Recent research suggests that the cause of OCD from a from a psychological perspective can be summed up in four steps.

  • Step # 1
  • Step #2
  • Step #3
  • Step #4

A normal anxiety-producing thought enters conscious awareness. It can’t be overemphasized that the thoughts that become tormenting in obsessive-compulsive disorder are not, in themselves, pathological or indicative of mental disorder. Rather, they are a normal part of human experience. Stanley Rachman of the University of British Colum bia, considered by many the world’s leading expert on this disorder, first clarified the commonplace nature of obsessions. In a landmark paper published in 1978. Rachman asked 124 students, hospital workers, and nurses: “Do you ever get thoughts or impulses that are intrusive and unacceptable?” Fully 80 percent answered yes, they had such thoughts at least once a week. Dr. Rachman and his coworkers then transcribed these “unacceptable thoughts” and placed them alongside the obsessions of OCD patients. The experts could not tell the difference between the unacceptable thoughts of average people and the obsessions of individuals afflicted with the disorder. The plain fact is this: most people routinely experience thoughts that are exactly the same in content as clinical obsessions.

This fact has now been verified by over a dozen studies. For instance, a 1992 study details the percentages of all people who report various types of unacceptable thoughts. Here are a few of them: 55 percent of adults have impulses to crash their cars; 42 percent have urges to jump from high places; 25 percent experience thoughts that their phones are contaminated; 13 percent have images of exposing themselves in public; and a full 13 percent have thoughts to fatally stab loved ones. The only difference between these people and the sufferers of obsessive-compulsive disorder is that the latter experience obsessions more often and feel them more strongly.

The anxiety-producing thought is evaluated abnormally. Here is where the problems begin for OCD sufferers.  In the 1960s and 1970s researchers at the University of Pennsylvania, led by psychiatrist Aaron Beck, demonstrated that we all possess an automatic, almost instantaneous, evaluative process that lies outside our conscious awareness. Its function is to assign different levels of importance, or attentional value, to the ideas, images, and urges that come into our minds. In the 1980s, cognitive psychologists applied Beck’s findings to the development of obsessions. They discovered that the critical moment in the development of obsessive-compulsive disorder occurs when a person assigns a fearful thought a special importance. As Rachman puts it, “The majority of people dismiss or ignore their unwanted thoughts and regard them as dross. However, once a person attaches important meaning to these unwanted thoughts, they tend to become distressing and adhesive.”

The average person, struck by an unwanted idea, image, or urge, says to herself something like, “What a dumb thought!” Then she shakes her head and turns her mind to another subject, and the thought disappears. If that person has obsessive-compulsive disorder, however, the thought stays in her mind. What happens is that the intrusive thought provokes a kind of false alarm (“Something is wrong, and I must do something about it!”). Instead of being dismissed from consciousness as it should, it is given an inappropriate significance that propels it into the spotlight of attention.

The sufferer fights to get the thought out of mind. Recognizing the irrationality or inappropriateness of the thought that has taken over her awareness, the OCD sufferer naturally attempts to push it out of her mind. The mind, however, does not work like a computer, where a string of words can simply be backspaced or deleted. Rather, it is as if the mind says, “Because you have worked so hard to get rid of this thought, it must be very important. Therefore, I will make sure to bring it back to consciousness again!”

The frustrating outcome of “thought suppression” was first demonstrated experimentally by psychologist Daniel Wegner in 1987 at Trinity University in San Antonio, Texas. In a famous investigation, Wegner divided his subjects into two groups. One group was told a short story about white bears, while the other was told not to think about such animals. As you might guess, the group told not to think about white bears had bear-thoughts throughout the day, while the other group rapidly forgot about them. The conclusion: Trying not to think a thought only makes it come back stronger. OCD sufferers unwittingly turn normal unwanted thoughts into agonizing obsessions by resisting them and trying to force them out of conscious awareness.

The sufferer performs specific acts over and over in order to allay the anxiety caused by obsessions. A large number of research studies have demonstrated that although such acts, compulsions, do provide short-term relief, in the long run they only make obsessions stronger. OCD sufferers realize that their compulsive acts are self-defeating, yet they can’t stop themselves from repeating them.

Research by leading OCD expert Judith Rapoport and her team at the National Institutes of Health has shed light on this issue. In a lecture titled “Hand-Washing People and Paw-Licking Dogs,” Rapoport first suggested that the stereotypy of compulsions is explained by their close relationship to “fixed action patterns,” certain habits of behavior that are hardwired into the brains of all animals. Cats lick their faces and paws in just the same manner many times a day. Male fiddler crabs perform elaborate movements, invariable in form and timing, with one of their two claws before mating. These and a myriad of other examples represent rituals of behavior performed quickly and automatically, having value for evolutionary survival.

These same fixed action patterns, however, are sometimes set off when they shouldn’t be, especially in stressful situations. For instance, dogs under stress may start compulsively licking their paws, a sometimes injurious response that can lead to painful sores. In the case of humans, Rapoport and others have speculated that compulsive acts represent our own inappropriately discharged fixed action patterns.