Debate: Does it matter what causes OCD?

[snowbear]

There are lots of different ideas around on what causes OCD.

Some say it originates in the structures of the brain, others say there's an inherited predisposition that gets activated by something you're exposed to. Life events and how you react to them plays a big role. There's some evidence a bacterial infection might sometimes be involved, damaging the part of the brain that controls anxiety. A few researchers are currently investigating how mental health is influenced by diet and others are looking at the genetic code to find answers.

What all these different possibilities have in common is the idea there's something different about your brain when you have OCD. It certainly feels like our OCD brains must be different to 'normal' brains because most people don't seem to suffer with their thoughts the way we do.

Until recently it was thought brain anatomy was fixed, that it can't be changed and you're stuck with whatever you've got. That if the brain gets damaged it can only partly repair itself and the damage is otherwise permanent.

I think that puts an OCD sufferer into the mistaken mindset 'My brain is broken and it can't be fixed'. And when you've struggled to control the thoughts and compulsions it can seem like 'proof' your OCD can't be cured, reinforcing the belief your brain must be damaged or different.

But there's been lots of research in the last 10-15 years on brain function and how thoughts are turned into behaviours. The biggest revolution among professionals has been the realisation the brain is extremely plastic (changeable), and the biggest surprise has been the amount of change possible simply by thinking differently!

The brain never stops changing. Every thought you have has the potential to make new connections between brain cells. In creative people and flexible thinkers individual brain cells have a higher number of connections to other cells and greater connectivity to other regions of the brain.

But if you keep thinking along the same lines you've always thought, the diversity of connections wither and reduce in number, making the same thoughts ever more entrenched.

The type and amount of chemicals the brain manufactures also fluctuates. Which neurotransmitters are most active varies depending on your mood, your diet, how your genes interact with the environment around you, and (perhaps unsurprisingly) how you think and behave.

So if thinking differently and behaving differently allows your brain to change something as fundamental as its structure and chemistry, does it matter what causes OCD?

Have you got stuck in the belief that your OCD brain is different to a normal brain and can't be fixed?

Or do you agree that CBT (working to change your thoughts and behaviours) can cure OCD?

Edited September 13, 2015 by snowbear

[Guest Chickpea]

I'm pretty convinced CBT can cure OCD. It has, for so many people.

I also believe genetics play a big role, I have OCD, from the stories my grandmother tells me, I'm inclined to believe my great grandfather did too and now my little cousin is showing signs of what could be OCD too.

I also feel (because of the way I am) that maybe people who develop OCD have a more obsessive "personality". For example, when I really like a movie I can be obsessed with it for months, years even.

Maybe there are other people who have "obsessive" personalities and a predisposition for OCD but don't develop it because of the environment they're in.

I also found out recently, that animals can develop OCD too. I'm not sure if that adds anything to the discussion, but I found it interesting.

(I really hope this makes sense, English is my second language)

Edited September 13, 2015 by Rita27

[tia]

I found your post really interesting thank you for this.

[PolarBear]

What causes ocd might be fun to figure out but it doesn't matter much when you're the one who has it and you desperately want to get rid of it. If I count my brothers and sisters and our kids there are eight out of fifteen of us that have ocd. Does that information help much? Not really.

The important thing to know is that OCD is not a death sentence. People do change their thinking and behaviour and that does lead them to get better.

It would be nice to know a definitive cause but I don't think knowing is going to help us much.

[taurean]

I sat with my Doctor on one occasion to discuss my OCD ( as it happens he is the senior partner in a large practice), and he went looking back in my medical records onscreen to seek clues as to a cause

But I told him my psychiatrist had said this is pointless, and I told him when I realised something was "wrong" was in my childhood, that I now recognise as OCD - checking, not wanting to walk on cracks in paving stones, counting rituals. Plus OCD is genetic in my father's line.

I rather think though for certain types of OCD it seems to have a seeding event - like a phobia - but instead of remaining a phobia - only flaring up in that same situation - it develops into full-scale OCD.

