Cross cultural aspects of OCD in Islam and clinical practice

IntroductionReligious obsessions and compulsive acts compromise approximately two thirds of all obsessive compulsive disorder symptomatology in Muslim patients. Imam's mosque is consulted before a psychiatrist.ObjectivesTo explore the Islamic jurist's views and methods in dealing with obsessions and compulsions.AimsIntroduction of guidelines for managing OCD in some Muslim patients.MethodsWe began studying the different opinions of scholars in defining obsessive compulsive behaviour focusing on the tight criteria required by the Maliki Jurists to consider the individual being obsessed. This was followed by a thorough review of other Islamic doctrines.ResultsThe jurisprudential therapeutic approach includes:– obsessions are satanic whispers not originating from the self, which is equivalent to “It is not me but my OCD” in modern cognitive behavioural approach;– diverting attention from the obsessive thought rather than engaging with it;– not to respond to the obsessional thought (response prevention);– listing of religious permits;– focusing attention on acts of worship;– thought stopping.At the end we added various jurisprudential rules to be remembered by patients such as certainty does not fade with scepticism, no defiles by doubt, there are no doubts for a man with excessive doubts.ConclusionExposure and response prevention techniques are deeply rooted in Islamic jurisprudence and are practised with conviction by OCD Muslim patients. We produced specific guidelines that could be used by clinical psychologists and other mental health professionals in dealing with OCD patients top ensure their engagement in therapy.Disclosure of interestThe author has not supplied his declaration of competing interest.

Cognitive Therapy for OCD – Beyond ERP

Delivering cognitive–behavioural therapy (CBT) for obsessive–compulsive disorder (OCD) requires a detailed understanding of the phenomenology and the mechanism by which specific cognitive processes and behaviours maintain the symptoms of the disorder. A cognitive–behavioural model of OCD begins with the observation that intrusive thoughts, doubts or images are almost universal in the general population and their content is indistinguishable from that of clinical obsessions(1). The difference between a normal intrusive thought and an obsessional thought lies both in the meaning that individuals with OCD attach to the occurrence or content of the intrusions and in their response to the thought or image.

Predictors and Consequences of Suppressing Obsessional Thoughts

Cognitive-behavioral models of obsessive compulsive disorder (OCD) assert that negative appraisals of obsessional thoughts lead to distress over the thoughts and drive ameliorative actions such as thought suppression and compulsions. These responses in turn play a role in the persistence of the disorder. However, past research has not examined (a) what factors lead individuals to suppress obsessional thoughts; (b) whether certain predictors and consequences relate to suppression uniquely or can be explained by general factors such as negative mood and neuroticism; or (c) individuals' natural active suppression of obsessions. The current study addresses these limitations by examining the roles of natural suppression and distress over thought intrusions in the thought-appraisal/OC symptoms relationship while controlling for general factors. Ninety-one nonclinical participants completed a variety of measures assessing theoretically relevant constructs. After their obsessional thought was primed, they recorded their thoughts for 6 minutes and then rated their suppression effort. Four hours later, longer-term outcomes were assessed. Path analyses supported most components of cognitive-behavioral models.

Obsessional Thought Disturbance in a Gainfully Employed PTSD Patient

This is a single case study of obsessional thought disturbance in a currently employed Vietnam veteran who experienced traumatic stress during and subsequent to his tour of duty in Vietnam. It was hypothesized that with the diagnostic indicators present a systematic desensitization model with muscle relaxation, covert imagery, cognitive disputation and self-monitoring would offer relief to the patient's obsessive-compulsive features and allow maintenance of employment. Cognitive disputation, especially with spouse participation addressing the irrational belief system, proved to be a very effective component in the treatment program. The patient learned effective coping skills to guard against future obsessional thought disturbance and has been able to maintain gainful employment.

“Under-inclusion”—A Characteristic of Obsessional Personality Disorder: I

Although there is a voluminous psychiatric literature concerned with obsessional personality disorder, there are very few psychological studies of the condition. In particular, whilst the thinking of anankasts has been classically and perceptively described by many psychiatric authorities, only a handful of psychological experiments exclusively concerned with anankastic cognition have been reported (cf. Skoog, 1964). It is suggested that this is largely because interest has centred on the content of obsessional behaviour at the expense of its form. The present study is a brief report of one among several investigations suggested by consideration of the formal qualities of obsessional thought as opposed to its “dynamic” or symbolic features. The hypothesis (Reed, 1968) is that the formal characteristics of anankastic cognition are directly related to functional impairment in the spontaneous organization and integration of experience. It is postulated that this failure is expressed in the over-structuring of input and in the maladaptive over-defining of categories and boundaries. From this may be derived the prediction that, given a classificatory or conceptual task, the anankast will be over-specific in his interpretation of the given class and therefore too strict in his acceptance of appropriate class members and attributes.