Obsessive-compulsive disorder (OCD) is one of the psychopathological pictures that has attracted the most attention from experts and laymen, with many works having been made in the cinema and in literature in order to show its most flowery characteristics.

The truth is that despite this (or perhaps sometimes for this very reason…), it remains a misunderstood health problem for society, despite the fact that a large sector of the scientific community continues to research it relentlessly.

In this article, we’ll try to shed light on the dense shadows surrounding it by delving into what we currently know about how OCD develops and the “logic” that the disorder has for those who live with it.

How OCD Develops, in 10 Keys

OCD is a mental disorder characterized by the presence of obsessions (verbal/visual thoughts that are considered invasive and unwanted) and compulsions (physical or mental acts that are performed with the goal of reducing or relieving the discomfort generated by the obsession). The relationship established between them would build the foundation of the problem,**** a sort of recurrent cycle in which both feed on each other****, connecting in a functional way and sometimes lacking any objective logic.

Understanding how OCD develops is not simple, and for this it is necessary to resort to theoretical models from learning, Cognitive Psychology, and Behavioral Psychology; they propose explanations that are not mutually exclusive and that can clarify why such a disabling situation arises.

In the following lines, we’ll delve into ten fundamental keys to understanding what’s happening in the person living with OCD, and why the situation becomes more than just a succession of negative thoughts.

1. Classical and operant learning

Many mental disorders have elements that were learned at some point in life a. In fact, one starts from such a premise to propose that they can also be “unlearned” through a set of experiences that are articulated in the therapeutic context. From this perspective, the origin/maintenance of OCD would be directly associated with the role of compulsion as an escape strategy, since it is possible to alleviate the anxiety caused by the obsession (through negative reinforcement).

In people with OCD, in addition to the escape that is made explicit through compulsions , avoidance-type behaviors can also be observed (similar to those that occur in phobic disorders). In these cases the person would try not to expose himself to those situations that could trigger intrusive thoughts, which would severely limit his way of living and his options for personal development.

In any case, both are associated with the genesis and maintenance of OCD. Also, the fact that the behavior carried out to minimize anxiety has no logical connection with the content of the obsession (clapping when the thought arises, for example) suggests a form of superstitious reasoning that is usually aware of , since the person may recognize the illogicality behind what is happening to him or her.

2. Social learning

Many authors have pointed out that OCD can be influenced by certain forms of parenting during childhood. Stanley Rachman noted that cleansing rituals would be more prevalent among children who developed under the influence of overprotective parents, and that verification compulsions would occur especially in cases where parents placed high demands on the functioning of daily life. Today, however, there is not enough empirical evidence to corroborate these assumptions.

Other authors have tried to answer the origin of OCD by alluding to the fact that it could be mediated by traditional educational stereotypes , which relegated women to the role of “caregivers/homeowners” and men to “family maintenance”. This social dynamic (which fortunately is becoming obsolete) would be responsible for the more usual appearance of order or cleanliness rituals, and in them those of verification (since they would be related to the “responsibilities” attributed in each case by gender).

3. Unrealistic subjective assessments

A very significant percentage of the general population confesses to having experienced invasive thoughts during their lifetime. These are mental contents that access the consciousness without the mediation of will, and that tend to transit without major consequences until at a certain moment they simply cease to exist. However, in people who suffer from OCD, a very negative assessment of their transcendence would be triggered; this being one of the fundamental explanatory points for the further development of the problem.

The content of the thoughts (images or words) is often judged as catastrophic and inappropriate , or even triggers the belief that it suggests a deficient human quality and deserves punishment. Since these are also situations of internal origin (as opposed to external ones that depend on the situation), it would not be easy to avoid their influence on emotional experiences (such as sadness, fear, etc.).

In order to achieve this an attempt would be made to impose an iron grip on thought, seeking its total eradication . What finally happens, however, is the well-known paradoxical effect: it increases both its intensity and its absolute frequency. Such an effect accentuates the discomfort associated with the phenomenon, promotes a feeling of loss of self-control and precipitates rituals (compulsions) aimed at more effective vigilance. It would be at this point that the pernicious pattern of obsession-compulsion that is characteristic of the picture would be formed.

4. Alteration in cognitive processes

Some authors believe that the development of OCD is based on the involvement of a group of cognitive functions related to memory storage and emotion processing, especially when fear is involved. This is because these are patients with a characteristic fear of harming themselves or others , as a result (directly or indirectly) of the content of the obsession. This is one of the most distinctive characteristics with respect to other mental health problems.

In fact, it is the nuances of harm and threat that make it difficult to deal with the obsession passively, forcing an active approach through compulsion. Thus, three deficits of a cognitive nature could be distinguished : epistemological reasoning (“if the situation is not totally safe it is probably dangerous”), overestimation of the risk associated with the inhibition of the compulsion and impediments to integrating the information related to fear into the consciousness.

