widely used by mental health practitioners. ERP means a person would repeatedly approach or is "exposed to" the very thing/object that makes that individual anxious or uncomfortable. Afterwards, the individual would attempt to stop oneself from engaging in behaviors that are designed to lower that anxiety. Cognitive behavioral therapy, CBT, in contrast to traditional psychotherapy or "talk" therapy, is shorter in duration and focuses not so much on early life experiences or unconscious processes, but rather on "here and now" problems, and on the education and coaching of clients as they learn new ways of thinking and behaving in order to solve those problems. OCD or anxiety-producing intrusive thoughts or images, are normally followed by compulsions, or by behaviors that the individual does on purpose to lower anxiety. This is displayed by the forming thoughts such as "that thing is dirty or contaminated". Thereafter, the compulsion would be to avoid touching that certain object or thing, and it can also lead to excessive washing if the individual has touched it. The role ERP has in this matter would be to purposely have the individual touch "contaminated" things on purpose and have exposure to it. During ERP, with repeated "exposure trials", the person then "learns" to let go of the fear through a process called desensitization. In hopes of exposing the individual repeatedly to feared thoughts, things or situations over and over, it would become less of a bother or fear and essentially the individual would get accustomed to it. As this process is initially a scary process to OCD patients, they are either exposed gradually or quickly, in order to be able to handle their obsessive-compulsive behaviors allowing them to feel control of it.
Sheldon Cooper
All of our characters are in theory on the neuropsychiatric spectrum, I would say. Sheldon often gets talked about in terms of Asperger’s or OCD. He has a thing with germs, he has a thing with numbers, he’s got a lot of that precision that we see in OCD. There’s a lot of interesting features to all of our characters that make them technically unconventional socially... And what we’re trying to show with our show is that this is a group of people who likely were teased, mocked, told that they will never be appreciated or loved, and we have a group of people who have successful careers, active social lives (that involve things like Dungeons and Dragons and video games), but they also have relationships, and that’s a fulfilling and satisfying life.
Dianic Wicca
There is therapeutic value inherent in Dianic ritual—many women use it to overcome personal trauma and raise awareness about violence towards women, earning comparisons to feminist consciousness-raising groups in the 1960s and 70s. In fact, some groups develop rituals specifically to confront gendered personal trauma, such as battery, rape, incest, and partner abuse. In one ethnographic study of such a ritual, women shifted their understanding of power from the hands of their abusers to themselves. It was found that this ritual had improved self-perception in participants in the short-term, and that the results could be sustained with ongoing practice. 
Dianics pride themselves on the inclusion of lesbian and bisexual members. It is a goal within many covens to explore female sexuality and sensuality outside of male control, and many rituals function to affirm lesbian sexuality, making it a popular tradition for women who have come out. Some covens exclusively consist of same-sex oriented women and advocate lesbian separatism.
Sexual obsessions
Sexual obsessions are obsessions with sexual activity. In the context of obsessive-compulsive disorder (OCD), these are extremely common, and can become extremely debilitating, making the person ashamed of the symptoms and reluctant to seek help. As preoccupation with sexual matters, however, does not only occur as a symptom of OCD, they may be enjoyable in other contexts (i.e. sexual fantasy).
Hoarders
Hoarding could have simply remained a symptom and been included under multiple disorders. However, treating the comorbid disorders in a patient often does not eliminate hoarding behaviors. Another significant factor in the disorder's reclassification was the discovery that more people could be diagnosed with hoarding behaviors than could be diagnosed with OCD. This showed that hoarding could not be a subtype of OCD. Rather, it had to be a separate illness with similarities (the fear of letting go being the obsession, and the hoarding of unneeded items as the compulsion). These similarities are recognized in the DSM-5, as hoarding is classified under obsessive compulsive related disorders. Other disorders in this category include body dysmorphic disorder, trichotillomania, and excoriation. These disorders share common features such as "obsessive preoccupation and repetitive behaviors."
Intrusive thought
When intrusive thoughts occur with obsessive-compulsive disorder (OCD), patients are less able to ignore the unpleasant thoughts and may pay undue attention to them, causing the thoughts to become more frequent and distressing. The thoughts may become obsessions which are paralyzing, severe, and constantly present, and can range from thoughts of violence or sex to religious blasphemy. Distinguishing them from normal intrusive thoughts experienced by many people, the intrusive thoughts associated with OCD may be anxiety provoking, irrepressible, and persistent.
Ritual
The field of ritual studies has seen a number of conflicting definitions of the term. One given by Kyriakidis is that a ritual is an outsider's or "etic" category for a set activity (or set of actions) that, to the outsider, seems irrational, non-contiguous, or illogical. The term can be used also by the insider or "emic" performer as an acknowledgement that this activity can be seen as such by the uninitiated onlooker.
In psychology, the term "ritual" is sometimes used in a technical sense for a repetitive behavior systematically used by a person to neutralize or prevent anxiety; it is a symptom of obsessive–compulsive disorder.
Rodney Orpheus
We're chatting to a bloke, Rodney Orpheus, who is part of the religion which Crowley left behind after he died, it's called O.T.O. I'm asking him what would happen if we were to play out Crowley's magical spell ritual designed to call out demons. He tells me probably nothing, "If demons were to come out of the radio I'd be very surprised, if they're going to come out of anywhere, they'll come out of people's heads". Awesome. Great bit of radio. Hit play on the song. Two minutes in the station has a major technical glitch. The consoles in all three studios stop working. The mic won't turn on and then won't turn off. We play three songs in a row as we try to sort it out. Chaos as broadcast assistants and producers run about like headless chickens trying to sort it out. Technical response team on the phone. Finally we're back on air. Not the most impressive bit of radio ever. An example of Crowley's curse?
Osteochondritis dissecans
OCD is a relatively rare disorder, with an estimated incidence of 15 to 30 cases per 100,000 persons per year. Widuchowski W "et al." found OCD to be the cause of articular cartilage defects in 2% of cases in a study of 25,124 knee arthroscopies. Although rare, OCD is noted as an important cause of joint pain in active adolescents. The juvenile form of the disease occurs in children with open growth plates, usually between the ages 5 and 15 years and occurs more commonly in males than females, with a ratio between 2:1 and 3:1. However, OCD has become more common among adolescent females as they become more active in sports. The adult form, which occurs in those who have reached skeletal maturity, is most commonly found in people 16 to 50 years old.
