To date, no one is certain of the causes of OCD. Though there are a number of theories that
attempt to explain the development of the condition, there is little evidence to support them. We
know that for some the onset is during childhood, while for others, the onset may be during
adolescence or early adulthood. We also know that in some cases the onset is sudden, while
others have a slow, insidious onset. Some of the theories that have been proposed to explain the
development of OCD follow.
2.1 The Biochemical Theory
This theory was put forward after it was found that certain medications were of benefit in the
treatment of OCD. These drugs mainly affect one type of chemical in the brain called serotonin.
Consequently, it was hypothesized that a problem with serotonin could be the cause of OCD.
Although the drugs are indeed effective in the treatment of this condition, there is little hard
evidence to indicate that sufferers have a deficit of serotonin in their brain.
2.2 The Genetic Theory
This theory was put forward to explain the finding that OCD can sometimes occur in families.
Although a genetic predisposition may account for some sufferers developing the condition,
there is also the strong possibility that the OCD behavior was learned from the parents or siblings.
It is extremely difficult to differentiate between OCD behavior thay may be the result of genetics
or OCD behavior that may be the result of the environment.
2.3 Learning Theory
This model suggests that obsessive-compulsive behavior has been learned through a process of
conditioning. Put simply, this theory states that a neutral event becomes associated with fear by
being paired with something that provokes fear, anxiety, or discomfort. This fear then generalizes
so that objects as well as thoughts and images also produce discomfort. The individual then
engages in behaviors that reduce the anxiety and because the behavior is successful in reducing
anxiety even if only for short periods of time it is performed each time discomfort or anxiety is
felt. The problem with this theory is that it fails to explain why particular fears such as
contamination or of harm to oneself and others commonly occur in OCD. Another problem is
that many sufferers do not recall any significant precipitating event that can explain the onset of
their symptoms. However, this theory does explain how obsessive-compulsive symptoms are
maintained, and as a result, this issue will be dealt with in much greater detail in subsequent
sections.
2.4 Psychoanalytic Theory
This theory basically states that obsessive-compulsive symptoms are attempts to keep
unconscious conflicts and impulses from conscious awareness. Unfortunately, there is little
evidence to support this theory and psychoanalysis is of little value in the treatment of the
majority of OCD sufferers. As can be seen, no theory is able to adequately explain the
development of OCD but that does not mean that there are no effective treatments. In fact, the
cause, though of considerable interest, has little bearing on treatment outcome. It is important to
note, however, that in some cases symptoms that resemble OCD may be the result of other
illnesses such as depression and schizophrenia. Effective treatment of these conditions will
generally result in a decrease in the OCD-like symptoms. Other conditions that may result in
symptoms that resemble OCD are Tourette’s Syndrome, dementia, brain trauma, or other
neurological disorders.
2.5 The Treatment Obsessive-Compulsive Disorder
There are currently two effective treatments available for OCD that may be used separately or
together. One is drug treatment, with medication that increases the availability of serotonin in the
brain; the other involves the use of behavior therapy techniques. At present, it appears that they
are both effective and there is little in the scientific literature to suggest that combining the two
results in a better outcome than using them individually. However, some sufferers who find
behavior therapy too difficult initially may benefit from a course of medication so that effective
behavior therapy can be undertaken.
2.5.1 Medication
The medications that have been found to be particularly helpful in the treatment of OCD come
from the antidepressant family of drugs and include clomipramine, fluoxetine, fluvoxamine, and
sertraline. They have specific effects on serotonin levels in the brain. Serotonin is the biochemical
substance that some researchers believe is involved in OCD. In general, these medications have
been shown to be effective for some OCD sufferers and assist them in bringing their symptoms
under control. If one of these medications is prescribed for you, you should be made aware of
possible side effects and report their occurrence to your therapist. It is important to remember that
these medications are not a cure for OCD. In addition, research indicates that ceasing the
medication in the short term generally results in a return of symptoms. It could be that sufferers
need to remain on the medication for long periods of time or that behavior therapy should be used
in conjunction with the drug.
2.5.2. Behavior Therapy
The rationale for using behavioral techniques is briefly explained in the learning theory section
above but it is important enough to state again in greater detail. Typically, the OCD sufferer has
intrusive thoughts that generate anxiety, discomfort, or an urge to carry out a ritual. Performing
the ritual results in a decrease in anxiety or discomfort, so that performing the ritual is actually
reinforcing through its ability to reduce these negative feelings. For example, an individual has
the thought that his or her hands may have touched something dirty or contaminated. This thought
produces anxiety in that the person feels uncomfortable about the possibility of being
contaminated or contaminating someone else. This unpleasant anxiety or discomfort is relieved
by washing of the hands or other contaminated objects and it feels good to rid oneself of such
negative feelings, so it feels “good” to wash. In the same manner, an individual who must check
the stove and heaters prior to leaving home in order not to cause a disastrous fire will feel some
relief after checking these items many times to ensure they are off. Thus the anxiety-producing
thought is temporarily minimized by checking, and it feels “good” to check.
This anxiety- or discomfort-reducing quality that the rituals possess is shown in the following
graph. Patients were asked to rate their levels of discomfort and urge to ritualize (1) before being
exposed to an anxiety-evoking stimulus, (2) after being exposed, and (3) after performing their
rituals. As can be seen, exposure to the stimulus results in a marked increase in discomfort and
urge to ritualize. Engaging in the ritual brings about an immediate and dramatic decrease in both
these measures.
attempt to explain the development of the condition, there is little evidence to support them. We
know that for some the onset is during childhood, while for others, the onset may be during
adolescence or early adulthood. We also know that in some cases the onset is sudden, while
others have a slow, insidious onset. Some of the theories that have been proposed to explain the
development of OCD follow.
