How does Obsessive-Compulsive Disorder develop?

Obsessive-compulsive disorder (OCD) is one of the psychopathological pictures that has attracted the attention of experts and laymen, having done many works in the cinema and literature in order to show its most florid characteristics.

The truth is that despite this (or perhaps sometimes for the same reason …), it remains a misunderstood health problem for society, despite the fact that a large sector of the scientific community continues to investigate it relentlessly.

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.

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How the TOC is developed, in 10 keys

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 in order to reduce or alleviate 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 reciprocally ****, connecting in a functional way and sometimes lacking any objective logic.

Understanding how OCD develops is not easy, and for this it is necessary to resort to theoretical models from learning, Cognitive Psychology and Behavioral Psychology; They raise explanations that are not mutually exclusive and that can clarify why such an invalidating situation arises.

In the following lines we will delve into ten fundamental keys to understand what is happening in the person living with OCD, and the reason why the situation becomes more than just the succession of negative thoughts.

1. Classic and operant learning

Many mental disorders have elements that were learned sometime from the vine . In fact, it is based on this premise to state that they can also “unlearn” 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 the compulsion as an escape strategy, since with it it is possible to alleviate the anxiety caused by the obsession (through negative reinforcement).

In people with OCD, in addition to the escape that is explained through compulsions, avoidant behaviors (similar to those that occur in phobic disorders) can also be observed . 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 life and their personal development options.

In any case, both are associated with both the genesis and the maintenance of OCD. Likewise, the fact that the behavior carried out to minimize anxiety lacks a logical connection with the content of the obsession (clapping when thinking arises, for example) suggests a form of superstitious reasoning that is usually conscious , since The person can recognize the illegality that underlies what happens.

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2. Social learning

Many authors have revealed that OCD may be influenced by certain forms of parenting 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 verification compulsions would happen especially in those cases where the parents imposed a high level of demand for functioning. of everyday life. Today, however, there is insufficient empirical evidence to corroborate these postulates.

Other authors have tried to respond to the origin of OCD by referring to the fact that it could be mediated by traditional educational stereotypes , which relegated women to the role of “caretakers / homemakers” and men to “family maintenance”. This social dynamic (which fortunately is becoming obsolete) would be responsible for the fact that in them the appearance of order or cleanliness rituals was more common, and in them those of verification (as they would relate to the “responsibilities” attributed in each case by gender ratio).

3. Unreal subjective assessments

A very large percentage of the general population confesses to having experienced invasive thoughts during their lifetime. These are mental contents that access consciousness without any will, and that tend to travel without major consequence until at a certain moment they simply cease to exist. But in people suffering from OCD, however, a very negative assessment of its significance would be triggered; This being one of the fundamental explanatory points for the further development of the problem.

The content of thoughts (images or words) is usually judged as catastrophic and inappropriate , or even triggers the belief that it suggests a poor human quality and merits punishment. How are they also situations of internal origin (as opposed to external ones that depend on the situation), it would not be easy to avoid their influence on emotional experiences (such as sadness, fear, etc.).

In order to achieve this , an attempt would be made to impose tight control over thought, seeking its total eradication . What finally happens, however, is the well-known paradoxical effect: it increases both its intensity and its absolute frequency. This effect accentuates the discomfort associated with the phenomenon, promotes a sense of loss of self-control and precipitates rituals (compulsions) aimed at more effective surveillance. It would be at this point that the pernicious pattern of obsession-compulsion that is characteristic of the painting would be formed.

4. Alteration in cognitive processes

Some authors believe that the development of OCD is based on the commitment of a group of cognitive functions related to the storage of memory and the processing of emotions, especially when fear is involved. And it is that they 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 with respect to other mental health problems.

In fact, the nuances of harm and threat are those that hinder the passive coping of the obsession, forcing its active approach through compulsion. In this way, three cognitive deficits could be distinguished : epistemological reasoning (“if the situation is not completely safe it is dangerous in all likelihood”), overestimation of the risk that is associated with inhibition of compulsion and impediments to integrate into consciousness Information related to fear.

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5. Interaction between intrusive thoughts and beliefs

Obsession and automatic negative thoughts can be distinguished by a simple nuance, although elementary to understand how the former has a deeper effect on the subject’s life than the latter (common to many disorders, such as those included in the anxiety categories and mood). This subtle difference, of deep draft, is the confrontation with the belief system .

The person suffering from OCD interprets that their obsessions dramatically threaten what they consider fair, legitimate, adequate or valuable. For example, access to the mind of bloody contents (scenes of murders or in which serious damage occurs to a family member or acquaintances) has disturbing effects on those who hold nonviolence as a value with which to conduct themselves in life.

Such disharmony gives the thought of a particularly disruptive (or egodistonic) coating , pregnant with a deep fear and inadequacy, and all this causes a secondary result, but of an interpretative 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 would arise that their contents could manifest in the objective plane (causing damage to oneself or others). A position of extreme responsibility would be assumed regarding the risk that something might happen, which is the definitive driver of an “active” (compulsive) attitude aimed at resolving the situation.

There is therefore a particular effect, and that is that the obsessive idea ceases to have the value it would have for people without OCD (harmless), being 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 severe erosion of self-esteem to occur, and even worth questioning oneself as a human being.

7. Fusion thought-action

The fusion between thought and action is a very common phenomenon in OCD. Describe how the person tends to equate having thought of a fact 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 event evoked (closing the door correctly, for example) is just an image that was artificially generated or if it really happened. The resulting anxiety expands by imagining “horrible scenes,” which are distrusted about its truthfulness or falsehood.

There are a number of assumptions that the person suffering from OCD uses and that are related to the fusion of thought-action, namely: thinking about something is comparable 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 wanting the negative consequences on which you are concerned and a person must always control what happens in his mind. All of them are also cognitive distortions that can be addressed through restructuring.

8. Bias in the interpretation of consequences

In addition to the negative reinforcement (repetition of the compulsion as a result of the primary relief of anxiety that is associated with it), many people can see their neutralization acts reinforced by the conviction that they act “consistent with their values ​​and beliefs,” which It provides consistency in the way you do 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, it will oversize the risk and act with the purpose of preventing it from expressing itself. The consequence of all this is that finally nothing will happen (as expected), but the individual will interpret that it was “thanks” to the effect of his compulsion , obviating the contribution of chance to the equation. In this way the problem will become entrenched in time, because 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 time, but in the serious ones a pattern of behaviors (or thoughts, because sometimes the compulsion is cognitive) rigid and precise can be observed. It can serve as an example to wash your hands for exactly thirty seconds, or give eighteen pats when you hear a specific word that precipitates the obsession.

In these cases, the compulsion must be carried out in an absolutely exact way so that it can be considered correct and alleviate the discomfort that triggered it. In many cases, however, the person comes to doubt whether he did well or perhaps made a mistake at some point in the process, feeling compelled to repeat it again . This is the moment in which the most disruptive compulsions are usually developed, and those that interfere more deeply with everyday life (taking into account 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 frontostriate system (neural connections between the prefrontal cortex and the striated nucleus that cross the pale globe, 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 its forms) and the motor sequence (compulsions) that could be released from them.

In direct association with these brain structures, it has also been proposed that for the development of OCD the activity of certain neurotransmitters might be involved. Among them, serotonin, dopamine and glutamate stand out; with a dysfunction that is associated with certain genes (hence its potential hereditary base). All 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

 

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