Ritual
In religion, a ritual can comprise the prescribed outward forms of performing the "cultus", or cult, of a particular observation within a religion or religious denomination. Although ritual is often used in context with worship performed in a church, the actual relationship between any religion's doctrine and its ritual(s) can vary considerably from organized religion to non-institutionalized spirituality, such as ayahuasca shamanism as practiced by the Urarina of the upper Amazon. Rituals often have a close connection with reverence, thus a ritual in many cases expresses reverence for a deity or idealized state of humanity.
The Kissing Hand
On a train ride in Wheaton, Maryland, Penn witnessed a ritual in which a mother raccoon placed its nose on a baby raccoon's paw, and then the baby raccoon placed its paw on its own face. The park ranger said that the purpose of the ritual was to transfer scent from the mother to the baby so that the baby could recall the mother's scent by bringing its paw to its face. Penn "started a similar ritual with her daughter — kissing her hand and telling her that whenever she was homesick, she could put her hand to her face."
Magic of Dungeons &amp; Dragons
In 4e, rituals are non-combat spells. There are nine categories: binding, creation, deception, divination, exploration, restoration, scrying, travel and warding. Each ritual has a key skill, Arcana, Heal, Nature or Religion, some rituals have multiple key skills, allowing a player to choose which key skill to use. Each ritual has a casting time and a component cost. There are five classes of ritual components: alchemical reagents can be used for arcana rituals, mystic salves can be used for heal rituals, rare herbs can be used for nature rituals, sanctified incense can be used for religion rituals and residuum can be used for any ritual. Rituals are performed from books or scrolls, unlike spells, rituals are not learned and are not restricted by class, a ritual can be performed by any character who has the Ritual Caster feat and meets the ritual's level requirement. Using a ritual scroll halves the time required to perform a specific ritual, however doing so expends the scroll, causing it to crumble to dust once the ritual has been performed.
International OCD Foundation
The mission of the organization at its founding is much the same as today: education, awareness, training, accessing resources and research. In 2009, the IOCDF hired Teak Media to help promote awareness about OCD and effective treatments. The collaboration between Teak and the IOCDF resulted in almost 100 media hits in newspapers, online, in magazines, and has been featured on Nightline and CNN. Teak regularly accesses the IOCDF's Speakers Bureau. The Speakers Bureau members include people with OCD who understand firsthand the challenges of this disorder in addition to well-known clinical and research experts who have treated people with OCD.
Indigenous religious beliefs of the Tagbanwa people
The "bilang" ceremony is the all-important ritual for the dead. It takes place after the rice harvest, a time when "tabad" becomes plentiful. Every family is expected to host one or more "bilang" rituals. The "bilang" rituals begin with the rite of divination, to determine which among the spirit relatives has caused a person's illness. This makes use of the babaylan, who performs the brief rite of "panawag" near the grave of the dead relative by making offerings of the betel quids and ceremonial cigarettes, and promises "tabad" should the ill become well. The celebrants together with the offerings prepare a jar of "tabad" with sipping reeds. The "bilang" ceremony involves the "paurut" (invocation) of as many spirit relatives as possible through incantation, and the burning of the "parina" (incense) whose pleasant smells attract the deities and spirits of the dead. The gongs are played as the "paurut" is being performed, and their music is an added incentive for the spirit to descend on the gathering. After the ritual offering of the articles have been laid out on the mat, the food is distributed to the children first, and then to the guests; then the "bilang" mat is removed. The communal drinking of "tabad" through the reed straws follows, a very festive social event that lasts through the night.
Exposure therapy
ERP is predicated on the idea that a therapeutic effect is achieved as subjects confront their fears, but refrain from engaging in the escape response or ritual that delays or eliminates distress. In the case of individuals with OCD or an anxiety disorder, there is a thought or situation that causes distress. Individuals usually combat this distress through specific behaviors that include avoidance or rituals. However, ERP involves purposefully evoking fear, anxiety, and or distress in the individual by exposing him/her to the feared stimulus. The response prevention then involves having the individual refrain from the ritualistic or otherwise compulsive behavior that functions to decrease distress. The patient is then taught to tolerate distress until it fades away on its own, thereby learning that rituals are not always necessary to decrease distress or anxiety. Over repeated practice of ERP, patients with OCD expect to find that they can have obsessive thoughts and images but not have the need to engage in compulsive rituals to decrease distress.
Obsessive–compulsive disorder
SSRIs are a second line treatment of adult obsessive compulsive disorder (OCD) with mild functional impairment and as first line treatment for those with moderate or severe impairment. In children, SSRIs can be considered as a second line therapy in those with moderate-to-severe impairment, with close monitoring for psychiatric adverse effects. SSRIs are efficacious in the treatment of OCD; people treated with SSRIs are about twice as likely to respond to treatment as those treated with placebo. Efficacy has been demonstrated both in short-term (6–24 weeks) treatment trials and in discontinuation trials with durations of 28–52 weeks.
Compulsive behavior
Addiction and obsessive–compulsive disorder (OCD) feature compulsive behavior as core features. Addiction is simply a compulsion toward a rewarding stimulus, whereas in OCD a compulsion is a facet of the disorder. The most common compulsions for people suffering from OCD are washing, and checking.
Compulsive hoarding
Compulsive hoarding does not seem to involve the same neurological mechanisms as more familiar forms of obsessive–compulsive disorder and does not respond to the same drugs, which target serotonin. In compulsive hoarding, the symptoms are presented in the normal stream of consciousness, and are not perceived as repetitive or distressing like in OCD patients. Despite statistics indicating that there is a prevalence of hoarding in 18% to 40% of patients with OCD, only 5% of compulsive hoarders experience symptoms of OCD. In another study, a sample of 217 patients diagnosed with significant hoarding, only 18% were diagnosed with OCD, as opposed to the 36% that were diagnosed with a major depressive disorder. There are significant differences and issues between the diagnostic features of compulsive hoarding and OCD which are being considered in a possible addition to the DSM-V of a new independent disorder such as compulsive hoarding. It is also said that there may be an overlap with a condition known as impulse control disorder (ICD), particularly when compulsive hoarding is linked to compulsive buying or acquisition behavior.
