Obsessive-compulsive disorder (or OCD) has been receiving a great deal of attention over the past two decades. The disorder combines elements of other, more established mental health disorders, while offering its own combination of symptoms and possible causes. Recently, studies have pointed to a new conceptualization of this condition, suggesting a link between OCD and phobia. Is OCD a phobia? Are the two somehow connected? Or do their dissimilarities outweigh any common ground they may share? Read on to find out more on this new direction in OCD research.
Obsessive-compulsive disorder occupies a unique section in the world of mental health, through its central, defining feature: the cyclical interplay between thoughts and actions. While OCD obsessions incessantly pull the mind toward the same disturbing theme, OCD compulsions coerce the individual to carry out the same behavior, in a self-feeding loop.
The relationship between OCD obsessions and compulsions can be understood through example: a patient finds themselves preoccupied with a terrible event occurring to a loved one. As she goes through her daily routine, she is bombarded by images of their involvement in a gruesome car accident, causing them excruciating pain and trauma.
Horrified by these thoughts, she begins trying to distract herself from them through her own actions. Whenever an image of her loved one going through a violent experience appears in her mind, she snaps her fingers three times, out of sight from those around her.
At first, this short ritual seems to do the trick: she is able to move away from her focus on such violent events and go on with her day. Eventually, though, her repeated action starts losing its effect, until it is no longer able to provide calm and distraction. To counter this, she comes up with a more elaborate routine, now getting up from her desk to exit and enter the room each time she has a violent thought.
Her reactions to disturbing thought content start to frustrate her, and she wishes she could quit them. However, she no longer feels like she should; though nonsensical, she nevertheless remains unsure whether these rituals help protect against such a horrible event from taking place. Since one can never be completely sure as to the effect of a certain action, she begins to entertain doubt. It is this magical thinking that pushes her to both obsess over potential tragedies, and carry out increasingly tiresome behaviors she feels forced to act out. As a result, the cycle of OCD is created and maintained.
Over the years, three major theories have risen, to explain the origins of OCD: the condition has been said to stem from anxiety, distress, or a multiplicity of emotions, with all three offering a different understanding of this disorder.
The American Psychiatric Association (APA) first recognized OCD as its own disorder in the third edition of the Diagnostic and Statistical Manual (DSM-III), published in 1980. From its mention until today, the APA has continued to consider OCD as an anxiety-based disorder.
Anxiety is defined as a survival mechanism thrown into overdrive. It mimics the unpleasant hyperarousal brought on by the fear of a potential, immediate threat (a nearby predator), but keeps the individual in a state of vigilance, even when there is no threat to their person.
As a result of anxiety, an individual can experience constant alertness, stress, and avoidance behavior. OCD can similarly activate such symptoms, as the individual’s intrusive thought content causes them to fear their own mind and dread the next time they will be forced to consider the focus of their obsession, despite it not posing a real threat to their lives or the world around them.
While the APA has adhered to the above theory of OCD-as-anxiety, recent studies have pointed to another possible source: that of OCD-as-distress.
This theory describes OCD not as an inefficient version of fear, but as a highly unpleasant sensation that the individual experiencing it cannot shake. As a form of distress, OCD is seen as a hindrance to returning to a sense of calm, while keeping the individual on edge, as they continue being preoccupied with their OCD-related obsession.
Another present-day theory aims to unseat the APA’s perception of OCD-as-anxiety, by distinguishing OCD from more “classical” forms of anxiety, such as phobias. Rather, this theory opens up the condition to a myriad of emotional sources, noting that OCD can develop out of many different emotional origins. Among them are:
Taken from this perspective, OCD is defined solely through its two central features—obsessive thoughts and compulsive actions—while allowing for a diverse set of emotional sources to bring about this condition.
The anxiety, distress and multiple-emotions theories can act as different paths toward conceptualizing a disorder that has to be fully understood. Whether viewing OCD as a fear-driven obsession, a nagging thought that will not relent, or an end result of several possible emotional triggers, its effect on an individual’s well-being can be deep-rooted and significant. To help aid against its adverse array of symptoms, it is important to account for its hypothesized root causes, the context in which OCD develops and is sustained, and the treatments that have been shown to offer patients some much-needed relief.
