Causes of Obsessive Compulsive Disorder (OCD)
Updated 23 October 2014
by Sarah Graham
Friday 17 October 20143391 61874
Contrary to common misconceptions, Obsessive Compulsive Disorder (OCD) is not the same as just being particular about cleanliness or organisation. Obsessions are intrusive and recurrent ideas, images or thoughts, which cause anxiety; compulsions are repetitive rituals, which are carried out in order to reduce the anxiety or prevent an imagined dreaded event.
If you are affected by OCD, you may find that it causes you a great deal of distress and can feel like it's taking over your life, as obsessions and compulsions consume time, cause delays, and disrupt day to day living. We asked some RSCPP therapists to explain some of the common causes of the condition.
OCD is a more common problem than people may think. It is believed that OCD is likely to be the result of a combination of either neurobiological, genetic, behavioural, cognitive, or environmental factors that trigger the disorder in a specific individual at a particular point in time.
Problems processing pain
When human beings experience shock, trauma, or emotions that are difficult to cope with, they need to process them in order to be able move forward in life. It is rather like the emotional equivalent of digesting food. Much of the time, despite the pain, this is exactly what happens, but sometimes it is just too much for your consciousness to bear. When this happens, your mind protects you by filing the traumatic experience away, outside the reach of consciousness. While this allows you to get on with life, so you are not immobilised by your shock or grief, it also prevents you from processing the pain, which is 'recorded' in the nervous system. In a further attempt to ease this, you may have developed a pattern of ritualised, repetitive behaviours, designed by your mind to ease the pressure, resulting in OCD.
Attaching significance to intrusive thoughts
One aspect of OCD that might be experienced is intrusive thoughts of causing harm to someone. These kind of thoughts are actually quite common, but where others might dismiss or forget about such thoughts, OCD might develop when a particular significance is attached to them. For example, you might have an argument with your partner and think 'I could kill them', or feel anger at someone you work with and think about hitting them. With OCD, you may confuse the thought with the action, for example by believing that having the thought means you are likely to carry out the action. To reduce your anxiety about this, you might then try to avoid triggers for having that thought, e.g. being in meetings with your colleague, seeing newspaper reports about domestic violence, or situations where you believe the action could take place, such as being near knives or being alone with colleagues. However, these avoidance patterns are actually likely to increase how often you have the intrusive thoughts and the anxiety you feel when you have them.
A behavioural response to internal anxiety
OCD can be considered as a behavioural response to internal anxiety. For some people, the action of their OCD behaviour, whether checking or cleaning, can reduce their feeling of anxiety. However, for many people over time, their OCD behaviours increase and their irrational thoughts increase - for example, 'if I check this door 15 times before going out, I will be safe'.
A way of seeking control
Some OCD behaviours develop when children, unable to control distressing events in their lives such as parental violence or divorce, will respond by finding something in their lives they can control, e.g. tidiness around the home, cleanliness, arranging their own possessions in a particular way. This gives a degree of comfort and so becomes entrenched as a coping strategy, often becoming exaggerated over time, to the extent that they may have to spend hours every day cleaning the house, or become distressed if someone moves an object. As adults, this can affect their ability to get to work or appointments on time and to maintain relationships.
Having a baby/post-natal depression
Having a baby is a common trigger of OCD, affecting an estimated 2-4% of all new mothers. It is normal for women to be focused on the safety of their new baby, and most will want to take reasonable precautions to protect their child from harm. For OCD sufferers these normal concerns are excessive and create a great deal of anxiety. During pregnancy, mothers with OCD may obsess about which foods are safe to eat, develop compulsive rituals such as hand-washing, or seek excessive reassurance from medical professionals that their baby is developing normally. After the birth, obsessions may revolve around the baby having an accident, or suffocating in their cot, causing mothers to continually check on them. They may even worry that they may deliberately harm their baby, which will result in a new mother feeling ashamed that she could even have these thoughts and worried about what they might mean.
Dr Jane Fenn adds: For some women, OCD presents in response to post-natal depression, and GP and health visitor support will be needed. Some women with post-natal depression become very anxious about routines and rituals around the baby, or coping and feeling in control of their household. What might start of as a comforting behaviour - becoming super organised, ridged routines, etc. - may escalate from just behaviours to thoughts like 'if I vacuum this room fifteen times there wont be any germs and my baby will be safer' or 'if I bleach the worktops in the kitchen four times my family won't get sick'. There seems to be a 'tipping point' between rational behaviours born from anxiety, and obsessive and compulsive behaviours.
Finally, Jane says that OCD may in some cases be a side effect of particular medications:
In my experience as a therapist, I have also seen people who have suddenly started OCD behaviours as a response to medication. I always check which medications they are on and, if the behaviours are a side effect of these, referral to their GP may be needed.
You can find out more about symptoms and causes of Obsessive Compulsive Disorder (OCD)
, including how to find a therapist. If this route is not appropriate for you, your GP can assess you and direct you towards support.