The manifestation of obsessive-compulsive disorder (OCD) centers around two core symptoms, obsessions, and compulsions. Symptoms can range in severity and content type, creating a diverse presentation depending on what is most distressing or prominent. Because of this diversity, understanding the core of OCD requires looking beneath these observable features.
Where does OCD stem from? Read on to learn more, beginning with what causes OCD. Then review the core beliefs of OCD and their influence on emotion. Finally, examine the other foundational aspect of OCD: core fears.
Though the exact causes of OCD are not known, research has revealed several correlations with the potential to form a more cohesive picture of the most essential aspects of this condition.
Brain scans have detected abnormal brain activity, blood flow, and metabolic activity in individuals affected by OCD. One key pathway centers around the cortico-striatal-thalamo-cortical (CSTC) circuit, a pathway associated with reward-based learning and habit formation. Each component also develops functional connections with the cerebellum, which is now thought to play a significant role in cognition and emotion.
When activity within the CSTC circuit is abnormally high, the connections between circuit components and the cerebellum decrease. Dysfunctional connections with the striatum are of particular concern because of its connections with habit formation and goal-directed action. This decreased connectivity may be part of the pathology of OCD.
Abnormalities in neurotransmitter secretion may play a meaningful role in OCD, particularly serotonin and dopamine. SSRI antidepressants and antipsychotics increase the impact of both neurotransmitters and provide effective relief for OCD. This positive response may be a clue that abnormal neurotransmitter activity is part of the biological foundation of OCD.
OCD carries significant genetic risk, with the highest rates among first-degree relatives. No specific gene or set of genes has been known to directly cause OCD. Instead, a broad profile of genetic variants is likely responsible for increased risk. This highly variable foundation adds even more complexity to the assessment, diagnosis, and treatment of OCD. Genetic risk is meaningful, but environmental factors also determine if an individual will develop the disorder.
Core dysfunctional beliefs are part of the psychological foundation of OCD. Decisions, thoughts, actions, and emotional reactions stemming from this foundation result in distressing symptoms.
OCD-related dysfunctional beliefs include:
Though all of the above beliefs have been shown to hold a substantive association with OCD, research points to distorted beliefs about one’s own thoughts as the most reliable predictor of OCD symptoms. Such self-related distorted beliefs are often judgmental and harsh, leading to feelings of guilt or shame.
Examples of Distorted Beliefs About One’s Thoughts:
Beliefs such as these are often the driving force behind OCD-related compulsive behaviors performed to relieve distress. Regardless of the thought content or symptoms, distorted beliefs about one’s thoughts appear to be at the core of OCD distress.
OCD is often categorized by what observable symptoms. However, every individual’s OCD operates around a core fear, an ultimate consequence that drives their emotional distress and compulsive behaviors. Each core fear is specific to the individual, though several themes have been highlighted as more common ones. They include a fear of being condemned, banished from their family, or dying from an incurable illness.
Individuals with OCD who are able to identify their own deeply-set fear can better understand the roots of their OCD obsessions and compulsions.
A patient’s core fear is often imagined as the worst-case scenario, escalating their emotional distress to an exhausting level. Since they cannot control their obsessive thoughts, they are repeatedly reminded that their most feared consequence, turning it into a near-constant threat.
An individual’s core fear and beliefs interact to drive the cycle of OCD. The triggers and reactions are observable to the individual and others, but they are surface features. Identifying the core of OCD is a critical task because it provides the target for treatment interventions. When these elements are defined accurately, an individual can learn to interrupt the cycle. The burden of emotional distress from OCD may begin to feel a little more manageable.
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