Unraveling the Mind:

Exploring the Root Cause of OCD

1. Biological Factors

Imaging studies, for instance, MRI and PET studies, have shown that people with OCD tend to have abnormal functioning in certain areas within the brain.  The orbitofrontal cortex—which is involved in self-regulating and decision making—is almost always seen as demonstrating “excess overactivity” in individuals with OCD and may be part of an area that accounts for the intrusive thoughts typically seen in OCD. There is also overactivity in the anterior cingulate cortex, an area that is involved in error detection, and gives a sense to the individual that things are not “just right”—even when they certainly are!  Thus, the overactivity in the basal ganglia could explain the compulsions seen in OCD, as this area is very closely involved in motor control and habit formation.  

All of these areas are part of a brain circuit that mediates the response to anxiety and/ or stress.  The overactivity and dysfunction seen in these areas, along with how the areas communicate, likely lead to the cycle of obsessions and compulsions.

2. Neurotransmitter Imbalances

The serotonin hypothesis has long been central to understanding OCD. Serotonin is a neurotransmitter involved with an array of functions including mood regulation, impulse control, and the management of anxiety. In people with OCD, the serotonin system is thought to work abnormally. While research is still emerging, there is evidence that an interruption in the transmission of serotonin in the brain may result in obsessive and compulsive symptoms. Treatment evidence to support the serotonin system’s role in OCD include the efficacy of the selective serotonin reuptake inhibitors (SSRIs) that are most often prescribed to treat OCD by increasing amounts of serotonin available in the brain. 

Furthermore, that some patients also respond to medications that work on dopamine suggests that multiple neuromodulator systems are implicated in the development of OCD symptoms. These medications show that chemical irregularities in the brain are likely a large part of the roots of OCD.

3. Genetic Factors

Genetic studies strongly indicate that OCD has a genetic aspect. Family studies show that first-degree relatives (parents, siblings, and children) of people with OCD are at a higher odds of developing the disorder than the general population. In addition, twin studies show greater concordance for OCD in identical twins than fraternal twins, indicating a genetic influence. 

Candidate gene studies and genome-wide studies have shown several candidate genes that may increase the risk of developing OCD such as SLC6A4 (the serotonin transporter gene), DRD4 (the dopamine receptor gene), and GRIN2B (a candidate gene associated with glutamate signaling). Nevertheless a single gene has not been identified as the only component of OCD; instead polygenic inheritance is probably the mechanism. Polygenic inheritance means that multiple genes interact with each other and the environment to produce the disorder.

4. Psychological Factors

Some cognitive styles seem to affect a person’s risk for OCD. For example, perfectionism describes when an individual has an excessive need for things to be perfect, which can lead to obsessive behavior. Likewise, a heightened sense of responsibility—believing that they are solely responsible for preventing danger—can promote anxiety and compulsive activity. Over-estimation of threat describes the belief that situations that are, actually, not dangerous pose a threat. These maladaptive cognitive patterns set the stage for obsessions and compulsions to flourish. Thus, OCD therapy in New York generally includes Cognitive Behavioral Therapy (CBT) to facilitate examining and restructuring these cognitive distortions.

5. Environmental Factors

Environmental factors often play a vital role in initiating or exacerbating symptoms. Trauma-related events (e.g., abuse or neglect) that occur during childhood can be a risk factor for OCD later in adulthood. Stressful events happen during our lives, e.g. losing a loved one, a divorce or job loss, can accentuate any underlying vulnerabilities. Furthermore, research has shown a connection between certain infections, particularly streptococcal infections, and the rapid behavior change associated with OCD in children (called PANDAS, or Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections). In This world, we do not know when stress or trauma will strike, but when it does, it can amplify the biological and genetic risks.