Obsessive Compulsive Disorder (OCD) is one of the most multifaceted disorders that exist within our world. It is the integration of thousands of years of evolution and natural selection, yet an exaggeration of once beneficial actions. Through an integration of evolutionary, developmental, biological and cognitive perspectives, one can gain a comprehensive understanding to the development of this disorder as well as a grasp on its manifestation. Without successful knowledge of all the factions that cause OCD, one cannot possibly treat it. The multidimensional approach is one that fully defines OCD, rather than limiting the definition to one aspect of psychology.
Obsessive compulsive disorder is characterized by both obsessions and compulsions that interfere with the functioning of 1% – 2% of the worldwide population, and is the fourth most common psychological disorder (Baxter, 2003). Despite the popular use in our vernacular, OCD is not simply any repetitive thought or behavior. Obsessions are persistent and intrusive images, thoughts or impulses that provoke resistance; compulsions are triggered by these intrusive thoughts and are repetitive, deliberate thoughts or behaviors that reduce personal anxiety (Doron & Kyrios, 2005). Those who suffer from OCD feel constantly as if something is wrong and must be corrected. This correction takes the form of compulsions that many with OCD know are useless, and are still compelled to perform these actions or thoughts (Baxter, 2005). They often experience a sense of increased responsibility for themselves and those around them, which often leads to anxiety and focus on intrusive thoughts (Barrett & Healy, 2003). However, the focus on intrusive thoughts increases their frequency and creates a vicious cycle of the obsessions and compulsions that define OCD, and sustains the disorder. Primarily, the compulsions consist of: washing, checking, needing to confess, counting, hoarding and requiring precision (Polimeni et al, 2005). Because OCD has a worldwide prevalence and afflicts the same amount of people regardless of location or culture, it suggests that the compulsions associated with OCD were somehow beneficial throughout evolution.
In a hunting and gathering society, the proto-human was almost constantly in danger. He faced predation and starvation nearly every day. Because he lived in tribes, the group he lived with was vital for his survival, and his contribution to the group must have been beneficial for the continuation of their existence. Worldwide prevalence rates suggest division of labor among ancient tribes and burdening only few with these tasks (that have become distorted compulsions). The compulsions that typify someone with OCD were beneficial to the survival of the ancient group. Through hoarding, one protected against scarcity; through excessive grooming and cleaning, one protected against infection and parasites; with constant checking and counting, one kept track of all the members in the small society; the compulsion to confess cemented his relationship and place in the group, while precision ensured order (Polimeni et al, 2005). Often those with OCD fear committing a social faux pas and have an over concern for harming others (and themselves), which would have compromised the proto-humans membership in the group and thus his own survival (Marks & Nesse, 1994). Many of the obsessive thoughts that those with OCD have are concerned with safety and security, which would have been an everyday issue with ancient civilizations.
The concept of safety and security was formed in the proto-human when he was an infant, and is still formed in that manner today. Attachment styles are formed between mother and infant due to her emotional responses and physical accessibility. As an infant, one forms either a secure, insecure, avoidant, or anxious ambivalent attachment to mother through her responses and these attachments have lasting effects. A secure attachment exists when the mother is emotionally responsive, loving, and available for her child; the child then forms a basis for security and safety, and feels comfortable asserting some independence. Unfortunately, those with OCD most often experience either insecure or anxious ambivalent attachments. Both of these attachment styles lack a feeling of safety and security in the world, and create a poor internal working model for the self and others (Doron & Kyrios, 2005). With this view that the world is a threatening place (perhaps a throwback from when it was constantly threatening), those with OCD are plagued with attempts to control and prevent harm. They experience a feeling of increased responsibility, as if they were the ones responsible for thwarting danger to themselves and others (Doron et al, 2006). This feeling of increased responsibility may not only be because of their attachment style, but perhaps because of the division of labor among ancient tribes and an underlying biological evolution.
