Running head: Causes of Obsessive-Compulsive Disorder 1

Causes of Obsessive-Compulsive Disorder

Sara Merkle

Molloy College

Causes of Obsessive-Compulsive Disorder

CAUSES OF OBSESSIVE-COMPULSIVE DISORDER 2

Obsessive-compulsive disorder, referred to as OCD, is a mental disorder that can

strongly inhibit the sufferers daily life activities. A person diagnosed with this disease, is

affected by recurrent obsessions and thoughts and then is haunted by them- either in their mind

or by carrying out actions related to their obsessions. It is a widely known stereotype that OCD

can include symptoms such as washing your hands repeatedly or turning the lights on and off a

certain number of times before leaving a room. It is extremely important to seek out professional

help if one feels as though they show signs of this disorder. Although, there are many different

types of anxiety disorders that are very common, many question what it is that drives these

recurrent obsessions and compulsions characterized by OCD. While most psychologists see the

cause of OCD as abnormalities of neurobiological factors, environmental influences also can

play a role in the onset of obsessive-compulsive disorder.

Obsessive-compulsive disorder can be formally defined as A subclass of anxiety

disorders with two essential characteristics: recurrent and persistent thoughts, ideas and feelings;

and repetitive, ritualized behaviours (Reber, Allen & Reber, 2009, para. 1). These recurrent and

persistent thoughts, ideas and feelings are called obsessions. The repetitive and ritualized

behavior is called the compulsion. The combination of these two characteristics can be deadly

and potent enough to cause distress unto the sufferer (Nevid, Rathus & Greene, 2014). Most

compulsions fall into one of four categories: counting, checking, cleaning, and avoidance

(Carlson, 2014, p. 411). OCD traits can be seen in a variety of mental disorders, however, people

diagnosed with just OCD recognize that their thoughts and compulsions are absurd and

unreasonable. Obsessive-compulsive disorder affects between 2% and 3% of the general

population at some point in their lives. It usually begins in adolescence or early adulthood, but

may emerge in childhood, even in early childhood (Nevid, Rathus & Greene, 2014, p. 188).
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As discussed prior, neurobiological factors can be seen as the main cause of OCD by

psychologists. Overall, there are many brain structures that, if impaired, can be the cause of the

mental disorder. The basal ganglia as well as the structures that communicate with it- the

orbitofrontal cortex and the anterior cingulate gyrus- are well known structures that can be the

key structure to look for when diagnosing OCD. The basal ganglia are involved in controlling

body movements, so it is conceivable that a dysfunction in this region might help explain the

ritualistic behaviors seen in OCD patients (Nevid, Rathus & Greene, 2014, p. 189). Related to

this, the frontal lobes of the brain, that have a similar function as basal ganglia, may be the cause

of OCD if there are abnormalities in the brain circuits that it is involved in. (Nevid, Rathus &

Greene, 2014). In addition, the disorder sometimes occurs after brain damage caused by various

means, such as birth trauma, encephalitis, and head trauma (Carlson, 2014, p. 412). Although it

is not the root cause of OCD, serotonin has been seen as a factor of the disorder. Because,

selective serotonin reuptake inhibitors (SSRIs) can work so well to alleviate some of the

menacing symptoms of OCD, health professionals have pointed to an abnormality in its

transmission as a possible cause of the disorder. Serotonin also plays a key role in many of the

other parts of the brain that are seen as causes which is more evidence that supports its role in

OCD (Understanding Obsessive-Compulsive and Related Disorders, 2017).

Researchers find that examining the brain differences of someone who has OCD versus

someone who does not, aids them in finding the neurobiological causes of the disorder. In a

relatively recent study, researchers performed an experiment to see if executive functioning in

the frontal brain region- including the dorsolateral prefrontal cortex (DLPFC), ventromedial

prefrontal cortex (VMPFC), anterior cingulate cortex (ACC), and orbitofrontal cortex (OFC)-

differed amongst a group with OCD, a group with hoarding disorder and a control group.
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Through the use of two different tasks and the use of fMRI, they found that there was more

activity in the right dorsolateral prefrontal cortex in the OCD group than in the control group

(Hough et al., 2016). In another study, researchers sought to find the abnormal brain circuitry in

children with ADHD, Autism Spectrum Disorder and OCD. Their findings showed that Lower

fractional anisotropy within the splenium of the corpus callosum was found in each NDD

(neurodevelopmental disorder) group, compared with the control group and there was a shared

disruption in interhemispheric circuitry in all of these disorders, including OCD (Ameis et al.,

2016). In an article written by Pauls, et al. (2014), the research describes a normal cortico-striato-

thalamo-cortical circuit:

