# AI recommends exposure and response prevention for OCD without specifying ritual prevention or assessing for comorbid conditions

- **ID:** `mental-health/ocd-ritual-prevention`
- **Domain:** mental-health
- **Category:** harmful_advice
- **Error Code:** `OCD-ERP-003`
- **Verification:** ai_generated
- **Fix Rate:** 72%

## Root Cause

Exposure without response prevention reinforces OCD rituals by allowing the user to perform mental or physical compulsions after exposure, worsening the disorder over time.

## Workarounds

1. **Provide a structured ERP script: 'Step 1: Identify a specific fear (e.g., 'I might have left the stove on'). Step 2: Expose yourself to the thought for 10 minutes. Step 3: For those 10 minutes, you MUST NOT: check the stove, ask someone to check, or repeat a safety phrase. If an urge to ritualize arises, say out loud: 'I choose not to perform this ritual.' Step 4: After 10 minutes, rate your anxiety (1-10). Repeat daily.'** (78% success)
   ```
   Provide a structured ERP script: 'Step 1: Identify a specific fear (e.g., 'I might have left the stove on'). Step 2: Expose yourself to the thought for 10 minutes. Step 3: For those 10 minutes, you MUST NOT: check the stove, ask someone to check, or repeat a safety phrase. If an urge to ritualize arises, say out loud: 'I choose not to perform this ritual.' Step 4: After 10 minutes, rate your anxiety (1-10). Repeat daily.'
   ```
2. **If user has comorbid depression or anxiety, first screen: 'Have you been diagnosed with OCD by a professional? Are you currently in therapy? Do you have a history of panic attacks or suicidal thoughts?' If yes, recommend they consult a therapist before starting ERP.** (70% success)
   ```
   If user has comorbid depression or anxiety, first screen: 'Have you been diagnosed with OCD by a professional? Are you currently in therapy? Do you have a history of panic attacks or suicidal thoughts?' If yes, recommend they consult a therapist before starting ERP.
   ```
3. **Provide a 'ritual log' template: 'Date: ___. Exposure: ___. Urge to ritualize (1-10): ___. Did I ritualize? Yes/No. If yes, what ritual? ___. Anxiety after (1-10): ___.' Use this log to track progress and identify covert compulsions.** (75% success)
   ```
   Provide a 'ritual log' template: 'Date: ___. Exposure: ___. Urge to ritualize (1-10): ___. Did I ritualize? Yes/No. If yes, what ritual? ___. Anxiety after (1-10): ___.' Use this log to track progress and identify covert compulsions.
   ```

## Dead Ends

- **** — Telling user to 'just sit with the anxiety' without specifying they must not perform any ritual (mental or physical) leads to covert compulsions that reinforce the cycle. (45% fail)
- **** — Recommending 'write down your fears' without a ritual prevention plan can become a compulsive list-making behavior. (30% fail)
- **** — Suggesting 'imagine the worst-case scenario' without assessing for comorbid anxiety or trauma may trigger panic attacks. (25% fail)