What Causes OCD?

Obsessive-compulsive disorder, otherwise known as OCD, can stem from a number of possible sources. The pervasive disorder has gained a great deal of attention from both the scientific community and the general public. This is in part due to our increased understanding of this condition, as well as to advances in research attesting to the safety and efficacy of several types of OCD treatment. And with the expansion of our knowledge on OCD comes a greater interest in learning about its origins. So, what are some of the empirically proven obsessive-compulsive disorder causes, and which can be avoided? More on this in the following article.

OCD Risk Factors

Obsessive-compulsive disorder has been shown to greatly hinder one’s well-being due to its constant and severely debilitating focus on stressful stimuli. It has also been linked to other adverse conditions, such as anxiety and depression, making it a part of a complex system of harmful mental health issues.

The Diagnostic and Statistical Manual’s fifth edition (DSM-V), published by the American Psychiatric Association (APA), lists a number of risk factors found to be associated with the obsessive thoughts and compulsive behavioral symptoms of OCD. They are:

•     Temperamental Risk Factors: The DSM notes that a tendency toward higher negative emotionality, internal symptoms, and behavioral inhibition during childhood are all possible temperamental risk factors for developing OCD.
•     Environmental Risk Factors: Experiencing physical or sexual abuse during childhood, as well as other stressful or traumatic events, have been shown to lead to an increased chance of developing OCD.
•     Genetic and Physiological Risk Factors: First-degree relatives of adults with OCD are twice as likely to develop OCD themselves, while first-degree relatives of those who had OCD as children are ten times likelier to develop it themselves.

Are OCD Risk Factors Also OCD Causes?

To deduce from the DSM’s list what conditions bring about OCD, instead of merely what factors are commonly found with this disorder, it is important to first establish the criteria for OCD causation.

First, since causation requires an association does need to be determined. As all of the above risk factors have been found in relation to OCD symptoms, they all meet this condition as long as environmental factors relate to the patient’s past, and most notably childhood environment.

Second, there is temporal priority. Simply put, for a risk factor to meet this criterion, they must appear before the appearance of OCD symptoms. Again, out of the above-mentioned risk factors, all three could meet this condition.

Last, the connection between OCD symptoms and a possible source must be nonspurious, meaning direct, and due to both being the result of another factor. This is where things get murky: is it really possible, for example, to determine whether witnessing a shooting as an impoverished child directly led to OCD symptoms, or whether another factor of their upbringing was the condition’s root cause? The question of nonspuriousness remains a point of uncertainty regarding OCD causes, though the above three risk factors have been shown to consistently appear within the backgrounds and present circumstances of patients with this disorder.

Is OCD Caused by Anxiety?

Obsessive-compulsive disorder is officially considered an anxiety-based disorder, whose obsessive thought patterns and compulsive rituals induce a significant amount of distress. Indeed, the APA had previously included OCD within the anxiety section of its Diagnostic and Statistical Manual (DSM). But while OCD symptoms have long been considered the result of acute anxiety, recent years have seen a change in perspective when it comes to this condition.

Possible OCD Causes from Recent Years

In 2013, the DSM’s latest edition, the DSM-V, separated OCD into its own section, for a number of reasons: for starters, contemporary clinical research has shown that OCD (and OCD-related disorders) share several familial and genetic factors, neurotransmitter and peptide systems, neurocircuitry, phenomenology, and comorbidity with each other (specifically, abnormalities in the anterior cingulate cortex and frontal striatal pathways have been shown to be associated with OCD). The above OCD-related factors do not, however, usually appear in relation to anxiety disorders, making the case for viewing them as their own, distinct family of disorders.

OCD also seems to differ from anxiety due to its assumed cognitive and emotional root causes. Under the executive functioning hypothesis, for example, OCD is considered to be the result of a disruption to the individual’s self-regulatory abilities. Anxiety, on the other hand, is more commonly associated with emotional processing.

A third distinction of OCD is its response to specific treatment courses. Cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) are both considered first-line treatments options for OCD, and have been shown to specifically aid with this disorder.

Is Distress the Missing Piece to OCD?

In addition to the more widely accepted, above-mentioned reasons for separating causes for OCD from causes for anxiety, recent years have also seen a growing hypothesis among researchers, who claim that OCD is the result of obsessive distress, and not anxiety. The distinction between the two is an important one: anxiety is understood to be a persistent overgeneralization of fear, which helps keep us alive by heightening our awareness of a perceived threat. While fear dissipates after the threatening stimuli has gone, anxiety keeps us in a state of adverse preparedness, long after the cause of fear has passed.

As opposed to anxiety, distress is defined as extreme uneasiness and an inability to return to a state of relative calm, due to the perceived proximity of an adverse stimulus. Like anxiety, distress is considered a maladaptive response to a disturbing experience. But while anxiety is seen as acute and prolonged fear, distress is more of an unsettling, pervasive sense of disquiet, with obsessive distress making the further distinction of focusing on adverse thought content.