Factors of Obsessive Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a long-term neuropsychiatric condition with a 1-3% lifetime prevalence (Stewart et al., 2013). It is the fourth most common mental illness (Stewart et al., 2013). OCD is defined by unwelcome thoughts and pictures that frequently cross the mind, causing worry and unease, as well as the need to engage in repetitive behaviors in order to alleviate the unpleasant ideas (Emmelkamp & Paul M.G, 2012). According to the World Health Organization, OCD is the most common anxiety disease, with the biggest non-lethal sickness burden on the community (Stewart et al., 2013). The etiology of OCD is quite complex but research reveals that it is associated with both biological and environmental factors. Understanding the causes of OCD is essential in improving treatment options and outcomes and even possibly in preventing the onset of the condition. It is against this background that this paper will analyze different pieces of literature to gain more understanding of the biological, psychological and social factors that are strongly linked to the etiology and/or maintenance of OCD.

Biological Factors

There exist substantial pieces of research that contend that OCD is associated with biological factors. Different family research on OCD has analyzed data for genetic patterns. A review by Stewart et al. (2013) stated that the risk of developing OCD is four to tenfold more among first-degree family members of a patient with OC symptoms (Stewart et al., 2013). Furthermore, the onset of OCD in children is more linked to genetic factors than the onset of OCD in adults. The prevalence of child OCD onset was estimated at 45 to 65% while the occurrence of OCD in adults was slightly lower at 27- 47%, as indicated by studies on twins (Stewart et al., 2013). However, there is still a gap in the literature with regard to why family members show different OC symptoms yet OCD is associated with family history.

Researchers have also revealed that OCD is associated with neurophysiology and anatomy. Using brain imaging techniques, researchers have identified that particular areas of the brain function differently between individuals with OCD and those who do not have the disorder. According to Steketee (2012), OC symptoms are related to communication errors in different neurological parts, for instance, the thalamus, striatum, orbitofrontal cortex and the anterior cingulate cortex. For instance, the clinical differences in individuals with OCD such as tic symptoms are linked to functional abnormalities of corpus striatum (Fava et al., 2014). In addition, research also shows that the onset and maintenance of OCD are related to inadequate levels of neurochemicals such as serotonin (Fava et al., 2014). Serotonin is responsible for regulating mood, aggression, impulse among other functions (Fava et al., 2014). Considering that serotonin is linked to the onset of OCD, drugs used in the treatment and management of OCD aim to increase serotonin levels in the brain (Reghunandanan, Stein, & Fineberg, 2015).

Psychological Factors

According to many cognitive theorists, OCD is probably caused by individual's misinterpretation of intrusive thoughts (Dykshoorn, 2014). As stated by the cognitive model of OCD, everybody experiences disturbing thoughts each and every time. However, individuals with OCD normally tend to have an exaggerated sense of responsibility and misconstrue these feelings as being very significant and important (Dykshoorn, 2014). As a result, it leads to catastrophic consequences. Such repeated misapprehension of disturbing thoughts leads to the development of obsessions. Given that the thoughts are distressing, a person starts to engage in compulsive behavior as he or she tries to repel, block, or defuse the obsessive thoughts (Lack, 2012). For instance, parents under pressure from caring for a newborn might develop disturbing feelings of hurting the child. In most cases, this is a thought that one would shrug off. However, those prone to developing OCD might exaggerate the importance of such a feeling and respond as if it was an actual threat (Gillan et al., 2014). This can cause negative emotions and high level of anxiety, for instance, guilt and shame.

People who are always in constant fear of their own thoughts normally try to defuse such feelings from their imagination (Lack, 2012). According to many pieces of literature, one way of minimizing the effects of OCD is to correct faulty appraisal of intrusive views (Turner, 2012). However, the symptoms of OCD are maintained when those affected are unable to reinterpret or consider another meaning for their invasive thoughts (McKay et al., 2015). Therefore, by identifying obsessions and compulsions, including the awareness of how a person interprets the fixations, individuals are taught how they can challenge their imaginations and re-examine the associated threats (McKay et al., 2015). This normally happens during therapy when an individual with OCD is challenged to oppose his or her obsession and compulsion behaviorally as a way of reversing the intrusive thoughts (McKay et al., 2015). However, in case an individual fails to re-examine the threats of their thoughts whenever they occur, the symptoms are likely to be maintained (Gillan et al., 2014).

