Obsessive-compulsive disorder (OCD) is one of the psychopathological conditions that has attracted the most attention of experts and laymen, with many works having been made in cinema and literature in order to show its most florid characteristics.
The truth is that despite this (or perhaps sometimes for this same reason…), it continues to be a misunderstood health problem for society, despite the fact that a large sector of the scientific community continues to research it tirelessly.
In this article we will try to shed light on the dense shadows that surround it, delving into what we currently know about how OCD develops and the “logic” that the disorder has for those who live with it.
OCD is a mental disorder characterized by the presence of obsessions (verbal/visual thoughts that are considered invasive and unwanted) and compulsions (physical or mental acts that are carried out with the aim of reducing or alleviating the discomfort generated by the obsession). . The relationship established between them would build the foundation of the problem,**** a kind of recurring cycle in which both feed each other****, connecting in a functional way and sometimes lacking any objective logic.
Understanding how OCD develops is not easy, and to do so it is necessary to resort to theoretical models from learning, Cognitive Psychology and Behavioral Psychology; since they propose explanations that are not mutually exclusive and that can clarify why such a disabling situation arises.
In the following lines we will delve into ten fundamental keys to understanding what is happening in the person who lives with OCD, and the reason why the situation becomes something more than the simple succession of negative thoughts.
1. Classical and operant learning
Many mental disorders have elements that were learned at some point in life to. In fact, we start from this premise to propose that they can also be “unlearned” through a set of experiences that are articulated in the therapeutic context. From this perspective, the origin/maintenance of OCD would be directly associated with the role of compulsion as an escape strategy, since with it it is possible to relieve the anxiety caused by obsession (through negative reinforcement).
In people with OCD, in addition to the escape that is made explicit through compulsions, Avoidant behaviors can also be observed (similar to those that develop in phobic disorders). In these cases, the person would try not to expose themselves to situations that could trigger intrusive thoughts, which would severely limit their way of living and their options for personal development.
In any case, both are associated with both the genesis and maintenance of OCD. Likewise, the fact that the behavior carried out to minimize anxiety lacks a logical connection to the content of the obsession (slapping when the thought arises, for example) suggests a form of superstitious reasoning of which one is usually aware because the person can recognize the illogicality that underlies what happens to them.
Many authors have shown that OCD can be influenced by certain forms of upbringing during childhood. Stanley Rachman pointed out that cleaning rituals would be more prevalent among children who developed under the influence of overprotective parents, and that checking compulsions would occur especially in those cases in which parents imposed a high level of demands for functioning. of everyday life. Today, however, there is not enough empirical evidence to corroborate these postulates.
Other authors have tried to answer the origin of OCD, alluding to the fact that it could be mediated by traditional educational stereotypes, which relegated women to the role of “caregiver/household” and men to “maintenance of the family.” This social dynamic (which fortunately is becoming obsolete) would be responsible for the appearance of rituals of order or cleanliness being more common in them, and in them those of verification (since they would be related to the “responsibilities” that were attributed in each case by gender reason).
3. Unrealistic subjective evaluations
A very significant percentage of the general population confesses to having experienced invasive thoughts at some point during their life. These are mental contents that enter consciousness without will, and that usually pass through without major consequences until at a certain moment they simply cease to exist. But in people who suffer from OCD, however, a very negative assessment of its significance would be triggered; This being one of the fundamental explanatory points for the subsequent development of the problem.
The content of thoughts (images or words) is often judged as catastrophic and inappropriate, or even triggers the belief that it suggests a deficient human quality and merits punishment. Since these are also situations of internal origin (as opposed to external ones that depend on the situation), it would not be easy to ignore their influence on emotional experiences (such as sadness, fear, etc.).
In order to achieve An attempt would be made to impose tight control over thought, seeking its total eradication What finally ends up happening, however, is the well-known paradoxical effect: both its intensity and its absolute frequency increase. Such an effect accentuates the discomfort associated with the phenomenon, fosters a feeling of loss of self-control and precipitates rituals (compulsions) aimed at more effective vigilance. It would be at this point that the pernicious pattern of obsession-compulsion that is characteristic of the picture would form.
4. Alteration in cognitive processes
Some authors consider that the development of OCD is based on the compromise of a group of cognitive functions related to memory storage and the processing of emotions, especially when fear is involved. And it is that These are patients with a characteristic fear of harming themselves or others, as a result (direct or indirect) of the content of the obsession. This is one of the most distinctive characteristics compared to other mental health problems.
In fact, the nuances of harm and threat are what make it difficult to passively confront the obsession, forcing its active approach through compulsion. That way, Three cognitive deficits could be distinguished: epistemological reasoning (“if the situation is not totally safe, it is most likely dangerous”), overestimation of the risk that is associated with the inhibition of compulsion and impediments to integrating information related to fear into consciousness.