Randall Collins
Collins argues sex, smoking, and social stratification and much else in our social lives are driven by a common force: interaction rituals. His "Interaction Ritual Chains" is a major work of sociological theory that attempts to develop a "radical microsociology." It proposes that successful rituals create symbols of group membership and pump up individuals with emotional energy, while failed rituals drain emotional energy. Each person flows from situation to situation, drawn to those interactions where their cultural capital gives them the best emotional energy payoff. Thinking, too, can be explained by the internalization of conversations within the flow of situations; individual selves are thoroughly and continually social, constructed from the outside in. The theory of interaction ritual chains is inspired by Emile Durkheim's theory of ritual, laid forward in his book "The Elementary Forms of Religious Life", by the conflict theory of Max Weber, and by the microsociology of Erving Goffman. It has itself inspired various domains across the social sciences, including Management Studies, Creative Tourism, International Relations, and Jeffrey C. Alexander's Cultural Pragmatics. Numerous empirical studies have likewise employed Interaction Ritual Theory, for instance to explore how specific institutions maintain themselves, how websites use interaction ritual chains to form the identity of its users, or how diplomats establish exchange programmes to invite foreign elites into their countries.
Jonathan Abramowitz
Abramowitz has argued that OCD symptoms lie on a continuum with normal everyday experiences, and that one’s learning history (and to a lesser extent, their biology) influence the frequency, intensity, and duration of OCD symptoms. He has also criticized the DSM-5’s re-classification of OCD as separate from the anxiety disorders and as overlapping with conditions such as Hair Pulling Disorder and Skin Picking Disorder. Abramowitz is generally critical of biomedical models which view problems such as OCD and anxiety as brain diseases or genetic disorders.
Sexual obsessions
Sexual obsessions can be particularly troubling to the individual with OCD, as something important and cherished becomes twisted into its nightmarish opposite. People with sexual obsessions are particularly likely to have co-occurring aggressive and religious obsessions, clinical depression, and higher rates of impulse control disorders, though the latter is less common in OCD patients.
Sexual obsessions
Because sex carries significant emotional, moral, and religious importance, it often becomes a magnet for obsessions in people predisposed to OCD. Common themes include unfaithfulness, deviant behaviors, pedophilia, the unfaithfulness or suitability of one's partner, and thoughts combining religion and sex. People with sexual obsessions may have legitimate concerns about their attractiveness, potency, or partner, which can serve as an unconscious catalyst for the obsessions.
Delayed- Maturation Theory of Obsessive Compulsive Disorder
The Delayed-Maturation Theory of Obsessive Compulsive Disorder 
suggests that Obsessive Compulsive Disorder (OCD) can be caused by delayed maturation of the frontal striatal circuitry or parts of the brain that make up the frontal cortex, striatum, or integrating circuits. Some researchers suspect that variations in the volume of specific brain structures can be observed in children that have OCD (Lambert, K.G; Kinsley, C.H., 2011). It has not been determined if delayed-maturation of this frontal circuitry contributes to the development of OCD or if OCD is the ailment that inhibits normal growth of structures in the frontal striatal, frontal cortex, or striatum. However, the use of neuroimaging has equipped researchers with evidence of some brain structures that are consistently less adequate and less matured in patients diagnosed with OCD in comparison to brains without OCD. More specifically, structures such as the caudate nucleus, volumes of gray matter, white matter, and the cingulate have been identified as being less developed in people with OCD in comparison to individuals that do not have OCD (Lambert, K.G.; Kinsley,C.H.). However,the cortex volume of the operculum (brain) is larger and OCD patients are also reported to have larger temporal lobe volumes; which has been identified in some women patients with OCD (Jenike, M.; Breiter, H.; at el, 1996). Further research is needed to determine the effect of these structural size differences on the onset and degree of OCD and the maturation of specific brain structures.
Sexual obsessions
Sexual obsessions take many forms. For example, a mother might obsess about sexually abusing her child. She might wonder if these thoughts mean that she is a pedophile and worry that she could act them out, despite the fact that she has never sexually abused anyone and feels disgusted by the idea. Another example is a man who worries that he may accidentally impregnate a woman by shaking her hand because he was not careful enough in washing his hands after touching his genitals. Patients may also experience fears that their obsessions have already been carried out, and this causes them great mental distress and suffering. The ignorance and misunderstanding of the general population about OCD, largely as a result of gross misinformation about the disorder, often leads to assumptions that sufferers are criminals or deviants. This can then reinforce the belief in the mind of the sufferer that they really have committed a crime or immoral act, when they have not, or lead to doubts. This causes great distress for an OCD sufferer, and occasionally leads to the sufferer making "confessions" - sometimes to the police - and suicidal thoughts or attempts.
Obsessive–compulsive disorder
Most people with OCD understand that their notions do not correspond with reality; however, they feel that they must act as though their notions are correct. For example, an individual who engages in compulsive hoarding might be inclined to treat inorganic matter as if it had the sentience or rights of living organisms, while accepting that such behavior is irrational on a more intellectual level. There is a debate as to whether or not hoarding should be considered with other OCD symptoms.
Ritualcide
Ritualcide is the systematic destruction or alteration of traditional ritual practices and their sequencing. Rituals have a prescribed form, source, and sequence that include sacred objects, places, times and seasons, music, dance, texts, songs and words, and mediators (such as monks, spirit mediums, religious leaders, and traditional healers). Ritualcide is not necessarily linked to genocide, but "genocidal priming" may gain a handhold when regimes tamper with collective tradition and leave inhabitants vulnerable and/or susceptible to spirit-based harm and angst. Herein ancestral pathways for intimate connection are often disrupted.
White coat ceremony
The white coat ceremony (WCC) is a relatively new ritual in some medical (MD, DO), dental, optometry, audiology, chiropractic, dietetic, occupational therapy, physical therapy, podiatric, pharmacy, physician assistant, pathologists' assistant, nursing, naturopathic and veterinary schools that marks the student's transition from the study of preclinical to clinical health sciences. At some schools, where students begin meeting patients early in their education, the white coat ceremony is held before the first year begins. It is an example of a matriculation.
