What is OCD?
Obsessive-Compulsive Disorder (OCD) is a psychological disorder marked by chronic intrusive or unwanted thoughts and images accompanied by ritualistic repetitive behaviors.
There is no single cause of OCD; rather, there are multiple and complex factors that are more common or likely to occur in individuals who are diagnosed with OCD. Here is a breakdown of these various factors.
Factor #1: Genetics
Research suggests that OCD may have a strong genetic component. Someone with a family history of OCD may be predisposed to developing the condition themselves.
Some studies estimate that 10-20% of individuals diagnosed with OCD also have a member in their immediate family who also has OCD .
In twin studies, the rates of OCD concordance (pairs of twins both having OCD) were higher among identical twins compared to fraternal twins . Generally, genetics are thought to contribute 45% to 65% of OCD risk (for childhood-onset OCD) although various factors, such as the age of onset, can affect this statistic; the numbers are approximately 27-47% for adult-onset OCD .
While there is not a “single gene” that is responsible for OCD, understanding how genetics contributes to OCD symptoms can help in understanding and treating the disorder.
Factor #2: Brain Biology
In addition to one’s genetic makeup, OCD may be related to specific elements of the brain.
Research suggests that serotonin (and how we process it) may be associated with OCD. Serotonin is a chemical messenger that sends signals between nerve cells. It is connected to sleep, mood, and anxiety, among other things.
Medications that increase the availability of serotonin are shown to have some effectiveness in reducing OCD symptoms. As a result, scientists theorize that serotonin may be related to OCD.
Studies have also shown that a mutation in the human serotonin transporter gene (hSERT) may be connected to OCD. This mutation causes problems with the regulation of serotonin.
Scientists have also connected OCD with specific regions of the brain. Imaging studies show that metabolic activity increases in certain areas of the brain when individuals with OCD are provoked with the triggers connected to their obsessions or compulsions.
OCD is also associated with abnormal activity and messaging in the circuits involving parts of the brain such as the orbitofrontal cortex, anterior cingulate cortex, striatum, and thalamus.
This suggests that people with OCD may have physical differences in their brains compared to the brains of people who do not have OCD.
Factor #3: Trauma
Another potential factor in the development of OCD is trauma.
The prevalence of OCD symptoms after a traumatic incident ranges from 30 to 82% in various studies. Some of these individuals also met the criteria for Post-Traumatic Stress Disorder (PTSD) . Also, among people with PTSD, the twelve-month prevalence rate of OCD is 30%, which exceeds that of the general population .
Potential connections between OCD and PTSD are complex. If you think you have OCD, PTSD, or both, you should seek professional help from a licensed mental health professional.
While people respond to trauma differently, for some people with OCD, it may contribute significantly to their symptoms.
Factor #4 Infections
Children can develop OCD in different ways. In most cases, Pediatric OCD is gradual and can be seen progressing over years.
Children can also develop OCD suddenly, often following a strep or viral infection. This form of OCD is associated with a condition known as PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus)/PANS (Pediatric Acute Neuropsychiatric Syndrome).
This type of OCD may seem like it appeared “out of the blue”. Instead of gradual progression, a child with PANDAS/PANS can develop “full-blown” OCD and other anxiety disorders within a day or two of symptoms first appearing.
This may happen because of the way the body responds to certain types of infections. Research suggests that the antibody response to the infection, and not the infection itself, may be responsible for the OCD and other symptoms associated with PANDAS/PANS . Autoimmune antibodies may attack parts of the brain that are connected to the sudden onset of OCD, tics, and other neuropsychiatric symptoms .
Cause vs Cure
While OCD is not linked to a specific cause, there are certain psychological, environmental, and biological factors that are more common in individuals with OCD. These factors help researchers understand more about the development and treatment of the disease.
It is not unusual for someone to have questions about what caused their OCD or what they could have done to prevent themselves or a loved one from getting the disease.
However, knowing the cause of one’s OCD, even if it were possible, does not automatically result in being cured.
Instead, it’s more helpful to focus on getting better. The current gold standard for OCD treatment are evidence-based approaches like Exposure and Response Prevention (ERP) therapy. ERP works by directly addressing and changing the behaviors that maintain OCD.
For instance, a person with OCD may practice rituals when they leave their house, like compulsively checking the door to make sure that it is locked. A therapist may guide this person through a process in which they leave the house and are not allowed to perform their checking routine. When they feel the anxiety and the urge to check (with the support of the therapist) they “sit with the anxiety” and eventually learn to tolerate it.
ERP also involves learning to tolerate fear and uncertainty (“what if I forgot to lock the door?”. “what if I did not check enough times?”). While the patient may have responded to the fear in the past by going to check the door and lock it again, this will only provide temporary relief and prevent the OCD symptoms from improving.
Theorizing as to what may have caused one’s OCD, while temporarily reassuring and even a common practice in some forms of therapy, really does not have any current evidence in effectively reducing obsessions and compulsions. A more effective way of addressing OCD symptoms is to use research-based treatments, such as ERP.
If you have (or think you may have) OCD in any form, you can find a licensed therapist by scheduling a call with the NOCD team.