Maybe to successfully treat those situations, it is very relevant to focus on the seeding event; maybe a very specific - different - approach is needed - as in the case of some close forum friends here who have this type of problem. and the usual methods of therapy have been unsuccessful.

[Guest Arrow]

I think knowing what causes OCD is vitally important as it may help us and future sufferers from having to live a life like this.

Multiple family members suffering from it like mine must indicate its genetic and if genes are involved then things can be improved.

[bruces]

I wish I could think differently try to be a bit more positive but I just can't seem to do it

[Sodovka]

I think knowing what causes OCD is vitally important as it may help us and future sufferers from having to live a life like this.

Multiple family members suffering from it like mine must indicate its genetic and if genes are involved then things can be improved.

Yes, Arrow--exactly! If we can uncover a gene or set of genes that are responsible for OCD, we (scientists) can develop medical solutions that aren't available today. maybe this disorder can be actually cured, as opposed to merely managed.

[snowbear]

Yes, Arrow--exactly! If we can uncover a gene or set of genes that are responsible for OCD, we (scientists) can develop medical solutions that aren't available today. maybe this disorder can be actually cured, as opposed to merely managed.

Sodovka, there's no right or wrong here, it's a debate to get us all thinking and examining our attitudes and beliefs. So I'm just going to point out an observation.

Do you think your statement agrees or disagrees with the idea your brain is fixed?

Does the idea CBT only manages OCD and doesn't cure it agree or disagree with the evidence that thoughts alone can change brain structure and brain chemistry?

Can you see you may have a subconscious belief your brain needs something external to you to fix what is broken? And can you begin to acknowledge that believing this (despite all the evidence to the contrary) may be holding you back from fixing yourself and being cured by CBT?

Interesting that we're getting back to learned thought processes again, and how they influence our deepest held, subconscious beliefs.

[Guest doris]

So far I believe that cbt and meds only manage ocd, as that has been my experience so far. And also so many people seem to see a comeback of their symptoms even after feeling well for fairly lengthy periods of time once meds are stopped or a stressful situation comes up.

I think it'd be great to see more about what causes ocd as I think there can be many physical causes--and I, like arrow and sodovka mentioned, would love to see a physical fix in the future. I imagine being able to identify something either diet-wise that could be changed, or an antibiotic that can be taken (though it might be a bit frightening to see an ocd super bug come into play.)

I do believe that the brain is malleable and we can learn new ways of thought etc, but I also think that if there are physical causes to a disorder, these causes may need addressing to actually cure a mental disorder.

[snowbear]

So far I believe that cbt and meds only manage ocd, as that has been my experience so far. And also so many people seem to see a comeback of their symptoms even after feeling well for fairly lengthy periods of time once meds are stopped or a stressful situation comes up.

I think it'd be great to see more about what causes ocd as I think there can be many physical causes--and I, like arrow and sodovka mentioned, would love to see a physical fix in the future. I imagine being able to identify something either diet-wise that could be changed, or an antibiotic that can be taken (though it might be a bit frightening to see an ocd super bug come into play.)

I do believe that the brain is malleable and we can learn new ways of thought etc, but I also think that if there are physical causes to a disorder, these causes may need addressing to actually cure a mental disorder.

Doris, as I said to Sodovka, I'm just making observations here to generate further debate. There's no right or wrong answers.

If 'management only' has been your experience so far, then it's understandable you will be skeptical of he idea of a 'cure'. Once upon a time I would have agreed with you, based on my own experience and on my observations of others. Now I'm increasingly observing sustained improvements in many people (effectively cured) and am finally making some progress myself, and these combined have changed my opinion.

Your superbug emoticon made me laugh. :laugh: But your comment raises an interesting point.

Do you think the desire to see a physical fix for OCD stems from the common feeling experienced by sufferers that we'd love it if somebody else took the burden off our shoulders and made us well, rather than having to engage with CBT and do the work ourselves?

