Mental Health

Which came first: the obsession or the compulsion?

| by

Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by uncontrollable thoughts (obsessions) and repetitive behaviors (compulsions). It has generally been thought that compulsions are a response to obsessive thoughts, and that people with OCD develop ritualistic behaviors in an attempt to quiet the involuntary and unwanted thoughts.

This belief, however, is challenged by a new study that was recently published in the American Journal of Psychiatry. Researchers at the University of Cambridge and the University of Amsterdam compared the behavior of 20 OCD patients and 20 control subjects who were required to perform a task that could win them points. They found that the OCD patients tended to continue to perform the task even when they didn't earn any points, suggesting that compulsive behavior in OCD patients is present even in the absence of related obsessions.

This study provides evidence that compulsive behavior may be the central feature of OCD, rather than obsessive thoughts. This idea is also supported by the effectiveness of a form of cognitive behavioral therapy known as "exposure and response prevention." This technique treats OCD by focusing on eliminating compulsive behaviors, with obsessions fading away once compulsions are eliminated.

Claire Gillan, a PhD student at the University of Cambridge, explains that people with OCD may develop obsessions as a way to justify their compulsive behavior: "It has long been established that humans have a tendency to 'fill in the gaps' when it comes to behaviour that cannot otherwise be logically explained. In the case of OCD, the overwhelming urge to senselessly repeat a behaviour might be enough to instill a very real obsessive fear in order to explain it."

Read more: