Explaining OCD: A Cognitive Approachby Jerry Kennard, Ph.D. Medical Reviewer
In a previous Sharepost I wrote about the ways in which obsessions and compulsions relate. In this post I'm focusing on one of the leading models to help explain why some people develop OCD while others don't.
Over the past couple of decades a huge amount of research has been undertaken into why people with OCD interpret their thoughts differently. Over time these cognitive approaches have revealed a number of characteristic differences in people with OCD.
Outcomes and Responsibilities
A common feature of people with OCD is an inflated sense of responsibilities over outcomes. Essentially, this involves a distorted pattern of thinking which hinges around a belief that to omit something is likely to lead to some harm to others or themselves. It is this perception that leads to various attempts at neutralizing obsessive thinking by conducting compulsive rituals. One of the features of rituals is what is termed 'magical thinking' (e.g. '13 is an evil number. When I see the number 13 I must neutralize it. To do this I must count backwards from 13 for a total of 13 times).
The misinterpretations that come about from a sense of responsibility leads to a situation where the person feels they need greater control over their thoughts. However, in their attempts to suppress intrusive thoughts a rebound effect quickly follows in which the frequency of thoughts actually increases. The more the person attempts to suppress thoughts the more they become preoccupied with anything they feel has relevance to the obsession.
This rather catchy term describes a feature of thinking in OCD where the edges between thought and action become blurred. For example, if you think about setting fire to a church then you will set fire to a church. Strictly speaking, thought-action fusion is the belief that the thought is as bad as the action.
According to cognitive theorists these various processes feed into reinforcing obsessive compulsive disorder. First, it is argued that the person with OCD has what is known as an attentional bias towards certain stimuli. These biases means the person actively seeks out obsessive-relevant issues and they have a belief that certain forms of magical thinking may prevent certain outcomes. Heightened sensitivity often relates to changes in mood (anxiety or depression for example). Once obsessive thinking takes hold the person attempts to suppress them, which in turn makes things worse. The ritual, which is intended to neutralize the problem and in so doing reduce the related anxiety, actually reinforces the importance of the event.
The cognitive model provides an interesting and useful explanation as to the processes involved in OCD. Where it currently falls short is explaining the mechanism by which some people develop OCD and others do not.
Salkovskis, P.M., & Kirk, J. (1989). Obsessional disorders. In K. Hawton, P.M. Salkovski, J. Kirk, and D. M. Clark (Eds.), Cognitive Behaviour Therapy for Psychiatric Problems: A Practical Guide. Oxford: Oxford University Press.