Which Came First: The Obsession or the Compulsion?
January 22, 2013
A recent study provides insight into how obsessive compulsive disorder (OCD) develops. Led by Claire Gillan and Trevor Robbins at the University of Cambridge and Sanne de Wit at the University of Amsterdam, the study suggests that compulsive behavior may not be a response to obsessive fears, but instead may be a precursor to those fears (American Journal of Psychiatry, July 2011). That is, compulsions such as repetitive hand-washing may lead to an obsessive fear of germs—rather than the other way around.

“It has long been established that humans have a tendency to ‘fill in the gaps’ when it comes to behavior that cannot otherwise be logically explained,” said Gillan in a recent issue of Cambridge’s Research News. “In the case of OCD, the overwhelming urge to senselessly repeat a behavior might be enough to instill a very real obsessive fear in order to explain it.”

The study, which involved 20 patients suffering from OCD and 20 control subjects, measured patients’ tendency to develop habit-like behavior. Participants were required to learn simple associations among stimuli, behaviors, and outcomes in order to win points on a task. The researchers found that patients suffering from OCD were much more likely to continue to respond with a learned behavior, even when that behavior did not produce the desired outcome; that is, they quickly formed habits, or irresistible urges, to perform a task. These behaviors, initiated and observed in a laboratory setting and in the absence of any related obsessions, suggest that the compulsions themselves may be the critical feature of OCD.

This finding seems to support the approach of exposure and response prevention (ERP) as a treatment for OCD. ERP is a therapy that challenges patients to discontinue compulsive responding and learn that the feared consequence does not occur. Proponents of ERP say that once the compulsion is stopped, the obsession tends to diminish or disappear.

What do you think? What therapies have you found most effective for your clients with OCD? PAR wants to hear from you, so leave a comment and join the conversation!