Interview with the Vampire
After completing the novel and following many rejections from publishers, Rice developed obsessive–compulsive disorder (OCD). She became obsessed with germs, thinking that she contaminated everything she touched, engaged in frequent and obsessive hand washing and obsessively checked locks on windows and doors. Of this period, Rice says, "What you see when you're in that state is every single flaw in our hygiene and you can't control it and you go crazy."
Animal psychopathology
Canine compulsions are more common in some breeds and behavioral dispositions are often shared within the same litter. This suggests that there is a genetic factor to the disorder. A questionnaire to dog owners and a blood sample of 181 dogs from four breeds, miniature and standard bull terriers, German shepherds, and Staffordshire bull terriers showed these to be more susceptible to compulsive and repetitive behaviors. It is suggested that the more we learn through studying OCD in dogs, the more we can to understand human biology and the genetics involved in the heredity of susceptibility to disorders such as OCD.
A chromosome has been located in dogs that confers a high risk of susceptibility to OCD. Canine chromosome 7 has been found to be most significantly associated with obsessive compulsive disorder in dogs, or more specifically, canine compulsive disorder (CCD). This breakthrough helped further relate OCD in humans to CCD in canines. Canine chromosome 7 is expressed in the hippocampus of the brain, the same area that Obsessive Compulsive Disorder is expressed in human patients. Similar pathways are involved in drug treatment responses for both humans and dogs, offering more research that the two creatures exhibit symptoms and respond to treatment in similar ways. This data can help scientists to discover more effective and efficient ways to treat OCD in humans through the information they find by studying CCD in dogs.
Just Checking: Scenes From the Life of an Obsessive-Compulsive
Those with obsessive-compulsive disorder continually practice rituals or routines in order to satisfy their intrusive worries and fears. Emily Colas describes several routines that she completes daily in order to ensure that she does not contract a disease. Colas has a rather complex routine for taking out the garbage. She had her husband undergo an extensive procedure of taking out the trash to ensure that no germs entered her home. Colas also had a habit of double checking things. When putting on the dishwasher she would check several times to be certain that her cats were not inside the appliance. Eventually she started locking the cats in the bathroom when it was time to wash the dishes. Routines like Colas' are typical of OCD patients. These routines are meant to satisfy their worries and make the person feel better temporarily. Often the patients feel compelled to perform these rituals. A person's worries generally fit into three categories: overestimation of threat, intolerance of uncertainty, and the over-importance of one's thoughts and the desire to control these thoughts. Common rituals or routines of OCD patients include excessive cleaning, checking locks, ordering or arranging items in a certain way, and saving or sometimes hoarding items. These routines are exhausting for the person to keep up with and they only satisfy their worries temporarily.
Cause of obsessive-compulsive disorder
While there seems to be a ubiquitous understanding that neurochemical functioning is responsible for mediating the symptoms of OCD, recent psychopharmacologic studies have found that the serotonin (5-HT) neurotransmitter system plays a particularly critical role. In comparison to healthy controls, the long-term administration of selective serotonin reuptake inhibitors (SSRIs) have been found to be more effective than noradrenergic reuptake inhibitors in the treatment of OCD. For example, Rapoport "et al." demonstrated that clomipramine was more effective than desipramine in decreasing several types of repetitive behavior. Research has also shown that the administration of 5-HT antagonists often exacerbates symptoms of OCD. If this were to be true, one would expect mirtazapine (which among others is a 5-HT receptor antagonist) and atypical antipsychotics that also have antagonistic effects at this receptor to attenuate the effect of SSRIs. Clinical studies with these drugs, however, have shown the opposite. Mirtazapine, although not effective by itself, has been shown to hasten the effect of paroxetine (Pallanti "et al.," 2004), and several studies have shown that atypical antipsychotics augment the effects of SSRIs in refractory OCD patients (Bloch "et al.," 2006). While these findings do not provide an explicit cause, they do set the stage for the notion that psychiatric conditions can be dissected pharmacologically. Thus, the efficacy in controlling obsessions and compulsions with SSRIs suggests that OCD has an underlying neurochemical etiology.
Obsessive–compulsive personality disorder
Some OCPD features are common in those afflicted with OCD. For example, perfectionism, hoarding, and preoccupation in details (which are three characteristics of OCPD) were found in people with OCD and not in people without OCD, showing a particular relationship between these OCPD traits with OCD. The reverse is also true: certain OCD symptoms appear to have close parallels in OCPD ones. This is particularly the case for checking and ordering and symmetry symptoms. OCPD samples who have OCD are particularly likely to endorse obsessions and compulsions regarding symmetry and organization. Washing symptoms, which are among the most common OCD symptoms, don't appear to have much of a link with OCPD, in contrast.
Basal ganglia disease
Tourette syndrome is a disorder that is characterized by behavioral and motor tics, OCD, and Attention-deficit hyperactivity disorder (ADHD). For this reason, it is commonly believed that pathologies involving limbic, associative, and motor circuits of the basal ganglia are likely. Since the realization that syndromes such as Tourette Syndrome and OCD are caused by dysfunction of the non-motor loops of basal ganglia circuits, new treatments for these disorders, based on treatments originally designed to treat movement disorders are being developed.
Delayed- Maturation Theory of Obsessive Compulsive Disorder
The first record of Obsessive Compulsive Disorder dates back to the 14th century in Europe. It was believed that people who had OCD were possessed by the devil, and treatment included a series of performed exorcisms. In the 1910s, Sigmund Freud, a neurologist from Austria described Obsessive Compulsive Disorder to a case of touching phobia. This phobia is said to start in early childhood and happens when a person has a strong desire to touch. However, the opposite can also develop where the person develops what is called external prohibition. This happens when someone has the fear of a form of touching sensation. There are some circumstances where this disorder can be delayed. The earliest signs of OCD can start showing up in as little as six months. The brain becomes even more hyperactive around 54 months, and it is easier to notice obsessive-compulsive behavior at this time. Although there is no exact date as to when OCD begins to develop in later stages of life; different environments or events in a person’s life can quickly become the catalyst to the development of this disorder.