Darwinian Theory promotes the idea that traits exist due to natural selection and evolution. Although humanity often attempts to separate themselves from animals, we are no exception to the rule. Our brain exists in the manner it does due to this natural selection. Those with OCD have fundamental differences in brain functioning than those who do not. They experience dysfunction within the Basal Ganglion system, prefrontal cortex, and limbic system (Claridge & Davis, 2003). This dysfunction is critical in the behaviors that characterize OCD, with increased activity in the prefrontal cortex and anterior cingulated gyrus (Kim & Gorman, 2005). Increased activity in these areas leads to emotional discomfort, and are responsible for regulating repetition and extinction of behaviors (Kim & Gorman, 2005). When the symptoms of OCD are provoked, activation of the orbital frontal cortex, the caudate nucleus, and the ventromedial thalamus occurs (Baxter, 2003). Circuitry between the Basal Ganglia and the Prefrontal cortex may be compromised somehow, and are responsible for initiating and suppressing basic behaviors (such as responses to stimuli regarding sex, hygiene, and violence) (Claridge & Davis, 2003). Perhaps the evolutionary benefits to quick and basic responses has shaped these brains in such a manner that the circuitry suppressing them is compromised. Baxter (2003) has attributed this to mis-released territorial maintenance and fragments of defense motor routines (such as ordering, counting, washing, checking for danger, etc.). Although the behaviors are elicited by the Basal Ganglion system, the feeling of fear and anxiety is mainly caused by the amygdala and limbic system (Kim & Gorman, 2005). With natural selection these brain regions have been shaped to promote territorial behaviors, but with the development of the prefrontal cortex and logic they malfunction in those with OCD and create cognitive difficulties.
Through evolution, attachment styles, and biology, those with OCD have cognitive difficulties with self precept and dysfunctional beliefs. Behaviors meant to decrease or avoid anxiety are ineffective, and are brought about by beliefs such as inflated personal responsibility, overestimation of threat, and the need to control one’s thoughts (Doron et al, 2006). The negative or dooming interpretation of intrusive thoughts leads to compulsions and dysfunctional behaviors. Sensing an inflated responsibility, those with OCD feel as if they are the sole bearers of protection and safety. If anything goes wrong, they often feel that it is their fault. To make matters worse, a negative view of the world and the self (perhaps caused by insecure or anxious ambivalent attachment styles) only serves to exacerbate symptoms. Rachman’s theory of thought action fusion (TAF) (as cited in Barrett et al, 2003) helps explain the obsession with morality and responsibility that those with OCD frequently experience. The TAF theorizes that those with OCD experience thoughts and actions that are harmful as if they, themselves were causing the harm (Barrett et al, 2003). They believe that because a thought occurs, the chances of that happening have increased substantially and they are the ones responsible for the catastrophic outcome. Thinking in such a way leads to avoidance or escapism through the maladaptive behaviors that classify OCD.
Despite the compulsions having once been perhaps beneficial for the tribe, the attachment styles that created them, the biological component that triggers them, and the cognitive precepts that sustain them, compulsions remain detrimental and crippling for individuals with OCD. Through a further understanding of its etiology and history, one can help treat the disorder through medications to aid neurotransmitters, family therapy to help recover attachment, and cognitive therapy to reset precepts. Fully understanding the causes and effects of OCD through its multidimensionality, there is hope for those who live daily with obsessions and compulsions.
References
Barrett, Paula M., & Healy, Lara J. (2003) An examination of cognitive processes involved in childhood obsessive compulsive disorder. Behavior Research and Therapy, 41, 285-299.
Baxter Jr, L. R. (2003) Basal ganglia systems in ritualistic social displays: Reptiles and humans; Function and illness. Psychology and Behavior, 79, 451-460.
Claridge, G. & Davis C. (2003) Personality and psychological disorders. London: Arnold Publishing. 113-130.
Doron, G. & Kyrios, M. (2005) Obsessive compulsive disorder: A review of possible specific internal representations within a broader cognitive theory. Clinical Psychology Review, 25, 415-432.
Doron, G.; Kyrios, M.; & Moulding, R. (2006) Sensitive domains of self concept in obsessive compulsive disorder (OCD): Further evidence for a multidimensionality model of OCD. Journal of Anxiety Disorders. (Article in press).
Kim, J. & Gorman, J. (2005) The psychobiology of anxiety. Clinical Neuroscience Research, 4, 335-347.
Marks, Isaac M. & Nesse, Randolph M. (1994) Fear and fitness: An evolutionary analysis of anxiety. Ethology and Sociobiology, 15, 247-261.
Polimeni, Joseph; Reiss, Jeffrey; & Sareen, Jitender. (2005) Could obsessive compulsive disorder have originated as group selected adaptive trait in traditional societies? Medical Hypotheses, 65, 655-664.