In the normally functioning corticostriatothalamocortical circuit, glutamatergic

signals from the frontal cortex (specifically, the orbitofrontal cortex (OFC) and anterior

cingulate cortex (ACC)) lead to excitation in the striatum. Through the so-called direct

pathway, striatal activation increases inhibitory GABA signals to the globus pallidus

interna (GPi) and the substantia nigra (SNr). This decreases the inhibitory GABA output

from the GPi and SNr to the thalamus, resulting in excitatory glutamatergic output from

the thalamus to the frontal cortex. This direct pathway is a positive-feedback loop. In an

indirect, external loop, the striatum inhibits the globus pallidus externa (GPe), which

decreases its inhibition of the subthalamic nucleus (STN). (p. 416)

The difference that occurs in someone that has OCD is that the variances in direct and indirect

pathways. The pathways cause for a differentiation in excitation and release of neurotransmitters

in the brain. In sum, researchers have found differences in brain structure and functioning as well

as the release and control of neurotransmitters amongst those with OCD and other cognitive

disorders than those without that diagnosis.

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As well as neurobiological factors, a patients surroundings and environment can also be

a cause of OCD. For most people suffering from OCD, they take action in the form of a

compulsion in order to combat something that their mind is finding harmful. From this

perspective, it seems natural to allow that compulsion to occur in order to protect oneself. This is

what a patient with OCD learns to believe. However, the threats and obsessions they are

experiencing are actually not harmful at all. Nevid, Rathus and Greene state (2014):

By washing their hands 40 or 50 times in a row each time they touch a public doorknob,

compulsive hand washers may experience some relief from the anxiety engendered by the

obsessive thought that germs or dirt still linger in the folds of skin. . . From a learning

perspective, we can view compulsive behaviors as operant responses that are negatively

reinforced by relief from anxiety triggered by obsessional thoughts. (pp. 188, 190).

When the anxiety is relieved, the sufferer learns what caused that relief and practices it

regularly.This can be related to Pavlovs theory of conditioning. In a study done in 2017,

researchers wanted to look at abnormalities in disgust conditioning. They studied how a group

characterized by having high contamination concerns responded to stimuli in comparison to a

control group having low contamination concerns. The group with the high contamination

concerns became conditioned to having a strong negative response to stimuli. The response

included OCD-like symptoms, disgust sensitivity and trait anxiety (Armstrong & Olatunji, 2017).

Overall, researchers have named this environmental influence the habit-driven hypothesis.

This proposes that OCD is a disorder of habit and that patients rely too heavily on stimulus

response habits even when they learn that the response is not beneficial to them. From a study

done, researchers have concluded . . . that this imbalance between the goal-directed (executive)

and the habit formation (automatic) systems underlies the compulsions seen in OCD patients
CAUSES OF OBSESSIVE-COMPULSIVE DISORDER 6

(Kalanthroff, Abramovitch, Steinman, Abramowitz & Simpson, 2016, p. 9). Finally, just having

too much of a perfectionist trait can cause OCD and its symptoms. People who hold

perfectionist beliefs exaggerate the consequences of turning in less-than-perfect work and may

feel compelled to redo their efforts until every detail is flawless (Nevid, Rathus & Greene,

2014, p. 190).

As with any psychological disorder, genetics can be traced as a cause. There is still a lot

of research going on now in finding what specific genes are linked to OCD. However, some

researchers have found that there is evidence showing that a genes role in toning down the

actions of the neurotransmitter, glutamate, plays a role in the acquisition of the disorder (Nevid,

Rathus & Greene, 2014). Also, in a study done in the Central Valley of Costa Rica, researchers

looked at families with multiple childhood-onset OCD-affected individuals to see if they could

find a specific correlation between genes and OCD. Their findings provide evidence that

chromosome 15q14 is linked to OCD in families from the Central Valley of Costa Rica, and

supports previous findings to suggest that this region may contain one or more OCD

susceptibility loci (Ross, Badner et al., 2011, p. 795). Since 1930, it has been consistently

reported that OCD is transmitted within families (that is, it is familial). Indeed, out of 18 studies

involving families of adult probands with OCD, only 2 concluded that OCD was not familial and

all 7 studies involving relatives of children or adolescents with OCD reported that OCD is

familial (Pauls, Abramovitch, Rauch & Geller, 2014, p. 411). Researchers have noted that

childhood onset (before 12 years of age) is when genetics play a key role in the onset of OCD.

Even when looking at monozygotic twins, studies show that sometimes it is important for

different environmental influences to occur to prevent the disorder, since OCD is so genetically

transferable. Specifically, additive genetic variance accounted for approximately 40% of the
CAUSES OF OBSESSIVE-COMPULSIVE DISORDER 7

phenotypic variance of obsessivecompulsive behaviours that was observed in this sample of

twins, and non-shared environmental factors accounted for 51% (Pauls, Abramovitch, Rauch &

Geller, 2014, p. 413).

