What Causes OCD ?

The exact causes of OCD are still ambiguous. Researchers are trying to piece together the puzzle.

i. Does it run in families?

Inherited tendencies include subtle variations in brain structure, neurochemistry and circuitry. OCD is speculated to be, at least in part, a genetically inherited disorder. There is no solid proof to suggest, though, that OCD is genetically transmitted or by what mechanism. However, many researchers have held the opinion that is genetically inherited. It might as well be inherited because the child follows the parents, and learns the compulsions as the normal way to do since birth from one of the parents. Nonetheless, there is nothing conclusive to prove whether or not OCD is transmitted genetically (Davis, 2008).

ii. Neurological Factors

The most widely held biological theory of OCD is that it is related to abnormal functioning of one of the brain’s vital chemical messengers: serotonin. Serotonin is in the class of chemicals known as neurotransmitters, compounds that nerve cells use to communicate with one another. Serotonin plays a role in many biological processes including sleep, appetite, body temperature, pain, mood, aggression, and impulse control. Many recent studies also indicate that the brain chemical glutamate plays a role in OCD (Lafluer et al. 2005). Brain imaging studies have demonstrated abnormalities in several parts of the brain in people with OCD. These include the thalamus, caudate nucleus, orbital cortex, and cingulate gyrus. The thalamus processes sensory messages coming to the brain from the rest of the body and the caudate nucleus controls filtering of thoughts, the orbital cortex is the part of the brain where thoughts and emotions combine and the cingulate gyrus helps in shifting attention from one thought or behaviour to another.

If you find it difficult to empathize with OCD patients then realize that it might be that the thalamus of OCD patients sends messages from other parts of the body, making them hyperaware of everything going on around you. And their caudate nucleus opens the gate and lets in unwanted intrusive thoughts. Their Orbital Cortex gives them the feeling that something is wrong. And the cingulate gyrus tells them to perform your compulsions to relieve anxiety the rest of the brain has heaped on you.

iii. Other Physiological Factors

Some autoimmune diseases like rheumatic fever, pediatric streptoccal infections, lupus, and Sydenham’s chorea, also may be related to some instances of OCD. In addition, some studies have shown an association between OCD and head trauma, brain tumors, epilepsy, hypothalamic lesions. However, in most cases OCD does not have such dramatic causes (Jenike 1998).

iv. Environmental Factors

Environmental factors include psychological and physical trauma, childhood neglect, abuse, family stress, illness, death, and divorce, plus major life transitions, such as adolescence etc.

v. The Extra dimensional Factors

This extra-dimensional explanation resolves a contradiction in the details of OCD as understood by main stream psychologists. On one hand they say that “The individual senses that the content of obsessions is alien, not within his/her own control and not the kind of thought that he/she would ever expect to have.” (American Psychiatric Association, 2000:457) On the other side they also say that “the individual is able to recognize these obsessions as the product of his/her own mind” (American Psychiatric Association, 2000:457). The question arises “how can a person be able to create thoughts that he/she does not even expect to be his/her thought?”

From an extra dimensional point of you, it is the Satan/devil that confuses you. The strategy of Satan is that it looks for opportunities when you have anger, fear or anxiety and then it capitalizes on them by exaggeration. These recurring, intrusive thoughts are referred to as Was-was-ah in the Islamic literature. The very etymology of the word Was-was-ah shows the recurring, intrusive nature of these thoughts. The characteristics of Obsessions laid down by the psychologists are precisely what the Islamic Sources tell us about intrusive thoughts from Satan. And, as the enemy is invisible we are unable to recognize that these are not our thoughts. Furthermore, the enemy merely needs to plant the doubt, and then humans nurture it on their own, remember that OCD feeds on itself.

Various religions and cultures recognize the existence of devil as an extra-dimensional personification of evil. And, it has been observed that even the toughest forms of OCD are overcome when one takes OCD as an enemy (See the Book: Life in Rewind). So, from a practical point of view it is important to recognize the alien nature of these obsessive thoughts; it is important to re-attribute and revalue.

vi. The Bio Cultural History

In 1973 a researcher wrote about OCD with confidence that it is ‘unquestionably one of the rarest forms of mental disorders’ (Davis, 2008:209). And, now after just a few decades we are living in times when OCD is considered the fourth most common mental disorder (National Institute for Health and Clinical Excellence, 2006). World Health Organization’s 2001 mental health report mentions Obsessive Compulsive Disorder as one of the top 10 causes of disability in the world (Davis, 2008:210). Davis (2008) questions this sudden rise in OCD, and attributes it to the way perception has been modified by mass-media campaigns etc. He argues that we are living in an age of ‘obsessional panic’.

We protect our computers against viruses, squirt sanitizers on our hands after riding the subway or shaking hands with someone who seems to be coming down with a cold, use latex to filter out the unwanted germs, wipe down the gym equipment with handy antibacterial wipes provided by the facility, and so on and so on. (Davis, 2008: 242)

Hence, OCD has a socio-cultural history. We are fed with obsession since we grow up. I stumbled upon a television ad today regarding hand sanitizers which started with ‘it takes time to learn few things like washing your hands’. If we are made to believe that washing our hands is a skill that requires training and ‘equipment’ no wonder we end up with the ‘ The boy who couldn’t stop washing’, that is the title of the book published in 1991 and considered as an eye opener on OCD.

