Is OCD the Product of a “Faulty System” or Does it Happen by Default when I’m Reticent to Make a Difficult Decision?

[deValentin]

People with OCD appear to be in contradiction with themselves. On the one hand, they feel compelled to engage in compulsions. It’s extremely difficult to resist them and they’re not even sure they want to. Irrational thoughts won’t leave them alone, and giving in to compulsions provides them with temporary relief. On the other hand, they lose the ability to focus on the other domains of their life, which makes them neglect what they hold dear, and they suffer guilt because of it. The question is, what makes the OCD side win over the more genuine side?

A possible answer is that there is a false alarm in the brain of people with OCD. The alarm may go off at a lower threshold than for OCD-free people. Neurosciences and brain imaging are currently studying that line of research. Personally, I doubt that hypothesis because with CBT alone I was able to overcome OCD.

Another possible answer is that the OCD side wins when there is a lack of purposeful intention. It doesn’t mean that with willpower alone (or for that matter reasoning alone) OCD can be overcome. It’s rather a matter of deciding when to let the passing of time appease one’s mind and when to reach a conclusion in spite of the difficulties. Sometimes in a world full of uncertainties some tough choices have to be made. For instance, maybe if I seek more certainties, if I keep pondering, if I eliminate all risks or all disorder, etc., I may find the peace of mind I’m looking for, maybe not. So, at one point in time I need to stop seeking more certainties, tormenting myself about an issue, checking, etc., so the other domains of my life won’t be neglected and I’ll be able to live a balanced life. It’s not easy because there is no absolute guarantee it’s the right decision, but, if I don’t make it, my self-esteem will be degraded and my only hope to return to normal will be to make my obsessional search succeed. So, I won’t be able to stop it and at the same time I won’t be able to make it succeed because if good reasons are not enough now for me to decide, nothing will be enough. Once the difficult decision is made, it’s normal for discomfort to linger because it's not a perfect decision, but if it’s the best decision possible given the information available at the time, the lingering of discomfort will end at one point.

I’ll be glad to get feedback on that explanation. In my case, that way to look at OCD helped me navigate through it and not be a slave of it anymore. I’m comparing my situation to that of a person with an alcohol use disorder. The longer I’m sober/OCD-free, the more motivated I’m to stay on the same path. As long as I don’t start to drink /to obsess senselessly, I don’t feel the need to try to end all my troubles by any means, including drinking/obsessing some more.

[Natureloverpeace]

People with OCD attach meaning to some intrusive thoughts but they are able to treat other intrusive thoughts as junk mail. We tend to attach meaning to the intrusive thoughts that are related to things we highly value. We focus on the “what ifs” and blow those way, way out of proportion. We keep chasing certainty that will never come. It’s a wild goose chase until we learn to accept uncertainty and trust ourselves to be handle unpredictable things when they occur.

OCD is an illness of the brain AND the mind. It is caused by a dysregulation of brain circuits and dysregulated patterns of thought and feeling according to current research. Cognitive inflexibility, perfectionism and distress intolerance tend to run high in people with OCD. Neuroscientists believe that the brain affects the mind and that the mind can affect the brain. Things such as learning, thoughts and focus can change the brain as shown on brain imaging scans.

[deValentin in reply to Natureloverpeace]

I fully concur with what you said in the first paragraph. People with OCD do attach meaning to their intrusive thoughts. Personally, I think it’s because they’re disturbing them, so they say to themselves: “If they’re so disturbing, they must mean something significant about me”. That type of reasoning makes the thoughts so much more disturbing. It’s a vicious cycle. It’s a wrong reasoning because it’s rather a matter of letting the discomfort subside on its own (that is, treating the intrusive thought as junk mail, as you fittingly said).

As for the connection between dysregulation of brain circuits and mental disorder, things are fuzzier. It’s true that brain imaging shows that some parts of the brain are more activated than others in OCD, but it’s difficult to ascertain whether it’s the cause or the result of the mental disorder. It could also be a vicious cycle like you said (the brain affects the mind and the mind can affect the brain). The question that remains is to determine whether CBT alone can treat OCD, or do we also need to modify brain function with medication or magnetic/electric stimulation, for instance?