Obsessive–compulsive disorder
Some common compulsions include hand washing, cleaning, checking things (e.g., locks on doors), repeating actions (e.g., turning on and off switches), ordering items in a certain way, and requesting reassurance. Compulsions are different from tics (such as touching, tapping, rubbing, or blinking) and stereotyped movements (such as head banging, body rocking, or self-biting), which usually aren't as complex and aren't precipitated by obsessions. It can sometimes be difficult to tell the difference between compulsions and complex tics. About 10% to 40% of individuals with OCD also have a lifetime tic disorder.
Obsessive–compulsive disorder
Behaviorally, there is some research demonstrating a link between drug addiction and the disorder as well. For example, there is a higher risk of drug addiction among those with any anxiety disorder (possibly as a way of coping with the heightened levels of anxiety), but drug addiction among people with OCD may serve as a type of compulsive behavior and not just as a coping mechanism. Depression is also extremely prevalent among people with OCD. One explanation for the high depression rate among OCD populations was posited by Mineka, Watson and Clark (1998), who explained that people with OCD (or any other anxiety disorder) may feel depressed because of an "out of control" type of feeling.
Racing thoughts
In people with OCD, racing thoughts can be brought on by stressors, or triggers, causing disturbing thoughts in the individual. These disturbing thoughts, then, result in compulsions characterizing OCD in order to lower the stress and gain some sort of control over these stressful, racing thoughts.
Obsessive–compulsive disorder
Compulsions become clinically significant when a person feels driven to perform them in response to an obsession, or according to rules that must be applied rigidly, and when the person consequently feels or causes significant distress. Therefore, while many people who do not suffer from OCD may perform actions often associated with OCD (such as ordering items in a pantry by height), the distinction with clinically significant OCD lies in the fact that the person who suffers from OCD "must" perform these actions, otherwise they will experience significant psychological distress. These behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these activities are not logically or practically connected to the issue, or they are excessive. In addition, at some point during the course of the disorder, the individual must realize that their obsessions or compulsions are unreasonable or excessive.
Obsessive–compulsive personality disorder
Apart from perfectionism, other OCPD traits have been observed in the childhoods of those with eating disorders in much higher frequency than among control samples, including among their unaffected sisters.
Like those afflicted with OCPD, anorexics and bulimics also tend to have a great need for order and symmetry in their activities and surroundings, something seen in their relationship with a third disorder, OCD. Eating disorders are largely comorbid with OCD; with some studies showing that OCD symptoms are nearly as severe among anorexics as among a classic OCD sample, and that this remains so even after discounting food- and weight-related obsessions and compulsions.
Causes and origins of Tourette syndrome
Some forms of obsessive-compulsive disorder (OCD) may be genetically linked to Tourette's, or an alternate expression of the condition; genetic studies show an increased rate of tics and obsessive-compulsive behaviors or OCD in relatives of patients with Tourette's, and "reinforce the idea that at least some forms of OCD are etiologically related to TS, and may, therefore, be a variant expression of the same etiologic factors that are important for the expression of tics." Further evidence supporting that OCD and Tourette's are alternative expressions of a common genetic vulnerability is that males inheriting the genetic vulnerability are more likely to display tics, while females are more likely to display obsessive-compulsive traits.
Trichotillomania
Trichotillomania may lie on the obsessive-compulsive spectrum, also encompassing obsessive-compulsive disorder (OCD), body dysmorphic disorder (BDD), nail biting (onychophagia) and skin picking (dermatillomania), tic disorders and eating disorders. These conditions may share clinical features, genetic contributions, and possibly treatment response; however, differences between trichotillomania and OCD are present in symptoms, neural function and cognitive profile. In the sense that it is associated with irresistible urges to perform unwanted repetitive behavior, trichotillomania is akin to some of these conditions, and rates of trichotillomania among relatives of OCD patients is higher than expected by chance. However, differences between the disorder and OCD have been noted, including: differing peak ages at onset, rates of comorbidity, gender differences, and neural dysfunction and cognitive profile. When it occurs in early childhood, it can be regarded as a distinct clinical entity.
Intrusive thought
Blasphemous thoughts are a common component of OCD, documented throughout history; notable religious figures such as Martin Luther and Ignatius of Loyola were known to be tormented by intrusive, blasphemous or religious thoughts and urges. Martin Luther had urges to curse God and Jesus, and was obsessed with images of "the Devil's behind." St. Ignatius had numerous obsessions, including the fear of stepping on pieces of straw forming a cross, fearing that it showed disrespect to Christ. A study of 50 patients with a primary diagnosis of obsessive-compulsive disorder found that 40% had religious and blasphemous thoughts and doubts—a higher, but not statistically significantly different number than the 38% who had the obsessional thoughts related to dirt and contamination more commonly associated with OCD. One study suggests that content of intrusive thoughts may vary depending on culture, and that blasphemous thoughts may be more common in men than in women.
Obsessive–compulsive disorder
OCD is often confused with the separate condition obsessive–compulsive personality disorder (OCPD). OCD is egodystonic, meaning that the disorder is incompatible with the sufferer's self-concept. Because ego dystonic disorders go against a person's self-concept, they tend to cause much distress. OCPD, on the other hand, is egosyntonic—marked by the person's acceptance that the characteristics and behaviours displayed as a result are compatible with their self-image, or are otherwise appropriate, correct or reasonable.
Intrusive thought
A 2007 study found that 78% of a clinical sample of OCD patients had intrusive images. Most people who suffer from intrusive thoughts have not identified themselves as having OCD, because they may not have what they believe to be classic symptoms of OCD, such as handwashing. Yet, epidemiological studies suggest that intrusive thoughts are the most common kind of OCD worldwide; if people in the United States with intrusive thoughts gathered, they would form the fourth-largest city in the US, following New York City, Los Angeles, and Chicago.