Social Factors

Another essential factor in understanding the onset of OCD is the interplay between OCD and social factors. Individual behavior and thought processes are shaped by observing others. This is to say that people can learn to react to certain stimuli by observing the response of others in the surrounding as opposed to necessarily having a direct exposure to the stimulus. This concept of learning plays a significant role in the development of OCD. According to behavioral theories of OCD, people initially learn anxiety and unease from relations between those emotions and an originally neutral stimulus (Lack & McKay, 2015). Through conditioning, the neutral stimuli become a habituated anxiety stimuli to which an individual proceeds to develop avoidance responses. The anxiety stimulus is then maintained through negative reinforcement from the social environment. Therefore, the development of OC symptoms can be associated with prior contact with other people such as caregivers, parents, teachers among other role models in a child's social environment. For example, individuals with OC symptoms associated with recurrent handwashing may have been provided with information that germs are everywhere and if exposed to, they will become ill. On that note, the manner in which role models manage anxiety issues may directly or indirectly condition a child to react in a similar way.

Research findings reveal that parents whose children present with OC symptoms show higher levels of expressed emotion as compared to the parents of non-OCD children (Saei, Sepehrmanesh, & Ahmadvand, 2017). Expressed emotions, in this case, refer to the associations between family members and individuals who depict OC symptoms. For instance, in a study among 46 children with OCD, 26 fathers as well as 30 mothers exhibited expressed emotions (Saei et al., 2017). Furthermore, these parents had more familial conflicts. In addition, the study revealed that poor social and familial functions and negative family relations characterized by higher levels of expressed emotion may worsen the progression of OC symptoms (Saei et al., 2017).

Interaction between Biological, Psychological, and Social Factors in Causing/Maintaining OCD

Over the past few years, scholars studying the predisposing factors to onset and prognosis of mental conditions have come to the realization that it is exceedingly improbable that any distinct biological, social or psychological factor is responsible (Schuurmans et al., 2012). Different researchers have revealed that 27-47% of OC symptoms in adults are associated with biological factors while 55-73% are attributed to social, psychological among other environmental factors (Schuurmans et al., 2012). Cognitive models purport that the onset of OCD is out of a unique interaction between psychological functions and factors in the environment. For example, as much as stress is not associated with the etiology of OCD, it may trigger OC symptoms in a person who is predisposed to OCD due to biological factors such as genetic makeup (ADAA, 2016). Furthermore, if a patient is already presenting with OC symptoms, exposure to stressful conditions may worsen the symptoms.

In addition, social factors such as family issues, also affect the maintenance of OC symptoms (ADAA, 2016). In a bid to be supportive of patients with OCD, family members may be enabling them. For instance, by accommodating OCD habits or giving reassurance when the patient requests it as well as providing items for conducting rituals, parents may contribute to the maintenance of OC symptoms (Francazio et al., 2016). Due to the complex interaction between the social, psychological and biological factors associated with the onset and maintenance of OCD, it is essential to adopt an integrated approach to OCD management and treatment that Incorporates medications and cognitive behavioral therapy (Reghunandanan et al., 2015).

Conclusion

The paper has presented a discussion on the biological, psychological, and social factors that are related to the etiology and maintenance of OCD. Based on this discussion, OCD is not linked entirely to a single factor, but it has a strong association with social, biological or psychological factors. For instance, biological factors such as genetic makeup, inadequate levels of serotonin, and communication errors in different parts of the brain have been linked to the disease. On the other hand, individual's misinterpretation of intrusive thoughts is considered the major psychological factor that causes OCD. The paper has also discussed the concept of social learning in the development of OCD. Therefore, based on the discussion, it could be argued that an integrative model is useful in understanding and maintaining OCD. Finally, there is a general limitation when it comes to the association approaches used to link social, psychological, and biological factors to OCD leading to differential patterns of results. For instance, the biological basis is still not clear. Therefore, more studies should be conducted to address the differential patterns.

