What Causes OCD?
by Nick Flower, Psy.D. and Megan Barone, Psy.D.
When I’m out and about and I tell people that I’m a psychologist and I specialize in the treatment of Obsessive Compulsive Disorder (OCD), I get some very interesting responses...and often many questions. One of the questions I am asked the most is, “What causes OCD anyway?” My response is typically brief and somewhat vague, but here I’ll elaborate a bit further because the answer is both complicated and, interestingly, really not all that important when it comes to treatment.
To begin, let’s briefly talk about OCD. OCD is a disorder in which a person has unwanted thoughts, images, or urges, known as obsessions, and a strong drive to perform mental or behavioral rituals, known as compulsions, in an effort to avoid or reduce the anxiety caused by the obsession. People with OCD get trapped in a cycle where they have unwanted obsessions followed by seemingly endless and time-consuming compulsions.
One thing researchers and clinicians can agree upon is that there is no one specific “smoking gun” cause that fully explains how a person develops OCD. Instead, we have found that OCD is likely the result of a combination of genetic influences, environmental factors, and, most importantly, learned behavior that is reinforced over time.
Genetic influences refer to actual genetic material that is inherited and becomes part of our DNA. For example, behavioral inhibition, a temperament characterized by the tendency to withdraw from novel stimuli and experience fear, includes several specific genetic markers. Behavioral inhibition is considered to have a strong influence in the risk for developing an anxiety disorder, such as OCD. That being said, genetics are not exclusively responsible for the development of OCD. Environmental factors play a crucial role in whether or not certain genes are expressed, as well as how they are expressed. For example, a child may be born with the genetic material for behavioral inhibition. The child’s parent, teacher, or babysitter may have modeled anxious behavior at one point (e.g., anticipating negative outcomes, overestimating risk, etc.), thereby increasing the likelihood that the child will experience symptoms of anxiety in response to a real or perceived threat.
Although genes and environment both play an important role in the development of OCD, treatment is more geared toward addressing the impact of what we call “learned behavior.” For individuals with OCD, fear is a product of classical conditioning where, at some point in their lives, they began to associate fear with a particular object, situation, or thought. This fear is maintained through a process called negative reinforcement, in which a compulsion is performed in a ritualized manner to reduce or avoid the anxiety In other words, the action of performing the compulsion reduces the fear (negative), which makes it all the more likely they will continue to repeat that behavior (reinforcement).
Exposure and Response Prevention (ERP) is a type of Cognitive Behavioral Therapy (CBT) that addresses learned behavior by helping individuals with OCD break two major associations: The first is the association between the feared object and fear and the second is between the avoidance behavior and safety. We achieve this in treatment by exposing the person to the feared stimulus for long enough of a period that they achieve habituation which simply means that they get used to it. The come to learn that avoiding their feared object doesn’t keep them safe and that the feared object isn’t that scary after all.