How does Obsessive-Compulsive Disorder develop?

An overview of the process by which OCD develops into a major problem.

Obsessive-compulsive disorder (OCD) is one of the psychopathological conditions that has attracted the attention of experts and laymen alike, and many works have been produced in film and literature in order to show its most florid characteristics.

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

In this article we will try to shed light on the dense shadows that surround it, by delving into what we currently know about how OCD develops and the "logic" of the disorder 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 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 sort of recurrent cycle in which both feed each other in a reciprocal way****, 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, as they offer 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 living with OCD, and the reason why the situation becomes more than just a succession of negative thoughts.

Classical and operant learning

Many mental disorders have elements that were learned at some time in lifea. In fact, it is based on this premise 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 used 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 displayed (similar to those displayed in phobic disorders). In these cases the person would try not to expose him/herself to situations that could trigger intrusive thoughts, which would severely limit his/her way of living and personal development options.

In any case, one and the other are associated with both the genesis and maintenance of OCD. Likewise, the fact that the behavior carried out to minimize anxiety lacks logical connection with the content of the obsession (clapping hands when the thought arises, for example) suggests a form of superstitious reasoning of which one is usually aware, because the person can recognize the illogicality underlying what is happening to him or her.The person can recognize the illogicality that underlies what is happening to him/her.

2. Social learning

Many authors have shown that OCD can be influenced by certain forms of upbringing during childhood. Stanley Rachman pointed out that cleaning rituals would be more prevalent among children who developed under the influence of overprotective parents, and that verification compulsions would occur mainly in those cases in which parents imposed a high level of demands for the functioning of everyday life. Today, however, there is insufficient empirical evidence to corroborate these postulates.

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

3. Unrealistic subjective evaluations

A very significant percentage of the general population confesses to having experienced invasive thoughts at some time during their lives. These are mental contents that enter the consciousness without any will, and which usually pass through without much consequence until at a certain point they simply cease to exist. But in people suffering from OCD, however, a very negative assessment of its significance 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 usually judged as catastrophic and inappropriate, or even detonates the belief that they are not important.or even detonates the belief that it suggests a deficient human quality and deserves punishment. As 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 control over thought, seeking its total eradication.. What finally ends up happening, 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 obsession-compulsion pattern that is characteristic of the condition would form.

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 the processing of emotions, especially when fear is involved. And the fact is that these are patients with a characteristic fear of harming themselves or othersas a result (directly or indirectly) of the content of the obsession. This is one of the most distinctive features with respect to other mental health problems.

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

5. Interaction between intrusive thoughts and beliefs

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

The person with OCD interprets his or her obsessions as dramatically challenging what he or she considers to be fair, legitimate, appropriate or valuable. For example, the access to the mind of bloody contents (scenes of murder or in which serious damages are produced on some relative or acquaintances) has disturbing effects on the person who holds non-violence as a value with which to behave in life.

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

6. Disproportionate responsibility

Given that the obsessive thought diametrically contradicts the values of the person with OCD, a response of guilt and cervical fear would arise that its contents could become manifest on the objective level (causing harm to oneself or others). A position of extreme responsibility would be assumed concerning the risk that something could happen, which is the definitive driver of an "active" (compulsive) attitude aimed at resolving the situation.

A particular effect is therefore produced, and it is that the obsessive idea ceases to have the value that it would have for people without OCD (innocuous), remaining (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 (preoccupation with being preoccupied). Severe erosion of self-esteem and even questioning one's own worth as a human being is not uncommon.

7. Thought-action fusion

Fusion between thought and action is a very common phenomenon in OCD. It describes how the person tends to equate having thought about an event with having directly performed it in real life, attributing the two assumptions the same importance. He also points out the difficulty in 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 is expanded by imagining "horrible scenes", which are distrusted.which are distrusted as to their veracity or falsity.

There are a number of assumptions made by the OCD sufferer that relate to thought-action fusion, namely: thinking about something is tantamount to doing it, trying not to prevent the feared harm is tantamount to causing it, low probability of occurrence does not exempt from responsibility, not carrying out the compulsion is tantamount to wishing for the negative consequences about which one is about which one is worried, and a person must always control what happens in his or her mind. All of these are, moreover, cognitive distortions that can be addressed by 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 may see their acts of neutralization reinforced by the conviction that they act "consistently with their values and beliefs", which provides consistency to their way of doing things and contributes to maintaining it over time (despite adverse life consequences). 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, he/she will overestimate the risk and act with the purpose of preventing it from happening. The consequence of all this is that finally nothing will happen (as it was foreseeable), but the individual will interpret that it was so "thanks" to the effect of his compulsion, ignoring the contribution of chance.obviating the contribution of chance to the equation. In this way, the problem will become entrenched over time, since the illusion of control will never be broken.

9. Insecurity before the ritual

The complexity of compulsive rituals varies. In mild cases it is sufficient to perform a quick action that is resolved in a discrete time, but in severe cases a rigid and precise pattern of behaviors (or thoughts, since sometimes the compulsion is cognitive) can be observed. For example, washing hands for exactly thirty seconds, or clapping one's hands eighteen times when hearing a particular word that precipitates the obsession.

In these cases, the compulsion must be performed absolutely exactly in order to be considered correct and to alleviate 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 tend to develop, and those that interfere in a more profound way on daily life (considering 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 (neuronal connections between the prefrontal cortex and the striatal nucleus that cross 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 form). (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. These include serotonin, dopamine and glutamate, with dysfunction 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.