I know in the past, when my OCD was at its worst, I often had such thoughts.But when I'm thinking positively and am more energised, the talking therapies do seem to make real, and lasting, progress. I'm certain it's not laziness that makes us think like this. I believe it's sheer mental exhaustion that creates the desire to passively be fixed instead of to actively fix ourselves when told the possibility is there.

Even though I do sometimes lapse into old behaviours and old thinking patterns under acute stress, the more I practise the new thinking patterns, the more capable I am of 'digging myself out of trouble' and the quicker the OCD symptoms resolve each time.

Just something I've observed.

CBT definitely isn't an instant cure, but people relapse with all kinds off illnesses after tablets and surgery. So can you identify specifically what it is about CBT/talking therapy which makes you feel it isn't a cure? I'm interested to see if we can find common trains of thought in the two camps: those who say CBT can be a cure, and those who maintain it only manages the symptoms. See if we can get to the underlying belief differences and resolve them.

[Sodovka]

Sodovka, there's no right or wrong here, it's a debate to get us all thinking and examining our attitudes and beliefs. So I'm just going to point out an observation.

Do you think your statement agrees or disagrees with the idea your brain is fixed?

Does the idea CBT only manages OCD and doesn't cure it agree or disagree with the evidence that thoughts alone can change brain structure and brain chemistry?

Can you see you may have a subconscious belief your brain needs something external to you to fix what is broken? And can you begin to acknowledge that believing this (despite all the evidence to the contrary) may be holding you back from fixing yourself and being cured by CBT?

Interesting that we're getting back to learned thought processes again, and how they influence our deepest held, subconscious beliefs.

Two thoughts occur to me based on your response, SnowBear:

1) I'm pretty sure there is a right and wrong here, and I'll tell you what I think it is: Right is what reduces our suffering. Wrong is what maintains or increases it. I don't know if your cognitive reprocessing is a valid therapy or not but I'm as open to learning about it as any other other techniques.

2) I agree that I have not only a subconscious belief that I have a broken brain that needs fixing, I would say my belief is quite conscious at this point. Is that holding back my recovery? Possibly, but that sounds a little too Freudian to me, and having experienced no alleviation of my symptoms from classic talk therapy, I don't have much faith in such methods. That said, whatever they are, they do seem to work for you, so I'll try to be open-minded about them.

I apologize if I am sounding defensive or hostile--I am feeling really quite terrorized by my OCD today.

[snowbear]

I'm sorry you're having a bad day, Sodovka.

I'm genuinely just trying to generate discussion and get people thinking, not trying to peddle CBT as though it's a miracle cure or anything. (Gosh it used to annoy me when people on the forum did that and it wasn't only not working for me but was making me worse.) I'm open-minded to the idea of physical cures as much as the next person. I'm just thinking about ''thinking'' a lot myself at the moment and that's whats driving these discussions. It helps me put my thoughts in order as much as anything else.

Reading it again I see I worded my reply badly, perhaps putting you on the defensive when I didn't mean to. Sorry for bringing up any hostile feelings on a day you really don't need it. :hug:

[Guest nervous]

Good topic snowbear, I actually gave up trying to figure this out because I have to accept that if it is ever determined it may not be in my life time and so I am not willing to wait for an answer as to what causes it and so for my recovery it doesn't matter. However...I do think the question should still be asked, what more can be learned? Just a few decades ago someone with compulsions as severe as mine once were would have been treated with confusion and improper treatment. Now we have a working process that does help, and has helped many (including me) regain some or all of their life. What more waits to be discovered?

To add to the topic though a few days ago I was reading about how fears develop in children over time as the grow and can understand more complex ideas. My 8 year old finds some shows scary that my 5 year doesn't, not because the younger one is more brave but because he is too young to understand the concept. Most parents worry about dangers that their kids have no fear of because they have no idea about them. Is the same true for people with OCD? Have we just moved to a time when we can understand something that passed us by when we were younger?

