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What are the most common causes of OCD?

What are the most common causes of OCD?

The cause of OCD is officially unknown. That is weird, considering that it is a disorder that affects around 3% of the population and that it is one of the 20 most incapacitating disorders according to the World Health Organization. There are some general indications that there is a genetic component and that there are usually several causes but that’s about how far general knowledge goes.

That’s why in this article we would like to explain the most common causes for OCD, including the genetic predisposition, external and internal causes, and the detonating factor, while focusing principally on infancy, childhood and adolescence.

OCD usually appears around adolescence or beginning adulthood (6-15), however most people show symptoms of anxiety way before that. The NIMH found that most children start showing the first symptoms around the age of 7. Normally the disorder develops gradually.

In this article we will provide a clinical perspective, obtained through the clinical experience and research performed at IPITIA.

How do we see OCD at IPITIA

OCD is a psychiatric and psychological disorder which, similar to a viral disease, has an incubation period. In this period the obsessions appear as a consequence of various factors and antecedents, which are occurring or which have occurred in the life of the people who suffer from this disorder.  One of the main underlying factors, is an intense anxiety and/or depression, which if  not dealt with can get trapped in the mind of the person, causing an OCD to develop.

When we work with adults who suffer from OCD, it is very important to make a profound anamnesis and a correct interpretation of their experiences and the multiple factors that make up their life. In this process we have to start with an exhaustive exploration of their infancy and adolescence, in order to profile them with more precision as adults, and to know the keys to the configuration of their psyche; Keys, which are necessary to start an effective treatment.

OCD usually develops in the moment the person undergoes a developmental evolution; the moment in which their reason or logos starts to become conscious of the antecedents of their personal history. Typically these experiences are alien to what they would have done under their own free will and their mature conscience, or not congruent to their natural way of being and doing. These experiences then start to cause anxiety and become more serious in the face of a detonator or traumatic experience.

Why do infancy and adolescence play such an important role in OCD?

Because it is a critical period in which the psyche of the person gets shaped and in which everything they experience, due to their immaturity, conditions their near and far future.

Let’s imagine a woman of 40-years-old. When she was 5-years-old, her parents separated, something not common at the time.  As a consequence her mother falls into a deep depression and sadness. The girl, who is conscious of the suffering in her environment, takes the “smart” decision not to annoy anybody, and to do everything right, in order to compensate the sadness of her mom. In order to be good and not to annoy anybody, she develops a big capacity to think and do things “well or properly”. She thinks that in this way mom will be proud or happy since she won’t have to worry about her. The child manages her objectives but at a price… She modifies her nature and instincts at a very young age, substituting her spontaneousness with a rational mind. Let’s continue…

Genetic predisposition: also known as the genetic sensitivity, or the influence on the phenotype of an individual organism. This translates into the capacity of an individual to develop a certain illness or disorder. What is important to know, is that the phenotype can be influenced by environmental conditions.

What does it mean to have a genetic predisposition?

It simply means there is a predisposition to suffer from a certain illness; however, the environment and personal experiences are the decisive factor in who does and who doesn’t develop the disorder. The families who have antecedents of OCD and anxiety have a bigger predisposition.

How can we interpret the fact that someone has a genetic predisposition?

Many children who will later suffer from OCD live in a family with strict rules about how they should live and behave, with rigid thoughts and obsessive tendencies with regard to the rules, cleaning, organizing, and with fear of what others might say about them. This can without going any further be “installed” in the hard disk of the child and can come out on the moment he/she acts. Even though he was against it during his childhood, he might end up integrating this rigidness into his mind and unconscious as if it were his own. It might show up nearly spontaneously and might become pathological when he tries to deal with life in a highly stressful moment, causing a huge internal conflict.