5. Interaction between intrusive thoughts and beliefs
Obsession and negative automatic thoughts can be differentiated by a simple nuance, although elementary to understand how the former has a more profound effect on the subject’s life than the latter (common to many disorders, such as those included in the categories of anxiety and mood). This subtle, profound difference is confrontation with the belief system
The person who suffers from OCD interprets his obsessions as dramatically attacking what he considers fair, legitimate, adequate or valuable. For example, access to the mind of bloody content (scenes of murder or in which serious damage is caused to a family member or acquaintance) has disturbing effects on those who hold non-violence as a value with which to conduct themselves in life.
Such dissonance gives thought a particularly disruptive coating (or egodystonic), pregnant with deep fear and inadequacy, and all of this causes a secondary result, but of an interpretive and affective nature: disproportionate responsibility.
6. Disproportionate liability
Given that obsessive thinking diametrically contradicts the values of the person with OCD, a response of guilt and fear that its contents could manifest on the objective level (causing harm to oneself or others) would arise. A position of extreme responsibility would be assumed regarding the risk that something could happen, which is the definitive driver of an “active” (compulsive) attitude aimed at resolving the situation.
Therefore, a particular effect is produced, and that is that the obsessive idea no longer has the value it would have for people without OCD (innocuous), becoming imbued with a personal attribution. The harmful effect would be associated to a greater extent with the way of interpreting the obsession than with the obsession itself (concern about being worried). It is not uncommon for a severe erosion of self-esteem to occur, and even to question one’s own worth as a human being.
7. Thought-action fusion
The fusion between thought and action is a very common phenomenon in OCD. It describes how the person tends to equate having thought about an event with having done it directly in real life, attributing the same importance to both assumptions. It also points out the difficulty in clearly distinguishing whether an evoked event (closing the door correctly, for example) is just an image that was artificially generated or whether it really happened. The resulting anxiety expands when imagining “horrible scenes” whose veracity or falsity is distrusted.
There are a series of assumptions that the person who suffers from OCD uses and that are related to the fusion of thought-action, namely: thinking about something is equivalent to doing it, trying not to prevent the feared damage is equivalent to causing it, the low probability of occurrence does not exempt from responsibility, not carrying out the compulsion is the same as wishing for the negative consequences about which one is worried and a person must always control what happens in his mind. All of them are also cognitive distortions that can be addressed through restructuring.
In addition to negative reinforcement (repetition of the compulsion as a result of the primary relief of anxiety associated with it), many people may see their neutralizing acts reinforced by the conviction that they are acting “consistently with their values and beliefs,” which It provides consistency to your way of doing things and helps maintain it over time (despite the adverse consequences on life). But there is something else, related to an interpretive bias.
Although it is almost impossible for what the person fears to happen, according to the laws of probability, he or she will overstate the risk and act with the purpose of preventing it from being expressed. The consequence of all this is that in the end nothing will happen (as was foreseeable), but the individual will interpret that it was this way “thanks” to the effect of his compulsion, ignoring the contribution of chance to the equation. In this way the problem will become entrenched over time, since the illusion of control will never be broken.
9. Insecurity before the ritual
The complexity of compulsive rituals is variable. In mild cases, it is enough to execute a quick action that is resolved in a discrete amount of time, but in severe cases, a rigid and precise pattern of behavior (or thoughts, since sometimes the compulsion is cognitive) can be observed. An example can be washing your hands for exactly thirty seconds, or clapping eighteen times when you hear a specific word that precipitates the obsession.
In these cases, the compulsion must be carried out absolutely accurately so that it can be considered correct and relieve the discomfort that triggered it. In many cases, however, the person comes to doubt whether he did it right or whether he perhaps made a mistake at some point in the process, feeling obligated to repeat it again This is the moment in which the most disruptive compulsions usually develop, and those that most profoundly interfere with daily life (given the time they require and how disabling they are).
10. Neurobiological aspects
Some studies suggest that people with OCD may have some alteration in the frontostriatal system (neural connections between the prefrontal cortex and the striatum that pass through the globus pallidus, the substantia nigra and the thalamus; finally returning to the anterior region of the brain). This circuit would be responsible for inhibiting mental representations (obsessions in any of their forms) and the motor sequence (compulsions) that could arise from them.
In direct association with these brain structures, it has also been proposed that the activity of certain neurotransmitters could be involved in the development of OCD. Among them, serotonin, dopamine and glutamate stand out; with a dysfunction that is associated with certain genes (hence its potential hereditary basis). All of this, together with the findings on the role of the basal ganglia (initiation and integration of movement), could suggest the existence of neurological factors in this disorder.
