How does Obsessive-Compulsive Disorder develop?

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

The truth is that despite this (or perhaps sometimes for this very reason...), it continues to be a health problem misunderstood by society, despite the fact that a large sector of the scientific community continues to investigate it without rest.

In this article we will try to shed light on the dense shadows that surround it, delving into what we currently know about how OCD develops and the "logic" that the disorder has for those who live with it.

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How OCD develops, in 10 keys

OCD is a mental disorder characterized by the presence of obsessions (verbal/visual thoughts that are considered intrusive and unwanted) and compulsions (physical or mental acts that are carried out with the aim of reducing or alleviating the discomfort generated by the obsession). The relationship established between them would build the foundation of the problem,**** a kind of recurring cycle in which both feed each other****, connecting in a functional and sometimes illogical way objective.

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

In the following lines we will delve into ten fundamental keys to understand what is happening in the person who lives with OCD, and why the situation becomes something more than just a train of thoughts negatives.

1. classical and operant learning

Many mental disorders have elements that were learned at some point in life.to. In fact, it is based on such a premise to suggest 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 escape strategy, because with it the anxiety caused by the obsession is relieved (through reinforcement negative).

In people with OCD, in addition to the escape that is made explicit through compulsions, avoidance type behaviors may also be observed (similar to those that are deployed in phobic disorders). In these cases, the person would try not to expose themselves to those situations that could trigger intrusive thoughts, which would severely limit their way of life and development options staff.

In any case, both are associated with both the genesis and the maintenance of OCD. Also, the fact that the behavior carried out to minimize anxiety lacks connection logic with the content of the obsession (clapping when the thought arises, for example) suggests a form of superstitious reasoning that is often self-aware, because the person can recognize the illogicality that underlies what happens to him.

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2. social learning

Many authors have shown that OCD can be influenced by certain forms of parenting during childhood. Stanley Rachman pointed out that cleansing rituals would be more prevalent among children who grew up under the influence of overprotective parents, and that Verification compulsions would occur above all in those cases in which the parents imposed a high level of demand for the functioning of the everyday life Nowadays, however, there is not enough empirical evidence available to corroborate these postulates.

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

3. unrealistic subjective ratings

A very significant percentage of the general population confesses to having ever experienced intrusive thoughts during their lives. It is about mental contents that access consciousness without the intervention of will, and that usually pass without major consequences until at a certain moment they simply cease to exist. But in people who suffer from OCD, however, a very negative assessment of its importance would be triggered; this being one of the fundamental explanatory points for the further development of the problem.

The content of thoughts (images or words) is often judged catastrophic and inappropriate, or even trigger the belief that it suggests a deficient human quality and warrants punishment. How, furthermore, it deals with situations of internal origin (as opposed to external ones that depend on the situation), it would not be easy to ignore its influence on emotional experiences (such as sadness, fear, etc).

In order to achieve it an attempt would be made to impose a tight control over thought, seeking its total eradication. What ends up happening, however, is the well-known paradoxical effect: both its intensity and its absolute frequency increase. This effect accentuates the discomfort associated with the phenomenon, fosters 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 painting would be formed.

4. Alteration in cognitive processes

Some authors consider that the development of OCD is based on the compromise of a group of cognitive functions related to memory storage and emotion processing, especially when the fear. And it is that these are patients with a characteristic fear of harming themselves or others, as a result (direct or indirect) of the content of the obsession. This is one of the most distinctive features compared to other mental health problems.

In fact, the nuances of harm and threat are what make passive coping with the obsession difficult, forcing its active approach through compulsion. That way, three cognitive deficits could be distinguished: epistemological reasoning (“if the situation is not totally safe it is dangerous in all probability”), overestimation of the risk that is associated with the inhibition of the compulsion and impediments to integrate into the consciousness the information related to the fear.

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5. Interaction between intrusive thoughts and beliefs

Obsession and negative automatic thoughts can be differentiated by a simple nuance, although elementary to understand how the former has an effect deeper into the subject's life than the latter (common to many disorders, such as those included in the categories of anxiety and mood cheer up). This subtle difference, of the deepest depth, is confrontation with the belief system.

The person suffering from OCD interprets that her obsessions dramatically attempt against what he considers fair, legitimate, adequate or valuable. For example, access to the mind of bloody content (scenes of murders or in which serious damage is done to a relative or acquaintance) has disturbing effects on those who hold non-violence as a value with which to conduct themselves in the life.

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

6. disproportionate liability

Since obsessive thinking diametrically contradicts the values ​​of the person with OCD, a response of guilt and cerval fear that its contents could manifest itself on the objective level (causing damage to oneself or others). the rest). It would assume a position of extreme responsibility regarding the risk that something could happen, which is the ultimate driver of an "active" (compulsive) attitude aimed at resolving the problem. situation.

Therefore, a particular effect is 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 to a greater extent with the way of interpreting the obsession than with the obsession itself (worry about being worried). It is not uncommon for a severe erosion of self-esteem to occur, and even to question one's own worth as a human being.

7. Thought-action fusion

The fusion between thought and action is a very common phenomenon in OCD. It describes how the person tends to equate having thought about a fact with having carried it out directly in real life, attributing the same importance to both assumptions. He also points out the difficulty in clearly distinguishing whether an evoked event (close correctly the door, for example) is just an image that was artificially generated or actually came to happen. The resulting anxiety is expanded by imagining "horrible scenes", of which there is suspicion about their veracity or falsity.

There are a number of assumptions made by the person suffering from OCD and that are related to thought-action fusion, namely: thinking about some thing is comparable to doing it, trying not to prevent the feared damage is equivalent to causing it, the low probability of occurrence does not exempt from responsibility, not carrying out the compulsion is the same as wishing for the negative consequences about which one is concerned and a person must always control what goes on in his mind. All of them are also cognitive distortions that can be addressed through restructuring.

8. Bias in the interpretation of consequences

In addition to negative reinforcement (repetition of the compulsion as a result of the primary relief of anxiety associated with it), many People can see their acts of neutralization reinforced by the conviction that they act "coherently with their values ​​and beliefs", which that provides consistency to their way of doing things and contributes to maintaining it over time (despite the adverse consequences on the life). But there is something else, related to an interpretive bias.

Despite the fact that 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 with the purpose of preventing it from expressing itself. The consequence of all this is that in the end nothing will happen (as was foreseeable), 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 before the ritual

The complexity of compulsive rituals is variable. In mild cases it is enough to carry out a quick action that is resolved in a discrete time, but in serious cases a pattern of behaviors (or thoughts, since sometimes the compulsion is cognitive) can be observed rigid and accurate. An example can be washing your hands for exactly thirty seconds, or clapping eighteen times when you hear a specific word that precipitates the obsession.

In these cases, the compulsion must be performed absolutely exactly so that it can be considered correct and alleviates the discomfort that triggered it. In many cases, however, the person comes to doubt whether they did it right or maybe made a mistake at some point in the process, feeling compelled to repeat it again. This is the moment in which the most disruptive compulsions usually develop, and those that interfere in a more profound way about daily life (according to the time they require and how invalidating they are result).

10. Neurobiological aspects

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

In direct association with these brain structures, it has also been proposed that the activity of certain neurotransmitters could be involved in the development of OCD. Among them, serotonin, dopamine and glutamate stand out; with a dysfunction that is associated with certain genes (hence its 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.