Culturally Speaking

Challenging assumptions about culture, race, and mental health.

Obsessive-Compulsive Disorder and the “Root of the Problem”

If I only knew what caused my OCD I could fix it — not!

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The elusive root of the problem
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What caused my OCD?

Obsessive-Compulsive Disorder (OCD) is often shrouded in mystery, as sufferers struggle to understand the cause of their disorder. Already prone to "over-thinking," many believe that if they can determine what caused their brain to go awry, they can figure out a way to fix it. People with OCD have been known to spend hours ruminating to find "the root of the problem."

Many will report their OCD was triggered by a particular life event. Common triggers I have heard from clients include traumatic events, cannabis use, and random interactions that planted a seed of doubt in the mind that would not go away.

It is true that the specific content of obsessions can be influenced by events that occur in a person's life, and this can be seen in cross-cultural studies of OCD. For example, OCD sufferers in Islamic cultures are more likely to have religious compulsions. However, Islam is not the reason the person contracted the illness, it is only the mask worn by a disorder that, like a chameleon, tries to blend into its surroundings.

Predisposed to obsess

Interestingly, people who have had more stressful life events before the onset of OCD are more likely to engage in checking and symmetry compulsions — perhaps as an attempt to impose a degree of order in a world filled with increasing unpredictability. However, despite the temptation to figure it all out, it is not possible to identify the exact cause of OCD in any particular person. OCD is not caused by religion, culture, or late toilet training. It is caused by a complex interaction of genetics, environment, personality, and stressors. There is no one psychological factor that causes OCD in a particular person, and likewise no single gene that can be identified and excised. Some people are born with a predisposition to OCD, and then a combination of life events light the fuse. In other cases, the onset was like a ticking time-bomb, destined to go off at the specified hour, regardless of the circumstances. Although most people can remember having some symptoms as a child, the average age of onset for OCD is around the age of 20 — potential evidence for a sinister genetic plan unfolding at an appointed time.

Cause does not lead to cure

Although negative life events, such as a psychological trauma, can be the catalyst for the onset of the disorder, psychological exploration of these events is not curative for OCD. These types of explorations are typical of treatment approaches, such as psychodynamic psychotherapy, that are focused on understanding a person's past and unconscious as a route to resolving emotional problems. The goals of these forms of therapy include uncovering hidden motivations and gaining insight, leading to their designation as "insight-oriented therapies."

Unfortunately, insight alone is not enough. People with OCD tend to be introspective and typically have already spent a great deal of time and effort ruminating about the origins of their disorder. In fact, this sort of rumination can be a mental compulsion, which will actually worsen the symptoms.

One problem is that too many therapists unwittingly participate in this counterproductive process. In my own practice, I have seen clients who previously spent years in therapy, as time and money were wasted trying to find the elusive root of the problem. And the irony is that even if a root were found, there is no evidence that an "ah ha!" moment would lead to resolution of the symptoms. Over a hundred years of research has shown us that psychodynamic approaches are just not enough for OCD. Unfortunately, even cognitive-behavioral therapists are sometimes sucked into the temptation to dig for the roots. A little digging might help the client feel he understands himself better, but it won't be enough to make the symptoms go away.

Root of the problem does not equal core fear

People with OCD should be encouraged to refocus their energies on combating the disorder through exposure and ritual prevention (EX/RP), a type of cognitive-behavioral therapy designed specifically for OCD. Digging for the "root" of the problem should not be confused with identifying the client's core fear, which in fact is essential in guiding the development of appropriate exposure exercises. There's no cure for OCD, but focused EX/RP is the best treatment science has to offer those plagued with distressing obsessions and repetitive compulsions.

Learn more: Read about the Top Mistakes Made by OCD Therapists

References:

Cromer, K. R., Schmidt, N. B., & Murphy, D. L. (2007). An investigation of traumatic life events and obsessive-compulsive disorder. Behaviour Research and Therapy, 45, 1683-1691.

Grisham, J. R., Anderson, T. M., & Sachdev, P. S. (2008). Genetic and environmental influences on obsessive-compulsive disorder. European Archives of Psychiatry and Clinical Neuroscience, 258, 107-116.

National Institute for Health and Clinical Effectiveness. (2006). Obsessive-compulsive disorder: Core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder. The British Psychological Society & The Royal College of Psychiatrists. www.nice.org.uk

Real, E., Labad, J., Alonso, P., Segalàs, C., Jiménez-Murcia, S., Bueno, B., ... & Menchón, J. M. (2011). Stressful life events at onset of obsessive-compulsive disorder are associated with a distinct clinical pattern. Depression and Anxiety, 28, 367-376.

 

Monnica Williams, Ph.D., is the Director of the Center for Mental Health Disparities in the Department of Psychological & Brain Sciences at the University of Louisville.

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