Obsessive–compulsive disorder
British poet, essayist and lexicographer Samuel Johnson (1709–1784) also suffered from OCD. He had elaborate rituals for crossing the thresholds of doorways, and repeatedly walked up and down staircases counting the steps. He would touch every post on the street as he walked past, only step in the middles of paving stones, and repeatedly perform tasks as though they had not been done properly the first time. The American aviator and filmmaker Howard Hughes is known to have had OCD. Friends of Hughes have also mentioned his obsession with minor flaws in clothing. This was conveyed in "The Aviator" (2004), a film biography of Hughes.
Relationship obsessive–compulsive disorder
Common obsessive themes include fear of contamination, fears about being responsible for harming the self or others, doubts, and orderliness. However, people with OCD can also have religious and sexual obsessions. Some people with OCD may experience obsessions relating to the way they feel in an ongoing relationship or the way they felt in past relationships (ROCD). Repetitive thought about a person's feelings in intimate relationships may occur in the natural course of the relationship development; however, in ROCD such preoccupations are unwanted, intrusive, chronic and disabling.
Safety behaviors (anxiety)
People with obsessive-compulsive disorder (OCD) use safety behaviors to reduce their anxiety when obsessions arise. Common safety behaviors include washing hands more times than needed and avoiding potential contaminants by not shaking hands. However, when people with OCD use safety behaviors to reduce the chance of contamination, their awareness of potential contamination increases. This heightened awareness then leads to an increased fear of being contaminated.
Cause of obsessive-compulsive disorder
Early onset OCD, manifesting in childhood or adolescence, is a subtype of OCD etiologically distinct from adult onset OCD. This early onset OCD is reported to be genetically related to tic disorders and Tourette’s syndrome, as one study has found that patients with early onset OCD have a higher rate of Tourette’s and other tic disorders. Family association studies have suggested that early onset OCD is correlated to increased familial and possibly genetic risk. The rate of OCD and subclinical OCD among relatives of probands whose OCD manifested in childhood or adolescence was at least twice as high as the rate among relatives of probands whose OCD manifested in adulthood. Other studies have also indicated that there is an inverse relationship between the age of onset of the proband and the risk of OCD in relatives. Consequently, it is possible that there are different genetic mechanisms behind the two types of OCD; therefore, it may be necessary to control for age of onset when examining candidate genes.
Sexual obsessions
The OCD sufferer may have a constant focus on not becoming aroused or checking that they do not become aroused, and this may lead to "groinal response". Many OCD sufferers take this groinal response as actual arousal, when in reality it is not. OCD sexual obsessions often result in guilt, shame, depression and may interfere with social functioning or work. Approximately 40% of sufferers (number could be higher due to the embarrassment associated) also report some accompanying physiological arousal. Reactions can include increased heart rate, a feeling of being turned on, and even erections, increased lubrication (in women), and orgasm. This response typically generates more confusion and uncertainty. However, this is a conditioned physiological response in the primitive thalamus of a brain which does not identify the thought as sex with a particular person, but just sex. This is generally not indicative of one's own personal desires.
Biology of obsessive–compulsive disorder
The biology of obsessive-compulsive disorder(OCD) refers biologically based theories about the mechanism of OCD. Cognitive models generally fall into the category of executive dysfunction or modulatory control. Neuroanatomically, functional and structural neuroimaging studies implicate the prefrontal cortex (PFC), basal ganglia (BG), insula, and posterior cingulate cortex (PCC). Genetic and neurochemical studies implicate glutamate and monoamine neurotransmitters.
Wicca
The Neopagan researcher and High Priestess Margot Adler, who defined ritual as being "one method of reintegrating individuals and groups into the cosmos, and to tie in the activities of daily life with their ever present, often forgotten, significance" noted that rituals, celebrations and rites of passage in Wicca are not "dry, formalised, repetitive experiences", but are performed with the purpose of inducing a religious experience in the participants, thereby altering their consciousness. She noted that many Wiccans remain sceptical about the existence of the gods, afterlife etc but remain involved in the Craft because of its ritual experiences, with one, Glenna Turner, saying that "I love myth, dream, visionary art. The Craft is a place where all of these things fit together – beauty, pageantry, music, dance, song, dream."
Primarily obsessional obsessive compulsive disorder
Exposure and Response Prevention for Pure-O is theoretically based on the principles of classical conditioning and extinction. The spike (intrusive thought) often presents itself as a paramount question or disastrous scenario (e.g., WHAT IF I actually want to harm someone? WHAT IF I committed a sin?). A therapeutic response is one that answers the spike (intrusive thought) in a way that leaves ambiguity. E.g., someone with primarily obsessive OCD might think, "If I don't remember what I had for breakfast yesterday my mother will die of cancer!" Using the antidote procedure, a therapeutic response (one that will help interrupt the cycle of obsessing) would be one in which the subject accepts this possibility and is willing to take the risk of their mother dying of cancer or the question recurring for eternity, rather than attempting to answer the question and reassure oneself that the feared occurrence will not happen. In another example, the spike/intrusive thought would be, "Maybe I said something offensive to my boss yesterday." A recommended response would be, "Maybe I did. I'll live with the possibility and take the risk he'll fire me tomorrow." Although resisting the need to reassure oneself and perform compulsions will initially cause anxiety to increase, refusing to practice compulsions over an extended period of time will eventually cause anxiety around the sufferer's intrusive thoughts to decrease, making them less prevalent (e.g. they will begin to occur less often), and less distressing when they do occur. Using this procedure, it is imperative that the distinction be made between the therapeutic response and rumination. The therapeutic response does not seek to answer the question but to accept the uncertainty of the unsolved dilemma.
OTC
Center
Obsessive–compulsive personality disorder
Some OCD patients show an obsessive need for cleanliness, usually combined with an obsessive preoccupation for tidiness. This obsessive tendency might make their daily life rather difficult. Although this kind of obsessive behavior can contribute to a sense of "controlling personal anxiety," the tension might continue to exist. On the contrary, OCPD patients might tend not to organize things, and they could become compulsive hoarders. This is due to their efforts in cleaning their surroundings, which can effectively be hindered by the amount of clutter that the person still plans to organize in the future.
