When you think about obsessive-compulsive disorder, or OCD, does being a \u201cneat freak\u201d or \u201cgermaphobe\u201d come to mind?<\/p>\n
In fact, OCD is not a personality quirk. It\u2019s a distressing and disabling psychiatric condition that affects around one in 50<\/a> of us.<\/p>\n Read more: But up to half of those<\/a> with OCD who receive the best psychological treatments don\u2019t significantly benefit from them. This is likely because our understanding of OCD is incomplete.<\/p>\n It\u2019s unclear what causes the disorder<\/a>, and is likely a combination of genes, biology, and environment, including traumatic or stressful experiences.<\/p>\n In a recent study<\/a>, we interviewed 16 adults with OCD. Our findings point to the role early experiences of rejection and trauma can play, for some people, in developing the disorder. <\/p>\n What is OCD, really?<\/p>\n OCD is characterised by obsessions, compulsions, or both.<\/p>\n Obsessions are recurring, unwanted and intrusive thoughts, images or urges. They commonly centre on contamination, harm, symmetry, or repugnant themes such as unwanted sexual or violent thoughts. <\/p>\n Compulsions are repetitive behaviours (such as checking and re-checking the car is locked, or arranging objects so they\u2019re \u201cjust right\u201d) or mental acts (such as repeating certain numbers in your head). People perform these to directly address the feared consequences of the obsession and to ease distress.<\/p>\n For example, someone with OCD might believe<\/a> someone they love will die or be injured if they don\u2019t pray in a certain way or if they step on footpath cracks.<\/p>\n The disorder typically begins around age 20<\/a> and, without treatment, tends to be lifelong.<\/p>\n What\u2019s behind intrusive thoughts?<\/p>\n Psychological theories<\/a> have traditionally suggested that everyone has random, intrusive thoughts. What makes them obsessions is their frequency, the distress they cause, and how much they interfere in daily life.<\/p>\n But a more recent theory<\/a> suggests intrusive thoughts and obsessions in OCD are not always random. For some people, they stem from core beliefs about who they are or dread becoming \u2013 their \u201cfeared self\u201d.<\/p>\n If someone believes, \u201cI am a dangerous person\u201d or \u201cI might be immoral,\u201d for example, intrusive violent thoughts can feel like evidence of this feared self. Compulsions can become desperate attempts to disprove it, by controlling the thoughts.<\/p>\n The feared self model is not the only account for what causes and maintains OCD symptoms. But there is evidence<\/a> to suggest people who view themselves in this way are more likely to experience OCD symptoms.<\/p>\n What we did<\/p>\n We wanted to explore the feared self theory in people with OCD.<\/p>\n We interviewed 16 Australian adults, mostly women, with a current, formally confirmed diagnosis of OCD. They had a range of symptoms (moderate to extreme) and the full spectrum of obsessions (contamination, harm, symmetry and repugnant thoughts).<\/p>\n We asked them about their sense of self and the life experiences they felt had shaped it. Two major themes emerged.<\/p>\n 1. Most had experienced childhood trauma<\/p>\n These experiences often happened within the family, and included sexual, physical or emotional abuse, harassment or bullying, and parental neglect.<\/p>\n Many feared they could become a bad person \u2013 capable of the very harm done to them. One man described how, after his parents\u2019 divorce, his father: <\/p>\n became very verbally abusive towards me [\u2026] just became a really angry person [..] I\u2019m just so scared that [\u2026] I\u2019ll do something like my dad.<\/p>\n Another participant, whose father was \u201cquite violent and an alcoholic\u201d, told us: <\/p>\n I\u2019d never wanted to drink on my own because I worry that I\u2019d just become dependent.<\/p>\n Harassment and bullying planted similar seeds of doubt. As one participant put it:<\/p>\n I guess it makes you question, what you\u2019re capable of, what you\u2019re not capable of.<\/p>\n Parental neglect also fed the fear of being negligent or irresponsible. One participant remembered checking the house as a child because their parents wouldn\u2019t: <\/p>\n I would sort of go downstairs to make sure that everything had been locked, like the stove was off [\u2026] I\u2019d do that so I could feel more safe.<\/p>\n For many participants, taking on responsibilities well beyond their years in childhood became the template for their obsessions and compulsions as adults.<\/p>\n 2. Rejection can be formative<\/p>\n The second theme was rejection \u2013 feeling dismissed, betrayed, or not good enough.<\/p>\n This could mean a sense of failing to live up to parental expectations \u2013 for example, about getting high marks at school \u2013 no matter what they did. Emotional coldness from parents also played a role.<\/p>\n One participant described a mother who was<\/p>\n very up and down [\u2026] you never knew when she was going to be nice to you [\u2026] she would say things that indicated that I was a bad person [\u2026] bring up tiny mistakes.<\/p>\n Early experiences of rejection could lead to an unstable and vulnerable sense of self, becoming the fertile ground for a feared self to take root.<\/p>\n What this means<\/p>\n Our findings strengthen the theory that, for some people, OCD is rooted in a \u201cfeared self\u201d developed through experiences of trauma and rejection.<\/p>\n Understanding this may lead to better OCD treatments that target deeply held beliefs. For example, imagery rescripting<\/a> is an established technique used to help people revisit and \u201crewrite\u201d the meaning attached to negative memories, which could be effective for challenging \u201cfeared self\u201d beliefs in OCD.<\/p>\n More broadly, a trauma-informed approach may help clinicians and clients understand that terrifying \u201cwhat if I\u2019m dangerous?\u201d thoughts often say more about a person\u2019s past wounds than their present character. And if these experiences are risk factors, identifying them early could inform prevention.<\/p>\n
\n Obsessive compulsive disorder is more common than you think. But it can take 9 years for an OCD diagnosis<\/a><\/p>\n