How does obsessive-compulsive disorder develop?

Obsessive Compulsive Disorder (OCD) is one of the psychopathological paintings that has captured the attention of experts and laymen alike, with many works in film and literature to show its most flourishing characteristics.

The truth is that despite this (or maybe sometimes for the same reason …), there remains a health problem unrecognized by society, even though a large sector of the scientific community continues to research relentlessly.

In this article, we’ll try to shed some light on the dense shadows surrounding it, exploring what we currently know. how OCD develops and the “logic” that the disorder has for those who live with it.

    How TOC evolves, in 10 keys

    OCD is a mental disorder characterized by the presence of obsessions (verbal / visual thoughts considered invasive and unwanted) and compulsions (physical or mental acts performed in order to reduce or alleviate the discomfort generated by “ the ” obsession). The relationship established between them would form the basis of the problem ****, a sort of recurring cycle in which the two feed into each other ****, connecting in a functional way and sometimes devoid of 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; because they raise explanations which are not mutually exclusive, and which can clarify why such a crippling situation arises.

    In the following lines, we’ll dive into ten fundamental keys to understanding what happens to the person living with OCD, and why the situation becomes more than just a succession of negative thoughts.

    1. Classical and operative learning

    Many mental disorders have things that were learned at some point in the vineyarda. In fact, it is based on this premise to suggest that they can also “unlearn” through a set of experiences that are articulated in the therapeutic context. From this point of view, the origin / maintenance of OCD would be directly associated with the role of compulsion as an escape strategy, as it manages to alleviate the anxiety caused by the obsession (through negative reinforcement).

    In people with OCD, in addition to the leakage which is made explicit by the compulsions, avoidant behaviors can also be observed (Similar to those deployed 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 lifestyle and options for personal development.

    In any case, time and again they are associated with both the genesis and maintenance of OCD. Likewise, the fact that the behavior exercised to minimize anxiety has no logical connection with the content of the obsession (clapping when the thought arises, for example) suggests a form of superstitious reasoning of which he is generally aware, Since the person can recognize the underlying illogicality to which this is happening to him.

      2. Social learning

      Many authors have shown that OCD can be influenced by certain forms of parenthood during childhood. Stanley Rachman noted that cleansing rituals would be more common in children who developed under the influence of overprotective parents, and that checking compulsions would occur especially in cases where the parents imposed a high level of demand. for the functioning of daily life. Today, however, there is insufficient empirical evidence to support these assumptions.

      Other authors have attempted to answer the origin of OCD by alluding to the fact that it it could be mediated by traditional educational stereotypesThis has relegated women to the role of “caregivers / owners” and men to “maintenance of the family”. This social dynamic (which fortunately is becoming obsolete) would be responsible for the more frequent appearance in them of rituals of order or purification, and in them those of verification (because they would be linked to the “responsibilities” which were attributed in each one). gender-based case).

      3. Unrealistic subjective assessments

      A very large percentage of the general population admit to having experienced invasive thoughts in their lifetime. These are mental contents which enter consciousness without there being any will, and which generally travel without major consequence until they simply cease to exist at some point. But in people with OCD, however, a very negative assessment would be drawn on its importance; being one of the fundamental explanatory points for the further development of the problem.

      The content of thoughts (images or words) is often deemed catastrophic and inappropriate, Or even explode the belief that it suggests poor human quality and deserves punishment. Moreover, these are situations of internal origin (as opposed to external situations which depend on the situation), it would not be easy to avoid their influence on emotional experiences (like sadness, fear, etc.) .

      In order to achieve this he would try to impose ferry control on thought, seeking its total eradication. What ends up happening, 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 feeling of loss of self-control and precipitates rituals (compulsions) aimed at more effective monitoring. It would be at this stage that the pernicious pattern of the obsessive compulsion which is characteristic of the image would form.

      4. Impairment of cognitive processes

      Some authors consider that the development of OCD is based on the engagement of a set of cognitive functions linked to memory storage and the processing of emotions, especially when it comes to fear. And this is it they are patients with a characteristic fear of harming or harming themselves, As a consequence (direct or indirect) of the content of the obsession. It is one of the most distinguishing features from other mental health issues.

      In fact, the nuances of prejudice and threat are those that hinder the passive adaptation of the obsession, forcing its active approach through coercion. Like this way, three cognitive deficits can be distinguished: Epistemological reasoning (“if the situation is not entirely sure, it is in all probability dangerous”), overestimation of the risk associated with inhibiting the compulsion and obstacles to the integration of information related to fear into the consciousness.

        5. Interaction between intrusive thoughts and beliefs

        Obsession and negative automatic thoughts can be differentiated by a simple nuance, although elementary in understanding 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 difference, of deep depth, is confrontation with the belief system.