What do I want to say with this? Let’s go back to the girl who had to take on a non-healthy overly mature role at a very young age. When her mom on top of this, implements stricter rules at home because she’s frustrated with the loss of her husband, saying things like: Don’t do that, be quiet, close the door, organize your stuff, clean your room, listen to me, do your homework… No, don’t do that! Be careful, no don’t go there… Correcting her over and over again, telling her she should be more careful and not make any mistakes; this is when the predisposition of developing OCD and becoming what they installed in her becomes more and more likely.

External factors

Until now we’ve spoken about the genetic predisposition while considering antecedents in the family and the atmosphere at home. In this paragraph we’ll focus on the external factors.

There are many external factors that can influence in the development of OCD but all of them have something in common; traumatic life experiences which caused the person to feel like they lost control, like the situation wasn’t in their hands:

A separation, accident, death, sexual or physical abuse, continuous rejection, illnesses, or an unaccepted sexuality; these are all experiences which depending on the circumstances can become traumatic.

You have to think that we’re dealing with a child. A child who accompanied by fear and a not fully developed reasoning or logos can experience a situation as very overwhelming. This is important because nor his psyche nor his central nervous system have been fully developed. Therefore these experiences can push their development into one direction or another.

When we enter into the period of puberty and adolescence, the child will start connecting his vital experiences to their current knowledge and vision on the world. This can oftentimes generate feelings of guilt and frustration with regard to their previous experiences.

Let’s imagine the case of a 12-years-old boy who develops homosexual OCD (HOCD)

This child has been raised in a highly protected environment. His mother tried to compensate the bad relationship they had with the boy’s father, who was predominantly absent and aggressive when he was around. The mother wants to know everything that happens with her son, obviously with good intentions. And the son complies by explaining his mom everything he does, thinks and wants to do, thereby potentiating an already existing sensitivity.

They boy grows up in morally rigid environment where religion defines the norms and sexual behavior, and gender discrimination is out and about…

He has difficulties understanding his early life experiences since his reasoning skills haven’t been fully developed yet. At this point of his life he finds out his best friend is gay. All of a sudden he’s afraid the same thing might happen to him. He loves his best friend but all of a sudden finds it difficult to be around him. Before he never thought anything of it but he now confuses his friendly love for sexual intentions from his side. On top of this he starts to develop a high libido, typical for adolescence. As a result his fear rises to extreme levels…

In summary

Genetic Predisposition: Family history of anxious and over controlling mom. Mother has obsessive tendencies, having frequent obsessive thoughts about what other people might think of her and about complying with religious norms and standards. (These factors also influence the phenotype obviously).

External Factor: The father is an alcoholic, who is mainly absent and aggressive when he’s around. Overprotective mother. Lives in a country where social norms are very strict and freedom of speech and personal expression is limited.

Detonating factor: The homosexuality of his best friend. Obviously the precedents could have caused the boy to develop OCD with a different kind of detonator as well.

(The detonator is the factor or determining situation that marks the moment in which the obsessions and compulsions first appeared).

It is clear that the causes of OCD are plethora and the reason for OCD to develop based on many different factors.

In this particular case, the boy was not able to integrate the masculine part of his psyche and went through various experiences that caused him to develop certain erroneous beliefs. There are various factors that influence the development of OCD but as you can see the early life experiences, especially those in infancy and adolescence are of vital importance.

We cannot be in a therapy process without contemplating the specific trajectory of the person and without configuration a strong and balanced psyche. Also, we always have to consider the nature of this particular person, his unique makeup and be able to look at him without seeing what OCD made of him.

General characteristics; cause and effect

  • Role models with obsessive compulsive tendencies.
  • An excess of responsibility and perfectionism.
  • Strict moral and religious upbringing where thinking something is the same as acting and wrong and right are instilled excessively in the child.
  • High levels of guilt.
  • Complete control about his thoughts and an overestimation of their importance.
  • Low tolerance for uncertainty and spontaneous elements.
  • Magnifying: “If I make a mistake it will have severe consequences”.
  • Overprotection
  • Rigidness.
  • Traumas (accidents, separation, bulling, abuse or maltreatment…)

Sergio Lara

Clinical Psychologist