OCD - What is it Really?

Vera Li
Sep 16, 2021
5 min read

Maybe you think it’s “so OCD” because you rearranged your room at 3am, or your friend says that they’re “so OCD” for keeping all their shoes in a neat line. While “OCD” has become a phrase synonymous with a desire to keep organized, the actual condition remains largely misunderstood. What really is OCD?

By Vera Li

What is OCD?

OCD is a chronic disorder in which one suffers from uncontrollable, recurring thoughts known as “obsessions” and/or the urge to repeat certain behaviors, which are called “compulsions”.

Obsessions are the anxiety-inducing and recurring thoughts or urges that bring OCD sufferers distress. OCD can manifest in various ways, such as a phobia of germs or contamination, an obsession with symmetry or perfect order, aggressive thoughts towards others or oneself, and forbidden or taboo thoughts.

Compulsions are the behaviors that the sufferer has an urge to repeat in response to an obsessive thought. Examples of compulsions are excessively washing hands or cleaning, arranging things in a certain way, repeatedly checking things, and compulsive counting.

OCD is a debilitating disorder that often coexists with other mental disorders like anxiety disorders, major depressive disorder, bipolar disorders, ADHD, feeding/eating disorders, autism spectrum disorder, and tic disorders. Some disorders that coexist with OCD also share very similar characteristics and are listed under the same DSM-5 category as OCD, such as body dysmorphic disorder, hoarding disorder, trichotillomania (hair-pulling) disorder, excoriation (skin-picking) disorder, and more.

What causes OCD?

As for the causes of OCD, there is no confirmed answer yet, but there are many theories that are still being researched.

Biological theory

There is much research being done on the potential biological causes of this disorder.

Studies have shown that, compared to someone who doesn’t have the disorder, a person with OCD is more likely to have another family member with OCD. This means that OCD may be related to genetics. Whereas genetics may not be the sole cause for

this disorder, it may cause someone to be genetically predisposed to OCD, meaning that certain environmental factors may trigger the onset of this disorder in that person.

Another proposal is that the body’s natural production of certain antibodies in response to streptococcal infections might be connected to OCD. When directed to parts of the brain, these antibodies might be linked to Pediatric Autoimmune Neuropsychiatric Disorders (PANDAS) associated with Streptococcal infection. Researchers believe that if PANDAS is not the cause for OCD, it can potentially be a trigger for OCD in those who are already genetically predisposed to the disorder.

Researchers have also studied biochemical imbalances to be a potential cause for OCD, specifically looking at serotonin, a brain chemical involved in regulation of various bodily functions like sleep and memory. Initially, researchers believed that a gross deficit in this chemical was a cause for OCD, but this was not actually properly proven. Researchers still believe that serotonin may be connected to OCD, perhaps in the maintenance of OCD, but the evidence on it being a major cause isn’t too strong.

Behavioral theory

According to the behavioral theory, it is hypothesized that obsessive thoughts have become associated with anxiety through conditioning, and OCD sufferers subsequently developed avoidance behaviors that keep the anxiety alive.

Research from the 50s and 60s proposed that ritualistic behaviors were a form of learned avoidance. Around the early 70s, researchers developed treatment methods where exposure to feared situations was the main treatment protocol, and these methods were eventually incorporated into the effective exposure and response prevention (ERP) protocol that is widely used today. It is observed that the occurrence of obsessions increases anxiety while compulsions ease this anxiety, at least temporarily. However, when compulsions were delayed or prevented, there was a quick decrease in the initial anxiety and urges to perform compulsions. Thus, therapists realized that if patients could confront their fears through delaying or abstaining from compulsions, then anxiety and discomfort surrounding obsessions would diminish and eventually disappear. In other words, to get over the fear of not performing an OCD behavior, you have to face the fear by abstaining from the behavior.

Cognitive-behavioral theory

Many cognitive theorists believe that people from OCD suffer because they misinterpret intrusive thoughts, which lead to OCD. Intrusive thoughts are unwanted thoughts, often disturbing or distressing to some degree, that pop into our heads without warning and repetitively. The theory is that while everyone has intrusive thoughts on occasion, people with OCD often misinterpret these thoughts to be very important, and because the thoughts are distressing, this causes the sufferer to engage in compulsive behaviors to try and resist, block or neutralize the obsessive thoughts.

The cognitive-behavioral theory proposes that normal obsessions turn into obsessive obsessions when either the occurrence or content of the thoughts are interpreted by the sufferer to be meaningful and threatening, causing distress. For instance, OCD would occur if the person believed that the intrusive thoughts were an indication that they may be responsible for harm or the prevention of harm.

Some researchers believe that this theory questions the biological theory since some people who are genetically predisposed to OCD never develop the full disorder whereas others that are predisposed do develop this disorder over the course of life experiences.

Psychoanalytic theory

This theory suggests that OCD develops because the sufferer fixates on unconscious trauma from the past such as from childhood or family relationships. However, this theory is often disregarded today because of the failure for psychoanalytic therapy to treat OCD.

Other theories

Depression is sometimes thought to cause OCD, but most experts believe that depression is a consequence of OCD rather than a cause. It most certainly will make OCD symptoms worse.

Stress is possibly a trigger that provokes the onset of OCD in someone who is already predisposed to the disorder, though it does not actually cause OCD. Daily stress will worsen symptoms of OCD.

Debunking Common Myths about OCD

Myth 1: All OCD sufferers are neat freaks

Not everyone with OCD has compulsions related to cleanliness. Other compulsions may include hoarding, constantly checking for threats, obsessively counting to a certain number, etc. OCD looks different for different individuals!

Myth 2: OCD mainly affects women

According to the statistics from the Anxiety & Depression Association of America, OCD is equally common amongst men and women.

Myth 3: OCD isn’t treatable

Whereas there is no “cure” for this disorder, there are various treatments that can help someone with OCD live their life like ERP, which is the most commonly used and most effective treatment. Additionally, medication can be a possible solution to address the biological aspect of OCD. The effectiveness of treatment will vary from person to person, but there are certainly treatments available to help people with OCD live a fulfilling life!

The bottom line is that OCD is a debilitating mental illness that is still not completely understood, but there are treatment options available out there to aid those who are suffering. If you are or believe you may be suffering from OCD, it is important to reach out to the proper healthcare professional and seek the help you need!

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