What causes Obsessive Compulsive Disorder?

There are a number of theories as to what lies beneath this troubling disorder. One prominent school of thought is that an anxiety disorder develops when children come to fear their own unconscious impulses and use defense mechanisms to lessen the resulting anxiety. What distinguishes obsessive-compulsive disorder from other anxiety disorders is that the battle between anxiety-provoking internal impulses and anxiety-reducing defense mechanisms is not buried in the unconscious but rather is played out in explicit and dramatic thoughts and actions. The internal impulses usually take the form of obsessive thoughts, and the defenses appear as counter-thoughts or compulsions.

Bridges to Recovery understands the suffering that goes on when an individual has this psychiatric disorder. Residential treatment in our community helps an individual learn to address the underlying issues. Individual therapy four times per week and regular visits with our staff psychiatrist are part of our clinical treatment approach. Learning to recognize the opportunities of time between impulsive thoughts and impulsive behaviors are part of the recovery process.

An excerpt from Macbeth...

Doctor: What is it she does now? Look how she rubs her hands.

Gentlewoman: It is an accustomed action with her, to seem thus washing her hands. I have known her to continue in this a quarter of an hour.

Lady Macbeth: Yet here's a spot. Out damned spot! Out I say! ... Yet, who would have thought the old man to have had so much blood in him?" (Macbeth, Act V, Scene 1)

Obsessive-Compulsive Disorder (OCD) is an anxiety disorder characterized by unwanted, tormenting, and persistent thoughts or ideas. The thoughts feel both intrusive and foreign to people that experience them. The thought may be offensive because it represents a blatant sexual or aggressive idea, or it may be neutral. Attempts to ignore or resist these thoughts may arouse even more anxiety, and before long they come back stronger than ever. In Obsessive Compulsive Disorder, obsessions are more than just thoughts; rather, they are impulses to perform some disturbing deed. Those suffering from obsessive-compulsive disorder seldom act out their hostile or sexual fantasies, but they live in dread that they will. They are quite aware that their thoughts are excessive and inappropriate, yet they are experienced as repugnant and painful.

An excerpt from Spitzer

"He now spent hours each night 'rehashing' the day's events, especially interactions with friends and teachers, endlessly making 'right' in his mind any and all regrets. He likened the process to playing a videotape of each event over and over again in his mind, asking himself if he had behaved properly and telling himself that he had done his best, or had said the right thing every step of the way. He would do this while sitting at his desk, supposedly studying; and it was not unusual for him to look at the clock after such a period of rumination and note that, to his surprise, two or three hours had elapsed" (Spitzer et al., 1981, pp 20-21)

Compulsive actions are another component of this disabling syndrome. These are repetitive acts an individual feels compelled to carry out without understanding as to why. If you have ever left for a vacation and returned home to check if you had locked the front door or left the oven on, then you may have some insight into the relationship between an obsessive thought and a compulsive action. The behaviors, or "rituals", are often carried out in hopes of preventing or stopping the unwanted thoughts and reducing anxiety. Compulsive rituals only provide temporary relief, but not performing them dramatically increases anxiety. Common sources of anxiety for victims of OCD include being contaminated by germs or dirt, requiring the sufferer to wash repeatedly, incessant doubt requiring the person to check the locks, doors, and windows over and over, or a desire for order requiring straightening, the repetition of words, praying, or counting. These symptoms cause significant distress and interfere with daily life. Sufferers of OCD often realize that their behavior is excessive or unreasonable. But they are unable to stop them. This can make the suffering embarrassing and unbearable.

Here is an example which vividly conveys obsessive symptoms and their intimate connection to compulsive acts:

"Shirley K., a twenty three year old housewife, came to the clinic with a complaint of frequent attacks of headaches and dizziness. During the preceding three months she had been disturbed by recurring thoughts that she might harm her two year old son, Saul, either by stabbing or choking him [the obsessive thought]. She constantly had to go into his room, touch the baby, and feel him breathe in order to reassure herself that Saul was alive [the compulsive act]; otherwise, she became unbearably anxious. If she read a report in the daily paper of the murder of a child, she would become agitated, since this reinforced her fear that she too might act on her impulse. Shirley turned to the interviewer and asked, with desperation, whether this meant that she was 'going crazy' " (Goldstein and Palmer, 1975)

No matter how elaborate the complex of obsessive thoughts and compulsive rituals of the sufferer, they do not reduce anxiety. Most people suffering from Obsessive Compulsive Disorder report constant tension and dissatisfaction with their lives, and it is not unusual for this dissatisfaction to blend imperceptibly into feelings of depression.

Example of an interview

Patient: If I heard the word, like, something that had to do with germs or disease, it would be considered something bad, and so I had things that would go through my mind that were sort of like "cross that out and it'll make it okay" to hear that word.

Interviewer: What sorts of things?

Patient: Like numbers or words that seemed to be sort of like a protector.

Interviewer: What numbers and words were they?

Patient: It started out to be the number 3 and multiples of 3 and then words like "soap and water", something like that; and then the multiples of 3 got really high, and they'd end up to be 124 or something like that. It got real bad then. (Spitzer et al., 1981, p. 137)