References

ADAA. (2016). What Does Not Cause OCD | Anxiety and Depression Association of America, ADAA. Retrieved from https://adaa.org/understanding-anxiety/obsessive-compulsive-disorder-ocd/what-doesnt-cause-ocd

Dykshoorn, K. L. (2014). Trauma-related obsessive-compulsive disorder: a review. Health Psychology and Behavioral Medicine, 2(1), 517-528. doi:10.1080/21642850.2014.905207

Emmelkamp, & Paul M.G. (2012). Phobic and obsessive-compulsive disorders: Theory, research, and practice. Berlin: Springer Verlag

Fava, L., Bellantuono, S., Bizzi, A., Cesario, M. L., Costa, B., De Simoni, E., … Mancini, F. (2014). Review of obsessive compulsive disorders theories. Global Journal of Epidemiology and Public Health, 1(1), 1-13. Retrieved from https://www.apc.it/wp-content/uploads/2013/03/rewiev-of-OCD-theories.pdf

Francazio, S. K., Flessner, C. A., Boisseau, C. L., Sibrava, N. J., Mancebo, M. C., Eisen, J. L., & Rasmussen, S. A. (2016). Parental accommodation predicts symptom severity at long-term follow-up in children with obsessive-compulsive disorder: A preliminary investigation. Journal of Child and Family Studies, 25(8), 2562-2570. doi:10.1007/s10826-016-0408-7

Gillan, C., Morein-Zamir, S., Urcelay, G., Sule, A., Voon, V., & Apergis-Schoute, A. et al. (2014). Enhanced avoidance habits in obsessive-compulsive disorder. Biological Psychiatry, 75(8), 631-638. http://dx.doi.org/10.1016/j.biopsych.2013.02.002

Lack, C. (2012). Obsessive-compulsive disorder: Evidence-based treatments and future directions for research. World Journal Of Psychiatry, 2(6), 86. http://dx.doi.org/10.5498/wjp.v2.i6.86

Lack, C. W., & McKay, D. (2015). The etiology of the obsessive-compulsive disorder. In obsessive-compulsive disorder: etiology, phenomenology, and treatment (pp. 25-37). Hampshire, UK: Ginger Prince Publications.

McKay, D., Sookman, D., Neziroglu, F., Wilhelm, S., Stein, D., & Kyrios, M. et al. (2015). Efficacy of cognitive-behavioral therapy for obsessive-compulsive disorder. Psychiatry Research, 225(3), 236-246. http://dx.doi.org/10.1016/j.psychres.2014.11.058

Reghunandanan, S., Stein, D. J., & Fineberg, N. (2015). Obsessive-compulsive and related disorders. Oxford: Oxford University Press.

Saei, R., Sepehrmanesh, Z., & Ahmadvand, A. (2017). Perceived emotions in patients with obsessive-compulsive disorder: Qualitative study. Journal of Fundamentals of Mental Health, 19(2), 84-89.

Schuurmans, J., Van Balkom, A. J., Van Megen, H. J., Smit, J. H., Eikelenboom, M., Cath, D. C., … Van Oppen, P. (2012). The Netherlands Obsessive Compulsive Disorder Association (NOCDA) study: Design and rationale of a longitudinal naturalistic study of the course of OCD and clinical characteristics of the sample at baseline. International Journal of Methods in Psychiatric Research, 21(4), 273-285. doi:10.1002/mpr.1372

Steketee, G. (2012). The Oxford handbook of obsessive compulsive and spectrum disorders. Oxford: Oxford University Press.

Stewart, S. E., Yu, D., Scharf, J. M., Neale, B. A., Fagerness, J. A., Mathews, C. A., … Pauls, D. L. (2013). Genome-wide association study of obsessive-compulsive disorder. Molecular Psychiatry, 18, 788-798. doi:10.1038/mp.2012.85

Turner, S. (2012). Behavioral theories and treatment of anxiety. Berlin: Springer Verlag.

Appendix