5. Interaction between intrusive thoughts and beliefs

Obsession and negative automatic thoughts can be differentiated by a simple, yet elementary, nuance to understand how the former exerts a more profound effect on the subject’s life than the latter (common to many disorders, such as those included in the anxiety and mood categories). This subtle difference, of very deep significance, is the confrontation with the belief system .

The person with OCD interprets his or her obsessions as a dramatic attack on what he or she considers fair, legitimate, appropriate, or valuable. For example, access to the mind with gory content (scenes of murder or serious harm to family members or acquaintances) has a disturbing effect on those who hold nonviolence as a value to live by.

Such dissonance endows thought with a particularly disruptive (or egodistonic) coating, pregnant with a deep fear and inadequacy, and all this provokes a secondary result, but one of an interpretative and affective nature: disproportionate responsibility.

6. Disproportionate liability

Because obsessive thinking diametrically contradicts the values of the person with OCD, a guilt and fear response would arise that its contents might manifest themselves on the objective plane (causing harm to oneself or others). One would assume a position of extreme responsibility regarding the risk that something might happen, which is the ultimate driver of an “active” (compulsive) attitude toward resolving the situation.

A particular effect is therefore produced, and that is that the obsessive idea ceases to have the value it would have for people without OCD (innocuous), being imbued with a personal attribution. The harmful effect would be associated more with the way the obsession is interpreted than with the obsession itself (concern for being worried). It is not uncommon for self-esteem to be severely eroded, and even for one’s worth as a human being to be questioned.

7. Thought-action fusion

The fusion of thought and action is a very common phenomenon in OCD. It describes how a person tends to equate thinking about an event with doing it directly in real life, giving both assumptions equal weight. It also points out the difficulty of clearly distinguishing whether an evoked event (closing the door correctly, for example) is just an image that was artificially generated or whether it actually happened. The resulting anxiety expands when imagining “horrible scenes” , of which one distrusts their veracity or falseness.

There are a number of assumptions made by the person with OCD that are related to the fusion of thought-action, namely: thinking about something is equivalent to doing it, trying not to prevent the feared harm is equivalent to causing it, the low probability of occurrence does not exempt from responsibility, not carrying out the compulsion is equal to desiring the negative consequences that one is concerned about, and a person should always control what happens in his or her mind. All of them are also cognitive distortions that can be addressed by restructuring.

8. Bias in the interpretation of consequences

In addition to the negative reinforcement (repetition of the compulsion as a result of the primary relief from anxiety that is associated with it), many people may be reinforced in their acts of neutralization by the belief that they are acting “in accordance with their values and beliefs,” which provides consistency in the way they do things and helps to maintain it over time (despite the adverse consequences on life). But there is something else, related to an interpretative bias.

Although it is almost impossible for what the person fears to happen, according to the laws of probability, the person will overestimate the risk and act to prevent it from being expressed. The consequence of all this is that finally nothing will happen (as it was predictable), but the individual will interpret that it was so “thanks” to the effect of his compulsion , ignoring the contribution of chance to the equation. In this way, the problem will become entrenched in time, since the illusion of control will never be broken.

9. Insecurity in the face of ritual

The complexity of compulsive rituals varies. In mild cases it is enough to execute a quick action that is resolved in a discreet time, but in severe cases a pattern of behaviors (or thoughts, since sometimes the compulsion is cognitive) can be observed rigid and precise. It can serve as an example to wash the hands during thirty seconds exactly, or to give eighteen pats when a concrete word is heard that precipitates the obsession.

In these cases, the compulsion must be carried out absolutely exactly so that it can be considered correct and relieve the discomfort that triggered it. In many cases, however, the person comes to doubt whether he or she did it right or perhaps made a mistake at some point in the process, feeling obliged to repeat it again . This is the moment in which the most disruptive compulsions are usually developed, and those that interfere in a deeper way with everyday life (taking into account the time they require and how disabling they are).

10. Neurobiological aspects

Some studies suggest that people with OCD may have some alteration in the frontostriatal system (neural connections between the prefrontal cortex and the striatal nucleus that run through the globus pallidus, substantia nigra, and thalamus; eventually returning to the anterior region of the brain). This circuit would be responsible for inhibiting the mental representations (obsessions in any of their forms) and the motor sequence (compulsions) that could be detached from them.

In direct association with these brain structures, it has also been proposed that the activity of certain neurotransmitters may be involved in the development of OCD. Among these are serotonin, dopamine and glutamate, with a dysfunction associated with certain genes (hence their potential hereditary basis). All this, together with the findings on the role of the basal ganglia (initiation and integration of movement), could suggest the existence of neurological factors in this disorder.

Bibliographic references:

  • Heyman, I., Mataix-Cols, D. and Fineberg, N.A. (2006). Obsessive-Compulsive Disorder. British Medical Journal, 333(7565), 424-429.
  • López-Solà, C., Fontenelle, L.F., Verhulst, B., Neale, M.C., Menchón, J.M., Alonso, P. and Harrison, B.J. (2016). Distinct Etiological Influences on Obsessive-Compulsive Symptom Dimensions: a Multivariate Twin Study. Depression and Anxiety, 33(3), 179-191.