2.1 The Biochemical Theory
This theory was put forward after it was found that certain medications were of benefit in the
treatment of OCD. These drugs mainly affect one type of chemical in the brain called serotonin.
Consequently, it was hypothesized that a problem with serotonin could be the cause of OCD.
Although the drugs are indeed effective in the treatment of this condition, there is little hard
evidence to indicate that sufferers have a deficit of serotonin in their brain.
2.2 The Genetic Theory
This theory was put forward to explain the finding that OCD can sometimes occur in families.
Although a genetic predisposition may account for some sufferers developing the condition,
there is also the strong possibility that the OCD behavior was learned from the parents or siblings.
It is extremely difficult to differentiate between OCD behavior thay may be the result of genetics
or OCD behavior that may be the result of the environment.
2.3 Learning Theory
This model suggests that obsessive-compulsive behavior has been learned through a process of
conditioning. Put simply, this theory states that a neutral event becomes associated with fear by
being paired with something that provokes fear, anxiety, or discomfort. This fear then generalizes
so that objects as well as thoughts and images also produce discomfort. The individual then
engages in behaviors that reduce the anxiety and because the behavior is successful in reducing
anxiety even if only for short periods of time it is performed each time discomfort or anxiety is
felt. The problem with this theory is that it fails to explain why particular fears such as
contamination or of harm to oneself and others commonly occur in OCD. Another problem is
that many sufferers do not recall any significant precipitating event that can explain the onset of
their symptoms. However, this theory does explain how obsessive-compulsive symptoms are
maintained, and as a result, this issue will be dealt with in much greater detail in subsequent
sections.
2.4 Psychoanalytic Theory
This theory basically states that obsessive-compulsive symptoms are attempts to keep
unconscious conflicts and impulses from conscious awareness. Unfortunately, there is little
evidence to support this theory and psychoanalysis is of little value in the treatment of the
majority of OCD sufferers. As can be seen, no theory is able to adequately explain the
development of OCD but that does not mean that there are no effective treatments. In fact, the
cause, though of considerable interest, has little bearing on treatment outcome. It is important to
note, however, that in some cases symptoms that resemble OCD may be the result of other
illnesses such as depression and schizophrenia. Effective treatment of these conditions will
generally result in a decrease in the OCD-like symptoms. Other conditions that may result in
symptoms that resemble OCD are Tourette’s Syndrome, dementia, brain trauma, or other
neurological disorders.
2.5 The Treatment Obsessive-Compulsive Disorder
There are currently two effective treatments available for OCD that may be used separately or
together. One is drug treatment, with medication that increases the availability of serotonin in the
brain; the other involves the use of behavior therapy techniques. At present, it appears that they
are both effective and there is little in the scientific literature to suggest that combining the two
results in a better outcome than using them individually. However, some sufferers who find
behavior therapy too difficult initially may benefit from a course of medication so that effective
behavior therapy can be undertaken.
2.5.1 Medication
The medications that have been found to be particularly helpful in the treatment of OCD come
from the antidepressant family of drugs and include clomipramine, fluoxetine, fluvoxamine, and
sertraline. They have specific effects on serotonin levels in the brain. Serotonin is the biochemical
substance that some researchers believe is involved in OCD. In general, these medications have
been shown to be effective for some OCD sufferers and assist them in bringing their symptoms
under control. If one of these medications is prescribed for you, you should be made aware of
possible side effects and report their occurrence to your therapist. It is important to remember that
these medications are not a cure for OCD. In addition, research indicates that ceasing the
medication in the short term generally results in a return of symptoms. It could be that sufferers
need to remain on the medication for long periods of time or that behavior therapy should be used
in conjunction with the drug.
2.5.2. Behavior Therapy
The rationale for using behavioral techniques is briefly explained in the learning theory section
above but it is important enough to state again in greater detail. Typically, the OCD sufferer has
intrusive thoughts that generate anxiety, discomfort, or an urge to carry out a ritual. Performing
the ritual results in a decrease in anxiety or discomfort, so that performing the ritual is actually
reinforcing through its ability to reduce these negative feelings. For example, an individual has
the thought that his or her hands may have touched something dirty or contaminated. This thought
produces anxiety in that the person feels uncomfortable about the possibility of being
contaminated or contaminating someone else. This unpleasant anxiety or discomfort is relieved
by washing of the hands or other contaminated objects and it feels good to rid oneself of such
negative feelings, so it feels “good” to wash. In the same manner, an individual who must check
the stove and heaters prior to leaving home in order not to cause a disastrous fire will feel some
relief after checking these items many times to ensure they are off. Thus the anxiety-producing
thought is temporarily minimized by checking, and it feels “good” to check.
This anxiety- or discomfort-reducing quality that the rituals possess is shown in the following
graph. Patients were asked to rate their levels of discomfort and urge to ritualize (1) before being
exposed to an anxiety-evoking stimulus, (2) after being exposed, and (3) after performing their
rituals. As can be seen, exposure to the stimulus results in a marked increase in discomfort and
urge to ritualize. Engaging in the ritual brings about an immediate and dramatic decrease in both
these measures.
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