[Natureloverpeace in reply to deValentin]

It’s a which came first question, the chicken or the egg. It’s also possible that it works both ways. Most of the underlying mechanisms aren’t understood yet.

[deValentin]

Thank you for your feedback.

[Kaiser18]

While science admits that no one understands the root causes or actual mechanisms that truly drive OCD, my reading and personal experience convinces me that it has a strong biological basis, that when combined with the right circumstances, activates the OCD pattern. So while CBT can be powerful to combat the symptoms, it is also reasonable to expect biological interventions to be helpful, at least until we truly understand how OCD originates and it’s true mechanisms.

[deValentin]

Thank you from your comment. If genetic and biological predispositions for OCD can be “activated” by certain stressful events or circumstances, is a change in thinking and behavior (CBT) sufficient to “deactivate” them? We’ll have indeed to wait for science to give us clearer answers.

[Natureloverpeace in reply to deValentin]

I don’t know about “deactivating” the biology part. Genes can be turned off and on. There are some of us who are in remission or have freedom from OCD without the use of medication, TMS, DBS, ketamine, etc. Sometimes treatments such as medication have no effect on a person’s OCD. Why they help some people but not others is anyone’s guess. The current medications given at a therapeutic dose for OCD can reduce symptoms up to 30 to 40% in some people. Medication alone isn’t enough.

[deValentin in reply to Natureloverpeace]

I agree. The problem with medication is that when you stop medication, OCD symptoms usually return. With CBT, results last even if relapses are possible and some maintenance work is required.

[SCC1 in reply to Natureloverpeace]

Personally, medication is not helping me. Not how it should. I am living in a very stressful, toxic environment and cannot leave right now. So, the stress of being here (with my mother) is causing my OCD to get worse or not be helped. I think that medication would be more helpful if I weren't in this environment. It would keep me at a level where I could actually feel better. The OCD will still be there, but not to the severity it is now.

I don't think one can really heal if they are consistently subjected to things that are triggering for them. I have other stressors that also contribute to my OCD not being under control. I think if stress is high enough, it will have a great impact on how one can function, with or without meds or therapy.

And, just a note-I see that my mother has many traits of OCD, although nothing was ever diagnosed. I have also read that OCD is hereditary.

[Natureloverpeace in reply to SCC1]

I’m sorry, that sounds like a difficult, challenging situation to be in. Easier said than done but I hope you can find even some little ways to relieve the stress here and there.

[SCC1 in reply to Natureloverpeace]

Thank you 🙂

[SCC1 in reply to Natureloverpeace]

Just to be clear, I wasn't trying to explain my situation as an actual problem, it was said because I was trying to say that different situations bring up things that OCD is affected by. It was more of a comparison between OCD and general stressors. I was just using my situation as an example.

[deValentin in reply to SCC1]

You’re right, OCD may run in families. Circumstances do also play a role in our mental state. Sometimes, in order to know how we would feel if circumstances were different, we need to get out of them for a while (it’s not always practical though), which would allow us to look at things with a fresh mind. We could also ask ourselves how disorder-free people would do in the same circumstances, and sometimes we may conclude that they wouldn’t do better because emotional resources are limited and it’s hard to replenish them when we’re subjected to the same stressors day after day. What’s left to do is to adjust our expectations: we can’t expect the same level of functioning from somebody who lives in a challenging environment than from somebody who benefits from a good support system.

[Natureloverpeace]

A lot more research needs to be done to understand the neurobiology part of OCD. The second paragraph of my post is a summary of a recent article written by Chris Pittenger, M.D., Ph.D., the director of the OCD research lab at Yale.

[Natureloverpeace]

I understood and I agree with you that it’s not certain. I think that communicating through social media instead of directly sometimes leads to misunderstanding each other. It sounds like we’re on the same page though.