Compulsive prayer and its management.

Religious symptoms have been recognized as a presentation of obsessive-compulsive disorder (OCD) for centuries. The two main treatment strategies for OCD, cognitive behavior therapy (exposure and response prevention [ERP]), and SSRIs have been shown to be effective in religious OCD. The presentation of religious OCD within formal prayer, reported in Judaism and Islam, poses special challenges of inaccessibility of personal prayer, sanctity of the symptom, and the status of the therapist. A method of guided-prayer repetition, a variant of ERP, is described, and its successful application is reported in three cases of ultra-orthodox Jewish men with prayer as the main symptom of their religious OCD.