Explanations For OCD
What is OCD?
OCD stands for obsessive compulsive disorder and is a mental illness in which sufferers are afflicted by irrational obsessions and their subsequent compulsions.
For example, a common obsession is being overly concerned with disease and a common compulsion for this obsession is washing your hands repeatedly (sometimes up to 100 times).
What is an Obsession?
An obsession is a thought, image or idea that recurs without a person's wanting it to. The range of obsessions by this definition is huge and includes less drastic obsessions like constantly worrying that you left your door unlocked when you go out to town, to much more serious ones like the recurring idea of violently murdering a loved one.
Obsessions often consume a person's mentality so that they are almost always thinking about some aspect of their obsession. Obsessions are therefore involuntary and sufferers find it difficult or impossible to distract themselves away from thinking about them.
A Common Compulsion: Hand washing.
What is a Compulsion?
A compulsion is repetitive activity that a person with an obsession performs in order to ease the anxiety of that obsession. Sufferers often admit that these activities are irrational and can see how what they're doing doesn't make much sense, but will still perform the action in order to ease their anxiety regarding the obsession. This can lead to depression through the shame of doing these ritual activities.
There are 5 general categories for people with OCD:
- Washers: compulsively wash things due to a fear of pathogens.
- Checkers: obsessed with danger from particular objects and so compulsively check dangerous objects like ovens, doors etc.
- Doubters: fear that if things are not done perfectly, terrible consequences will arise.
- Counters and Arrangers: obsessed with systems, order and symmetry. They arrange things in (seemingly random) specific ways. They have superstitions about numbers and colours.
- Hoarders: collect things compulsively with the fear that something bad will happen if they throw something away.
1. The Genetic Explanation of OCD
Many people see the causes of OCD as being purely to do with our genes. It has been proposed that the likelihood of having OCD is increased by having certain genes that make us more prone to the disease.
- McKeon and Murray (1987) found that OCD sufferers were more likely to have a brother, sister, parent or child who suffers from an anxiety disorder than people who don't, suggesting that anxiety disorders and OCD have a genetic link.
- Pauls et Al. (1995) found that 10.9% of patients with OCD had a family member who also had OCD whilst a control group (of non-sufferers) had only a 1.9% chance of having a family member with the disease.
The cause of OCD can be attributed to something in our genes that make us more prone to developing it. A specific gene has seemingly not been identified as of yet.
It's All About the Serotonin
The Biochemical Explanation of OCD
Other people see our biochemistry as the reason for the cause of OCD.
Although most anxiety disorders can be treated with a whole variety of drugs, OCD has only been found to respond well to drugs that affect levels of the neurotransmitter serotonin.
- Drugs like SSRI (anti-depressants) reduce the symptoms of OCD by increasing the levels of serotonin in the brain, giving strong evidence to the idea that OCD is caused from a lack of serotonin in the brain.
- Insel (1991) found that the use of SSRI's would only reduce the symptoms of OCD by around 50% and not fully treat the condition - therefore low serotonin levels cannot be the only cause of OCD.
- Increasing serotonin levels may only be a treatment for OCD and not actually anything to do with the cause of it - painkillers get rid of the feeling of pain but the pain was not caused by a lack of painkillers.
- It usually takes 4-12 weeks for a patient who takes SSRI treatment to report improvements but the SSRI drug itself actually increases serotonin levels within hours of taking it. This delay in improvement needs an explanation in order for serotonin theories to be validated.
It's About having the Right Conditions
The Behaviourist Explanation of OCD
Operant Conditioning can also be used to explain the cause of OCD in the following way:
Step 1. An association is made between two things: coming into skin contact with someone else is associated with disease and illness.
Step 2. Another act is thought up of in order to combat the anxiety from the first two things associated: the worry of catching a disease can be relieved by washing our hands.
Step 3. The behaviour is reinforced: each time a person comes into skin contact with another person they wash their hands and relieve themselves of some anxiety, reinforcing the behaviour in the process.
Step 4. This creates a strong tendency: to wash hands every time anxious about poor hygiene and the effect becomes very difficult to extinguish or reverse back to neutral.
1. Operant conditioning states that if a person with an OCD were to be prevented from doing their relieving compulsion then anxiety would rise steeply but then fall rapidly if the patient is allowed to perform his normal ritual.
2. Rachman and Hodgson (1980) found that this was indeed the case, and if a compulsive act is prevented the patient suffers great levels of anxiety for a long period of time, although eventually this anxiety drops by itself.
Although the behaviourist approach gives a very strong explanation for how OCD is continued, it does not explain how it arises in the first place – surely we are all prone to this reinforcement cycle that would lead us to OCD compulsions?
It's All About Robots
The Cognitive Explanation of OCD
Since people with OCD initially have obsessive thoughts, there must be an internal cognitive cause. The cognitive explanation for OCD is that people with the disease have a hypervigilant attention system i.e. the system used to respond to environmental cues is overactive.
The following two studies show that there is a link between OCD and memory (and so an internal cognitive process).
- Sher et al. (1989) found that people with OCD have poor memories for their own actions.
- Trivedi (1996) found that OCD sufferers had low confidence concerning their own memory competences and had impaired non-verbal memory.
But more conclusively:
Rachman (2004) had a patient who had a severe fear of blood. Her brain was hypervigilant when scanning the room (you could see her eyes move rapidly) for things that looked like blood, her brain would even often mistake dark red spots for blood and get a false sense of danger. As a result of her hypervigilance, she could also recall, in much greater detail than usual, events or images that she decided were relevant to blood.
A Summary of the Explanations of OCD
The biological approach to psychology offers:
- Genetic Explanation - we have genes that make us more likely to acquire OCD
- Biochemical Explanation - OCD results from below average levels of serotonin in the brain.
The behaviourist approach offers:
- The behaviourist explanation - OCD is a result of the reinforcing nature of compulsions which eventually become very ingrained into a person's mentality.
The cognitive approach offers:
- The cognitive explanation - suggests that OCD is a result of a hypervigilant 'awareness centre' or other part of the brain.
Make sure to cast your vote on which approach you think is most convincing in explaining OCD.