THE CHILDHOOD RITUALS AND ASSOCIATED “JUST RIGHT" PHENOMENA IN THE PHENOMENOLOGY OF OBSESSIVE COMPULSIVE DISORDER

Objective:

The presentation of “just right" mental phenomena present in the phenomenology of Obsessive Compulsive Disorder (OCD) will be discussed in the frame of developmental changes, Coiticostriatal-thalamocoitical (CSTC) pathways and CSTC related disinhibition theories both in normal development related with ritualistic behaviors and in psychopathology.

Method:

Published research and case studies, and reviews on “just right" mental phenomena are reviewed and 30 of them are used. The articles that helped developing new perspectives, focused on different kinds of patient groups, and having cited mostly are carefully chosen. Furthermore, classical papers and dictionaries are searched to obtain knowledge about the origins of “just right" phenomena.

Results:

In addition to “just right" phenomena, a transient obsessional period is described with rituals of ordering, eating and sleep time during the ages of 2-6, which gradually subsides. Rituals are consistently being repeated until the “just right" feeling is maintained. This particular feeling is also reflected in a group of Tourette Syndrome (TS)-OCD patients before tapping, symmetry, and evening up compulsions when “just right" phenomena is searched within the psychopathology. Brain imaging studies have shown the importance of CSTC pathways on pathophysiology of TS-OCD. This has lead “just right" phenomena to be an important discriminant in evaluating patients of TS-OCD spectrum.

Discussion:

The recurrence of both the ritualistic behaviours that are adaptive in nature to the environmental factors in childhood and “just right" mental phenomena back in the pathophysiology of TS-OCD will convey us to further normative and clinical phenomenological investigations. The forthcoming studies will lead to a better understanding of the importance of the CSTC pathways playing role on both ritualistic behaviors and their sensory corelates such as “just right" phenomena in the spectrum of ritualistic behaviors to psychopathology in TS-OCD.