Obsessive Compulsive Disorder (OCD)

Among the most serious and disabling forms of psychopathology we can certainly find obsessive compulsive disorder (OCD or OCD). This disorder is resistant to drug therapies and treatments through the main traditional psychotherapies due to its logical, non-ordinary and sometimes bizarre structure. As regards the traditional psychotherapeutic approaches, in fact, in the treatment of obsessive compulsive disorder, rational logical reasoning is used for its treatment, based on ordinary logic that ends up colliding with the non-ordinary logic of the disorder itself. Presenting OCD means exhibiting behavioral and / or thinking rituals that constitute a psychological trap from which it is difficult to break free. They can make life impossible for those who suffer from it but also for those around them. Ciorian EM stated: "Some have misfortunes; other obsessions. Which ones are most to be pitied? "

The rituals that the person can perform are inevitable and unstoppable and they can be performed to prevent or propitiate one's own reality, or to repair the negative effects of our action or thought. These are the three main classes of compulsive rituals but whether they are thought or behavioral they feed the disorder itself, making the person a slave to the mechanism through which he tries to control his own reality.

According to the classification proposed by the DSM-IV TR (Diagnostic and Statistical Manual of Mental Disorders) ofAPA (American Psychiatric Association), OCD is an anxiety disorder characterized by the presence of obsessions and compulsions. Subsequently, with the release of DSM V, published in 2014, we witness the creation of a new chapter called "Obsessive - compulsive disorder and related disorders", which has been distinguished from Anxiety Disorders. The novelty therefore lies in the fact that it is identified as an autonomous nosological entity together with other related disorders. Epidemiological studies have shown an incidence in the population of about 5%.

The disorder affects both sexes equally and the average age of onset varies between 22 and 35 years, but can begin to manifest gradually in childhood and adolescence. The most used therapeutic approaches in the treatment of OCD are the cognitive behavioral one and precisely the short strategic approach. There is a substantial difference between the two types of intervention: the cognitive behavioral approach, often associated with drug therapy, through a process of awareness and voluntary effort, guides the patient to learn how to fight or manage the disorder. We could summarize that first “explains then guides to act”. As for the strategic approach instead, the therapist uses therapeutic stratagems which aim to create corrective emotional experiences in perceptions, to then acquire management skills. In this case, we can summarize the concept by saying that "first he acts then he explains" starting from the assumption that, as Pascal said, whoever persuades himself does it sooner and better! Learning from a strategic point of view is therefore stronger if the patient first experiences the possibility of managing the problem through random events planned by the therapist.

Doubt is the springboard for creative thinking, but at the same time it is the mainspring of obsessive thinking.
(Giorgio Nardone)

The person who develops an OCD generally and initially uses the ritual to cope with a phobic situation from which he wants to protect. The ritual, created by controlling what is feared, creates the patient's self-deception of being protected. The repetition of these actions over time will thus consolidate the disorder, which has therefore become a trap that will imprison the person. From a strategic point of view, a person who presents an OCD exhibits three usual attempted solutions which, thinking they are decisive for the problem, actually feed and maintain it.
These attempted solutions are: avoidance strategy of what scares, request for reassurance and help, execution of preventive, propitiatory and restorative rituals. The therapeutic intervention will therefore focus on the interruption of the implementation of the attempted solutions that maintain the discomfort in the patient and in the family system.

As already anticipated, a patient cannot be persuaded to eliminate his obsessions or to interrupt the execution of his ritual acts through rational explanations.5 With a strategic intervention, for example through one of the maneuvers designed to act on the disorder, he will ask precisely to perform the ritual 'better', suggesting 'a more effective method' to satisfy one's needs and achieve one's purpose: to control fear.

The logic underlying the obsessive-compulsive symptomatology is then followed, to create a counter-ritual that allows access to the patient's perception and guide him to the release of the symptoms. The counter-ritual allows to break the rigid pattern made of perception of fear-reassuring action-confirmation of the threat of the phobic belief. Therefore the ritual (together with the other two attempted solutions) is seen as the "only chance" to stifle the phobic perception but at the same time, precisely because it is implemented for this purpose, it will only make it more threatening.
The maneuver will obviously be fitted and adapted to the patient and his problem, thus not resorting to the same "recipes" of intervention applied a priori but creating a personalized intervention, like a tailor would sew a tailor-made suit for the person.

Dr. Eleonora Campolmi (Psychologist - Official Psychotherapist of the Strategic Therapy Center)

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