Demystifying Obsessive Compulsive Disorder: What is OCD, what causes it and how does it affect people

Unfortunately, Obsessive Compulsive Disorder (OCD) is a disorder that is often harmfully misrepresented in the media and online as something potentially that it is not. There are many misconceptions about what it is, how it affects people and what causes it. In this blog, we aim to set the foundations to deconstruct this misrepresentation through discussing what it really is, the symptoms that commonly occur as a result, and finally what some of the possible causes might be.

What is Obsessive compulsive disorder (OCD)?

OCD is not just being tidy, clean, washing your hands regularly, and aligning our pens in colour order. You may have heard someone see a mess, panic, and say they need to tidy it because they are ‘so OCD’. I have heard this a myriad of times, and it is vital that we try and undo this pattern of thought in the publics’ minds. It is harmful to those with OCD, as they will be seen as a mirror of what a perfectionist is, or a tidy person, or a ‘clean freak’. Since OCD may present with these specific behaviours, not being perceived holistically as OCD can actively prevent them from getting the correct help, or any help at all.

The basics of what OCD start with what it is, and what it looks like. We will talk about what it looks like when we go through the primary symptoms later on. OCD has been found to impact around 1.2% of the population, and is a neurological and psychological mental disorder. This means it affects the body, nervous system, brain, emotions, thoughts, and behaviours. Another way of thinking about it is the neurological aspect is the hardware (referring to the brain pathways and chemical neurotransmitters), and the psychological aspect is the software (beliefs and conditioning), of which both contribute to OCD.

Common Symptoms of OCD

The diagnostic criteria according to the DSM-V for OCD states that there needs to be a presence of obsessions, compulsions, or both in order to be diagnosed. These are the two defining symptoms of OCD so we will take a closer look at them.

What are Obsessions?

Obsession is typically defined by when a person has an intense interest in something or someone. In mental health terms, this is often in a negative light. It might manifest into constant, reoccurring, and stressful thoughts, similar to rumination. This is a big part of OCD, often induced by anxiety, a person will latch onto a specific fear, problem, or doubt, and it will occupy their thoughts significantly. A common example of this is the fear of germs, which some people with OCD obsess about, causing behaviours to combat it such as excessive cleaning and hand washing.

Another side of this is the common symptom of intrusive thoughts. These are also unwanted, uncomfortable thoughts that the person may think against their will. It may be an image, words, or thoughts of performing an action. These intrusive thoughts may be violent, discriminatory, or sexual, but go against the person’s core values and that is why the thought of it coming into their head is so unpleasant and distressing.

 

What are Compulsions?

Compulsions are the actions that come as a result of the obsessions. Obsessive thoughts lead to distress and further anxiety, so people with OCD act to overcome this through performing certain behaviours and actions. These behaviours will sometimes match the obsession, such as checking the oven an excessive number of times to make sure it is off before they leave the house. Another example is one we mentioned earlier, about washing their hands and cleaning intensely to somewhat soothe their fear of germs. Other times, the behaviour will look not at all related to the obsession, for example, touching a doorknob five times to make sure that their family stays safe. These are all examples of compulsions that are in the physical world, however, compulsions can exist in their head only, such as performing mental rituals.

Although it seems to work against the anxiety, compulsions have negative impacts on the person’s mental health. It fuels the original problem, as they aren’t talking themselves out of the problem being significant, they are confirming it is a real issue that needs to be addressed and performing actions based on that. It makes future similar problems also become deemed a real issue. The thought that the issue is solved only by the compulsion is very tricky as it reinforces the behaviour to be carried on again and again, and often times the compulsion becomes more extreme. Not to mention, these compulsions themselves are often unpleasant and stressful, so using that as a sole coping mechanism can be very cyclical. Compulsions can have other negative impacts to go along with this such as constantly being late (due to the time it takes to complete them), declining academic or professional performance, and worsening relationships.

What causes OCD?

OCD, similarly to most mental health conditions, is not generally caused by a single determining factor. Not only can it come as a result of conditioning, environmental factors, and stress, it flows in a watershed from genetic and biological elements into the accumulated phenotypic symptoms we have studied and evaluated as psychologists. In short, OCD results from many things working in conjunction with one another, in some people starting with predisposed genetic factors. Here we will go through three of the cause categories for OCD.

Genetic and Biological Factors in OCD

The genetic side of OCD is pretty much exactly how you would expect it to be. If you are closely related to someone with it, you have a higher chance of having or developing it than those who aren’t related to anyone with it. This isn’t to say, however, that there is a gene you can inherit that will give you OCD – there is no such thing yet found due to the challenges in researching this area conclusively. The genetic side, to our knowledge so far, seems to be an accumulation of different genes that impact thinking patterns and behaviour types.

Different researchers have implicated the increased activity of different brain areas as more responsible for the disorder, such as the basal ganglia. The basal ganglia is a brain area located mainly in the forebrain, and is known to aid in the functions of learning and problem solving. You may be able to connect the dots of why this brain area can light up as more active in those with OCD. One of the treatments for OCD is by taking SSRIs (selective serotonin reuptake inhibitors - a form of antidepressants) which generally work to decrease the obsessive and compulsive symptoms. This would indicate that the serotonin uptake from synapses is involved in the causes for the disorder, as the drug works to increase the serotonin levels for the synapses to absorb. This may mean that there is an existing desensitisation of serotonin therefore things like sleep and mood are not regulated sufficiently, contributing to OCD.

Environment and Stress

We are constantly learning behaviours and thought patterns from our environment. This is often in the form of conditioning, whereby we learn to do things or not do things based on the consequences we have previously experienced from doing it. Similarly to what we discussed in the compulsion section of the symptoms of OCD, it is true that completing certain rituals, thoughts, or behaviours causes a negative obsession or anxiety to be temporarily subsided. This might teach them that there is a deceptively positive impact of their compulsions, and therefore they are more likely to do it again.

It has been commonly reported that stress has no direct link to OCD, but it can have it’s indirect pathways of contributing. For instance, major distressing life events can cause anxiety, which may manifest into OCD later on. There is emerging research suggesting that particularly difficult life events, such as those that make people feel a sense of responsibility or to feel as if they are contaminated, might make them more at risk of developing OCD. The impact of how life makes us think, feel and behave may be an important cause to pay attention to.

Illness

A totally different cause of OCD is through certain illnesses in children. We mentioned earlier that the basal ganglia is a part of the brain that is likely involved in OCD. Streptococcal infections are bacterial illnesses caused by Streptococcus bacteria, and leads to things like strep throat, scarlet fever, and tonsilitis. When these infection occurs, our body’s immune response is to release antibodies to fight the infection. However, these antibodies not only fight the streptococcal infection, but some of their brain cells – specifically cells of basal ganglia. A result of this, in a small number of cases, can be a sudden development of OCD symptoms. This is called PANDAS, and for this reason it is considered an autoimmune disease.

If you want to learn more about the causes we have discussed here, or about additional potential causes, click here. It is a link to a comprehensive and educational page by OCD UK.

We hope this blog has been useful in helping you learn more about OCD, in particular: what it isn’t, what it is, common symptoms, and some key causes. An important takeaway from this blog is that OCD will not look the same in any two people. A reoccurring theme has been that different people have different obsessions, compulsions, causes, and numerous of them. In many people with OCD, you would never know that they had it just by being with them, so it is important to stay educated on the basics so that we can identify and support those around us.

If you are in need of specialist psychological therapy for OCD, our team of qualified clinical psychologists and CBT practitioners can help.