Obsessive–compulsive personality disorder
Regardless of similarities between the OCPD criteria and the obsessions and compulsions found in OCD, there are discrete qualitative dissimilarities between these disorders, predominantly in the functional part of symptoms. Unlike OCPD, OCD is described as invasive, stressful, time-consuming obsessions and habits aimed at reducing the obsession related stress. OCD symptoms are at times regarded as ego-dystonic because they are experienced as alien and repulsive to the person. Therefore, there is a greater mental anxiety associated with OCD. 
In contrast, the symptoms seen in OCPD, although they are repetitive, are not linked with repulsive thoughts, images, or urges. OCPD characteristics and behaviors are known as ego-syntonic, as people with this disorder view them as suitable and correct. On the other hand, the main features of perfectionism and inflexibility can result in considerable suffering in an individual with OCPD as a result of the associated need for control.
Obsessive–compulsive disorder
Some people with OCD experience sexual obsessions that may involve intrusive thoughts or images of "kissing, touching, fondling, oral sex, anal sex, intercourse, incest, and rape" with "strangers, acquaintances, parents, children, family members, friends, coworkers, animals, and religious figures", and can include "heterosexual or homosexual content" with persons of any age. As with other intrusive, unpleasant thoughts or images, some disquieting sexual thoughts at times are normal, but people with OCD may attach extraordinary significance to the thoughts. For example, obsessive fears about sexual orientation can appear to the person with OCD, and even to those around them, as a crisis of sexual identity. Furthermore, the doubt that accompanies OCD leads to uncertainty regarding whether one might act on the troubling thoughts, resulting in self-criticism or self-loathing.
Ritual
A ritual is a sequence of activities involving gestures, words, and objects, performed in a sequestered place, and performed according to set sequence. Rituals may be prescribed by the traditions of a community, including a religious community. Rituals are characterized but not defined by formalism, traditionalism, invariance, rule-governance, sacral symbolism, and performance.
The OCD Project
The OCD Project is an American reality television series that debuted on May 27, 2010. The series follows Dr. David Tolin and his exposure-based treatment of six patients living together in a Southern California mansion. The treatment, called exposure and response prevention, can seem unorthodox, but is the leading evidence-based treatment for OCD.
Perfectionism (psychology)
The self-help book "Too Perfect: When Being in Control Gets Out of Control" by Jeanette Dewyze and Allan Mallinger contends that perfectionists have obsessive personality types. Obsessive personality type is different from obsessive-compulsive disorder (OCD) in that OCD is a clinical disorder that may be associated with specific ritualized behavior or thoughts. According to Mallinger and DeWyze, perfectionists are obsessives who need to feel in control at all times to protect themselves and ensure their own safety. By always being vigilant and trying extremely hard, they can ensure that they not only fail to disappoint or are beyond reproach but that they can protect against unforeseen issues caused by their environment. Vigilance refers to constant monitoring, often of the news, weather, and financial markets.
Ecclesia Gnostica Catholica
About the Gnostic Mass, Crowley wrote in "The Confessions of Aleister Crowley", "... the Ritual of the Gnostic Catholic Church ... I prepared for the use of the O.T.O., the central ceremony of its public and private celebration, corresponding to the Mass of the Roman Catholic Church." It is the single most commonly performed ritual at O.T.O. bodies, with many locations celebrating the Mass monthly or more frequently. Most O.T.O. bodies make some or all of these celebrations open to interested members of the public, so the Mass is often an individual's first experience of the O.T.O.
Compulsive decluttering
Compulsive decluttering is a type of disorder that is classified within a broad name, obsessive compulsive disorder, or OCD. Compulsive decluttering is the act of throwing items, or clutter, away, or getting rid of them in an attempt to "clean up" what one with the disorder may think is cluttered. Even though it is the polar opposite of compulsive hoarding, the two are related because they both fall under the umbrella of OCD in different ways. Compulsive decluttering is also known as compulsive decluttering disorder, and is also known as "compulsive spartanism."
Effects of stress on memory
Behavior therapy has proven to be an effective method for treating OCD. Patients are exposed to the theme that is typically avoided, while being restricted from performing their usual anxiety reducing rituals. Behavior therapy rarely eliminates OCD, but it helps to reduce the signs and symptoms. With medication, this reduction of the disorder is even more evident. Antidepressants are usually the first prescribed medication to a patient with OCD. Medications that treat OCD typically inhibit the reuptake of serotonin.
Biology of obsessive–compulsive disorder
The cortico-basal ganglia-thalamo-cortical loop (CBGTC) model is based on the observation that the basal ganglia loops related to the OFC and ACC are implicated in OCD by neuroimaging studies, although the directionality of volumetric and functional changes is not consistent. Causal evidence from OCD secondary to neuropsychiatric disorders supports the CBGTC model. Obsessions may arise from failure of the circuit to gate information that is normally implicitly processed, leading to representation in explicit processing systems such as the dlPFC and hippocampus, and thereby resulting in obsessions.
Biology of obsessive–compulsive disorder
OCD has also been conceptualized as resulting from dysfunction in response inhibition, and fear extinction. While hyperactivation of the OFC as a whole during resting is observed in OCD, hyperactivation of the lateral OFC and hypoactivation of the mOFC is seen. This is congruent with the localization of fear/avoidance behaviors to the lOFC and emotional regulation to the mOFC. Hyperactivity of the dACC during monitoring task, along with hyperactivity of the lOFC and amygadala may all contribute to generating obsessions, reduced regulation by the mOFC may enable them.
OCD Action
OCD Action is a membership organisation with members electing a management body, the board of trustees, every year at the charity's Annual General Meeting. The trustee group is currently made up of three medical experts, two carers, four people with OCD and one charity management and fundraising professional.
Kleptomania
Kleptomania is frequently thought of as being a part of obsessive-compulsive disorder (OCD), since the irresistible and uncontrollable actions are similar to the frequently excessive, unnecessary, and unwanted rituals of OCD. Some individuals with kleptomania demonstrate hoarding symptoms that resemble those with OCD.
Prevalence rates between the two disorders do not demonstrate a strong relationship. Studies examining the comorbidity of OCD in subjects with kleptomania have inconsistent results, with some showing a relatively high co-occurrence (45%-60%) while others demonstrate low rates (0%-6.5%). Similarly, when rates of kleptomania have been examined in subjects with OCD, a relatively low co-occurrence was found (2.2%-5.9%).