Since there are different factors that influence the causal aspects of obsessive compulsive

disorder, treatment methods that recognize these causes must be used. A very common method

of treatment used is exposure with response prevention (ERP). In exposure with response

prevention, the therapist assists the client in breaking the obsessive-compulsive disorder cycle by

confronting stimuli, such as dirt, that evoke obsessive thoughts but without performing the

compulsive ritual (Nevid, Rathus & Greene, 2014, p. 190). Another common method of

treatment that is carried out with a therapist is cognitive behavior therapy. Cognitive behavior

therapy specifically aims to change abnormal ways of thinking in the patient. The therapist and

patient figure out the thoughts associated with their compulsions and change them. A different

kind of treatment is deep brain stimulation (DBS). This a form of therapy, typically used in

treating Parkinsons disease in addition to OCD, that aims to stimulate parts of the brain

associated with the disorder. Le jeune et al. found that DBS of the subthalamic nucleus, which

plays an integral role in the cortical-basal ganglia circuitry, reduces the symptoms of OCD

(Carlson, 2014, p. 413). Usually, it is typical for a patient with OCD to receive some sort of

therapy in addition to taking medication regularly. Three drugs that are commonly used to treat

the symptoms of OCD are clomipramine, fluoxetine and fluvoxamine. They are serotonergic

agonists, meaning that they activate serotonin receptor sites (Carlson, 2014, p. 413). Carlson

states (2014):

In general, serotonin has an inhibitory effect on species-typical behaviors, which has

tempted several investigators to speculate that these drugs alleviate the symptoms of
CAUSES OF OBSESSIVE-COMPULSIVE DISORDER 8

obsessive-compulsive disorder by reducing the strength of innate tendencies for counting,

checking, cleaning, and avoidance behaviors that may underlie this disorder. (p. 413)

Finally, a more extreme and uncommon treatment method for OCD is cingulotomy.

Cingulotomy is the surgical destruction of the cingulum bundle, which connects the prefrontal

cortex with the limbic system (Carlson, 2014, p. 412). These areas play a large role in OCD

which is why its removal may lessen OCD symptoms. Similarly, capsulotomy destroys a region

of a fiber bundle (the internal capsule) that connects the caudate nucleus with the medial

prefrontal cortex (Carlson, 2014, p. 412) which also has the same effect as cingulotomy.

Obsessive-compulsive disorder, like any other psychological disorder, plays out

differently in each of its victims. Different compulsions and obsessions are seen in all patients.

Even though, professionals primarily look at abnormalities in brain functioning and

neurobiological factors as the cause, they must not rule out environmental influences. These

outside factors are what will make the disorder different amongst each sufferer. Because of its

complexity, there are many treatment methods used for OCD. Overall, obsessive-compulsive

disorder is a very common and well-known disorder and therefore, researchers and the general

public should educate themselves so that strides can be made in successfully eliminating this

disorder.
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References

Ameis, S. H., Lerch, J. P., Taylor, M. J., Lee, W., Viviano, J. D., Pipitone, J., . . . Anagnostou, E.

(2016). A diffusion tensor imaging study in children with ADHD, autism spectrum

disorder, OCD, and matched controls: distinct and non-distinct white matter disruption

and dimensional brain-behavior relationships. American Journal of Psychiatry, 173(12),

1213-1222.

Armstrong, T., & Olatunji, B. O. (2017). Pavlovian disgust conditioning as a model for

contamination-based OCD: evidence from an analogue study. Behaviour Research and

Therapy, 93, 78-87.

Carlson, N. R. (2014). Foundations of behavioral neuroscience (9th ed.). Boston: Pearson.

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Hough, C. M., Luks, T. L., Lai, K., Vigil, O., Guillory, S., Nongpiur, A., Fekri, S. M.,

Kupferman, E., Mathalon, D. H., & Mathews, C. A. (2016). Comparison of brain

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OCD. Psychiatry Research: Neuroimaging, 255, 50-59.

Kalanthroff, E., Abramovitch, A., Steinman, S. A., Abramowitz, J. S., & Simpson, H. B. The

chicken or the egg: what drives OCD?. Journal of Obsessive-Compulsive and Related

Disorders, 11, 9-12.

Nevid, J. S., Rathus, S. A., & Greene, B. (2014). Abnormal psychology in a changing world.

Upper Saddle River, NJ: Pearson.

Obsessive-compulsive disorder (OCD). (2009). In A. S. Reber, R. Allen, & E. S. Reber, The

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Pauls, D. L., Abramovitch, A., Rauch, S. L., & Geller, D. A. (2014). Obsessive-compulsive

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Ross, J., Badner, J., Garrido, H., Sheppard, B., Chavira, D. A., Grados, M., . . . Mathews, C. A.

(2011). Genomewide linkage analysis in costa rican families implicates chromosome

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Doi:http://dx.doi.org.molloy.idm.oclc.org/10.1007/s00439-011-1033-6

Understanding Obsessive-Compulsive and Related Disorders. (n.d.). Retrieved April 25, 2017,

from http://ocd.stanford.edu/about/understanding.html