        The person with OCD interprets their obsessions as dramatically attacking what they consider to be right, legitimate, appropriate, or valuable. For example, access to the mind of bloody content (scenes of murder or in which serious damage is done to a relative or acquaintance) has disruptive effects on those who show nonviolence as a value. with which to behave in life.

        Such dissonance gives thought a particularly disruptive coating. (O egodistónico), pregnant with deep fear and insufficiency, and all this causes a secondary result, but of an interpretive and affective nature: disproportionate responsibility.

        6. Disproportionate liability

        Since obsessive thinking diametrically contradicts the values ​​of the person with OCD, a guilt and cervical fear response would occur that its content could manifest. in the objective plane (causing harm to oneself or to others). He would take a position of extreme responsibility in the face of the risk of something happening, which is the ultimate driver of an “active” (compulsive) attitude to resolve the situation.

        So there is a particular effect, and that is that the obsessive idea it ceases to have the value it would have for people without OCD (Innocent), imbued with personal attribution. The detrimental effect would be associated more with the way we interpret the obsession than the obsession itself (worrying about). It is not uncommon for harsh self-esteem to erode and even self-esteem to be challenged as a human being.

        7. Thought-action fusion

        The fusion of thought and action is a very common phenomenon in OCD. Describes how the person tends to equate having thought of a fact with having done it directly in real life, giving the same importance to both hypotheses. He also underlines the difficulty in clearly distinguishing whether an evoked event (correctly closing the door, for example) is only an image which was generated artificially or if it actually occurred. The resulting anguish increases when you imagine “horrible scenes”, Of which we are wary of its veracity or its falsity.

        There are a number of assumptions made by the person with OCD which are related to the thought-action fusion, that is, thinking about something is like doing it, trying not to not preventing the feared damage is tantamount to causing – the low probability of occurrence does not relieve liability, not executing the compulsion is tantamount to desiring the negative consequences he is worried about and a person should always be in control of what is going on in his mind. All of them are furthermore cognitive distortions which can be corrected by restructuring.

        8. Bias in the interpretation of consequences

        Besides the negative reinforcement (repetition of the compulsion following the primary relief of the anxiety associated with it), many people may find their acts of neutralization reinforced by the conviction to act “in accordance with their values ​​and their beliefs,” Which gives consistency to their way of doing things and helps to maintain it over time (despite the harmful consequences on life). But there is something else, linked to an interpretive bias.

        While it is almost impossible for what the person is afraid to happen, according to the laws of probability this will oversize the risk and act to prevent it from expressing itself. The consequence of all this is that in the end nothing will happen (as was to be expected), however the individual will interpret that it was so “thanks” to the effect of his compulsion, Ignoring the contribution of chance to the equation. In this way, the problem will be anchored in time, because the illusion of control will never be shattered.

        9. Insecurity before the ritual

        The complexity of compulsive rituals varies. In mild cases it is sufficient to perform a quick action that resolves in a discrete time, but in severe cases a rigid and precise pattern of behaviors (or thoughts, because sometimes the compulsion is cognitive) can be observed. An example is washing your hands for exactly thirty seconds, or giving eighteen hands when you hear a specific word that precipitates the obsession.

        In these cases, the duress must be done with absolute precision so that it can be considered correct and alleviate the discomfort that caused it to explode. In many cases, however, the person comes to doubt whether they have done the right thing or whether they may have made a mistake at some point in the process, feel obligated to repeat it. This is the time when the most disruptive compulsions tend to develop, and those which interfere most deeply with daily life (taking into account the time they need and the resulting stresses).

        10. Neurobiological aspects

        Some studies suggest that people with OCD may have some alteration of the frontoostriado system (neural connections between the prefrontal cortex and the striatal nucleus that cross the pale globe, the substantia nigra and the thalamus; finally return 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 be deduced from it.

        In direct association with these brain structures, it has also been proposed that the activity of certain neurotransmitters may be involved in the development of OCD. These include serotonin, dopamine, and glutamate; with a dysfunction associated with certain genes (hence its hereditary potential). All of this, combined with the findings about the role of the basal ganglia (initiation and integration of movement), could suggest the existence of neurological factors in this disorder.

        Bibliographical references:

        • Heyman, I., Mataix-Cols, D. and Fineberg, NA (2006). Obsessive Compulsive Disorder. British Medical Journal, 333 (7565), 424-429.
        • López-Solà, C., Fontenelle, LF, Verhulst, B., Neale, MC, Menchón, JM, Alonso, P. and Harrison, BJ (2016). Different etiological influences on the dimensions of the obsessive-compulsive symptom: a study of multivariate twins. Depression and Anxiety, 33 (3), 179-191.

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