Compulsive behavior
Compulsive behavior is defined as performing an act persistently and repetitively without it necessarily leading to an actual reward or pleasure. Compulsive behaviors could be an attempt to make obsessions go away. The act is usually a small, restricted and repetitive behavior, yet not disturbing in a pathological way. Compulsive behaviors are a need to reduce apprehension caused by internal feelings a person wants to abstain from or control. A major cause of the compulsive behaviors is said to be obsessive–compulsive disorder (OCD). "The main idea of compulsive behavior is that the likely excessive activity is not connected to the purpose to which it appears directed." Furthermore, there are many different types of compulsive behaviors including, shopping, hoarding, eating, gambling, trichotillomania and picking skin, checking, counting, washing, sex, and more. Also, there are cultural examples of compulsive behavior.
Ritual of oak and mistletoe
The ritual of oak and mistletoe is a Celtic religious ceremony, in which white-clad druids climbed a sacred oak, cut down the mistletoe growing on it, sacrificed two white bulls and used the mistletoe to make an elixir to cure infertility and the effects of poison. The ritual, known from a single passage in Pliny's "Natural History", has helped shape the image of the druid in the popular imagination.
Otōri
This group ritual involves people sitting in a circle. One person, the "oya" (master of ceremonies), makes a speech related to the particular celebration or ceremony being observed, filling his own glass with alcohol, usually an Okinawan distilled beverage called awamori, and drains it. The "oya" then moves the circle and pours awamori for everyone. After that he makes a short closing speech and choose another "oya" to start the next round.
Elizabeth McIngvale
At one point doctors believed McIngvale's OCD was too severe to be treatable. Her rituals included having to repeat menial tasks 42 times, an obsession with religious symbolism, and washing her hands over 100 times a day. She engaged in exposure with response prevention (ERP) treatment for her OCD and now successfully manages her illness.
Sexual obsessions
In the midst of the thoughts, the sexual obsessions may seem real. Occasionally, individuals with OCD believe that their obsession is true, and in such a case they would be said to have "poor insight". But the vast majority of people with OCD recognize at some point that their fears are extreme and unrealistic. The problem is that even though they know the obsession is false, it "feels" real. These individuals cannot understand why they are unable to dismiss the obsession from their minds. The obsession may temporarily subside in the face of a logical argument or reassurance from others, but may spike when caught off guard by a sexual trigger.
Thought suppression
Thought suppression is a type of motivated forgetting when an individual consciously attempts to stop thinking about a particular thought. It is often associated with obsessive–compulsive disorder (OCD). OCD is when a person will repeatedly (usually unsuccessfully) attempt to prevent or "neutralize" intrusive distressing thoughts centered on one or more obsessions. It is also thought to be a cause of memory inhibition, as shown by research using the think/no think paradigm. Thought suppression is relevant to both mental and behavioral levels, possibly leading to ironic effects that are contrary to intention.Ironic process theory is one cognitive model that can explain the paradoxical effect.
Effects of stress on memory
A person that shows a constant need to complete a certain "ritual", or is constantly plagued with unwelcome thoughts, may suffer from OCD. Themes of obsessions include fear of germs or dirt, having things orderly and symmetrical, and sexual thoughts and images.
Signs of obsessions:
Satanic ritual abuse
SRA has been linked to dissociative identity disorder (DID, also known as multiple personality disorder or MPD), with many DID patients also alleging cult abuse. The first person to write a first-person narrative about SRA was Michelle Smith, co-author of "Michelle Remembers"; Smith was diagnosed with DID by her therapist and later husband Lawrence Pazder. Psychiatrists involved with the International Society for the Study of Trauma and Dissociation (then called the International Society for the Study of Multiple Personality and Dissociation), especially associate editor Bennett G. Braun, uncritically promoted the idea that actual groups of persons who worshiped Satan were abusing and ritually sacrificing children and, furthermore, that thousands of persons were recovering actual memories of such abuse during therapy, openly discussing such claims in the organization's journal, "Dissociation". In a 1989 editorial, "Dissociation" editor-in-chief Richard Kluft likened clinicians who did not speak of their patients with recovered memories of SRA to the "good Germans" during the Holocaust. One particularly controversial article found parallels between SRA accounts and pre-Inquisition historical records of satanism, hence claimed to find support for the existence of ancient and intergenerational satanic cults. A review of these claims by sociologist Mary de Young in a 1994 "Behavioral Sciences and the Law" article noted that the historical basis for these claims, and in particular their continuity of cults, ceremonies and rituals was questionable. However at a conference in November 1990, psychiatrist and researcher Frank Putnam, then chief of the Dissociative Disorders Unit of the National Institute of Mental Health in Bethesda, Maryland, led a plenary session panel that proved to be the first public presentation of psychiatric, historical and law enforcement skepticism concerning SRA claims. Other members of the panel included psychiatrist George Ganaway, anthropologist Sherrill Mulhern, and psychologist Richard Noll. Putnam, a skeptic, was viewed by SRA advocates in attendance as using fellow skeptics such as Noll and Mulhern as allies in a disinformation campaign to split the SRA-believing community.
Obsessive–compulsive spectrum
Tourette’s syndrome is a neurological disorder characterized by recurrent involuntary movements (motor tics) and involuntary noises (vocal tics). The reason Tourette’s syndrome and other tic disorders are being considered for placement in the obsessive compulsive spectrum is because of the phenomenology and co-morbidity of the disorders with obsessive compulsive disorder. Within the population of patients with OCD up to 40% have a history of a tic disorder and 60% of people with Tourette’s syndrome have obsessions and/or compulsions. Plus 30% of people with Tourette’s syndrome have clinically diagnosable OCD. Course of illness is another factor that suggests correlation because it has been found that tics displayed in childhood are a predictor of obsessive and compulsive symptoms in late adolescence and early adulthood. However, the association of Tourette’s and tic disorders with OCD is challenged by neuropsychology and pharmaceutical treatment. Whereas OCD is treated with SSRI, tics are treated with dopamine blockers and alpha-2 agonists.