Imagine yourself as an individual with this rare disease of OCD in the 1970s. You would have considered yourself to be alone and odd and you would have questioned your own sanity. And now we are living in times, when OCD is certainly something which attracts a lot of interest and research. It is certainly recognized as a mental disorder, and it does help the sufferer in realizing that ‘he is not crazy’. However, all this ‘authentic’ research should not stop us from questioning as to why we have reached a stage where a non- contagious disease like OCD is multiplying several folds everywhere. The researchers are still trying to analyse how brain is affected by OCD, or how OCD is affected by brain, but there is nothing concrete still. And even if we do discover the part of the brain where OCD resides its significance would be rather limited without the understanding of the biography of the disease.

It is worth pointing out that the definition of OCD and OCPD (obsessive compulsive personality disorder) has kept on changing over the years. The definitions have been amended from DSM I to DSM IV. And still, ‘no matter how tightly rigorously we define OCD in contemporary psychiatry, there is still conceptual over-lap with various ‘diagnostic near-neighbours’ (Davis, 2008:211). Hence, I have abstained from going into the depth of the thin-line differences between OCD and OCPD and other neighbouring disorders, because they might share the same biography and the same treatment.

Hence, we cannot understand diseases like OCD without a thoroughgoing knowledge of social, cultural, historical, anthropological, and political view of that ‘disease entity’ ( a term coined by Davis, 2008). The history of disease itself contains a therapeutic narrative. What is in essence a biocultural knowing of diseases can empower patients as well as physicians to rethink the way that disease is enforced and distributed through cultures and represented in popular and professional imaginations. In bioculutral case, the disease isn’t controlled through cure and eradication, although those goals are always worthy ones, but through a systematic rethinking of the way disease is structured and positioned in our society (Davis, 2008).

If knowledge is power, then the knowledge of disease amounts to a kind of power over that disease. Particularly in the cases of mental disorders, the way we think about the disease entity has a lot to do with how the sufferer regards his or her condition. Hence, the sufferer of OCD needs to be empowered as to how our view of obsession has been altered over the years, which is essential for cognitive restructuring i.e. perhaps the most important element of cognitive behavioural therapy.

Tracing the Socio-Cultural history of scrupulosity is even more essential. Religion has existed as long as humanity has. The ‘quantitative’ view of religion, one of the causes of scrupulosity has to be traced and eliminated through logical and scriptural reasoning. The case of the Children of Israel in Bible where they were forced to follow ‘impossible commandments regarding purity’ has a lesson for all those who suffer from scrupulosity. Children of Israel demanded ‘detailed and comprehensive’ rulings for everything, and were obsessed with ‘minute details’ and hence they were forced into these impossible rulings as an admonition and as a warning for those to come. Nevertheless, the same did happen with Christianity and with the Muslims. Prophet Muhammad had prophesized that Muslims will make same mistake like the children of Israel. The prophecy came true and in the name of ‘explanation and exegeses’, the religious practices and rituals were made to look like mathematical equations. Books with ‘detailed rulings’ of prayers were published and preached with pride, which took away the very spirit of worship away and made religion look like a mystery and, hence, resulted in the epidemic of preoccupation and obsession with fear of minute errors in religious rituals. On the other hands the flood of movies, books that preach atheism in blunt or covert fashion triggered the ‘doubts’ that resulted in the feelings and thoughts that OCD sufferers cannot even pronounce. Far away, from the time when the religious was brought to humanity as a source of inner peace, we are living in times when religion is presented either as a myth or a mystery, and both of them trigger OCD.

Hence, OCD certainly has its socio-cultural or ‘religious’ roots that need to be traced and eliminated. When OCD became common it was echoed as a ‘hidden epidemic’ that suddenly came to surface. However, with the right analysis of socio-cultural or religious factors that resulted in the mental disorder would make it clear that OCD was more of a ‘triggered epidemic’ rather than a ‘hidden epidemic’.

This is an extract from an article “Journey into an OCD mind”. The full article can be found here

References:

• American Psychiatric Association (2000), Diagnostic and Statistical Manual of Mental Disorders, 4th edition, American Psychiatric Association, Washington DC.
• Ciarrocchi, J. (1998), Religion, scrupulosity, and obsessive-compulsive disorder, Obsessive Compulsive Disorders: Practical Management, 3rd edition.
• Davis, L. (2008), Obsession – A History, The University of Chicago Press, London.
• Greenberg, D. (1984), Are religious compulsions religious or compulsive? A phenomenological study, American Journal of Psychotherapy, 38 (4) pp. 524-532.
• Hyman, B. and Pedrick, C. (2010), The OCD Workbook, Third Edition: Your Guide to breaking free from Obsessive Compulsive Disorder, New Harbinger Publications, Oakland.
• Jenike, M. (1998), Theories of etiology, Obsessive Compulsive Disorders: Practical Management, 3rd edition.
• Lafluer, D.L. et al. (2005), N-acetylcysteina augmentation in serotonin reuptake inhibitor refractory obsessive-compulsive disorder, Psychopharmacology, 184(2):254-256.
• Rasmussen, S. and Eisen, J. (1998) The epidemiology and clinical features of obsessive compulsive disorder, Obsessive Compulsive Disorders: Practical Management (eds M. Jenike, L. Baer & W. Miniciello), pp. 12 -43. St Louis, MO: Mosby.
• National Institute for Health and Clinical Excellence (2006) Obsessive compulsive disorder: Core interventions in the treatment of obsessive compulsive disorder and body dysmorphic disorder, British Psychological Society and The Royal College of Psychiatrist.< Available at: http://www.nice.org.uk/nicemedia/pdf/cg031fullguideline.pdf > [Last Accessed: 13th June, 2012]

Bibliography:

• The Noble Qur’an
• The Bible
• Sahih al-Bukhari
• Murphy, T., Zine, E. and Jenike, M. (2009) Life in Rewind, Harper Collins Publishers, London.