[Guest doris]

If 'management only' has been your experience so far, then it's understandable you will be skeptical of he idea of a 'cure'. Once upon a time I would have agreed with you, based on my own experience and on my observations of others. Now I'm increasingly observing sustained improvements in many people (effectively cured) and am finally making some progress myself, and these combined have changed my opinion.

Do you think the desire to see a physical fix for OCD stems from the common feeling experienced by sufferers that we'd love it if somebody else took the burden off our shoulders and made us well, rather than having to engage with CBT and do the work ourselves?

I know in the past, when my OCD was at its worst, I often had such thoughts.But when I'm thinking positively and am more energised, the talking therapies do seem to make real, and lasting, progress. I'm certain it's not laziness that makes us think like this. I believe it's sheer mental exhaustion that creates the desire to passively be fixed instead of to actively fix ourselves when told the possibility is there.

Even though I do sometimes lapse into old behaviours and old thinking patterns under acute stress, the more I practise the new thinking patterns, the more capable I am of 'digging myself out of trouble' and the quicker the OCD symptoms resolve each time.

Just something I've observed.

CBT definitely isn't an instant cure, but people relapse with all kinds off illnesses after tablets and surgery. So can you identify specifically what it is about CBT/talking therapy which makes you feel it isn't a cure? I'm interested to see if we can find common trains of thought in the two camps: those who say CBT can be a cure, and those who maintain it only manages the symptoms. See if we can get to the underlying belief differences and resolve them.

Well one thing that can make this discussion a little difficult is that there is such a wide range of severity of ocd. When I was younger I had slight symptoms of ocd which were easily managed with no work at all. my compulsions did not spiral out of control and so it was no issue. At that time I may have been able to cure ocd altogether with cbt.

When ocd became extremely problematic (rituals took about 12 hours a day at my worst), I applied both cbt and meds and got much better. however when I came off meds (and continued trying to apply cbt) I had a very bad relapse. I went back on meds, increased cbt/erp and am much better again. However, I see my decrease of symptoms as managing ocd rather than a cure, because I imagine that I risk a relapse if I come off the meds. A cure for me would be where I don't need to be on meds and be able to deal with ocd with minimal cbt upkeep.

I am so thankful for how far I have come in the management of my ocd symptoms and hope for continued improvement by applying whatever methods work. I would love to think that I could cure my ocd with cbt as I don't really want to stay on meds forever. and I am doing the cbt/erp anyhow so it is not that I am trying to avoid the work. It is just that I figure if there was a physical cause that could be safely addressed then that would be good. I've experimented with diet and vitamins and am open to any new ideas for therapy (such as possibly emdr) Look at the progress that has been made with autism and diet--I think there is a very important link between brain and body and we should not ignore the physical side in a mental disorder. and if we can identify directly a physical cause of something would this not be worthwhile addressing?

I am glad that you are seeing some good improvements with your ocd and hope that you continue to do so. are you also using meds or are you able to just apply cbt and talk therapy? I have been thinking about looking over some core belief worksheets again to see if there is some work there I can use. I'd also be interested to know that once you've identified your core belief is there some concrete method you use to resolve that? or is that just where your talk therapy comes in?

[taurean]

I have intent to manage my OCD such that I can address triggers, rendering them benign, and so preventing one suddenly bringing about a complete relapse (which has been my episodic experience for a few years).

Pure and simple. That is my goal I am working towards.

I think people who join the forum with a demand to be cured are deluding, and not helping, themselves; if it happens for them, wonderful - but clawing back chunks of one's life lost to OCD is a more comfortable, less pressured, likely achievable, aim.

[Caramoole]

It's very difficult to have the ultimate answer, especially when you can't experience someone else's OCD.

But I think that OCD is a disorder of thinking and response to thoughts, I don't think it' a broken brain. A change in reaction/behaviour can make a huge change on a given day, then it will shift back again if we resume with the former response. I don't feel that a broken brain works that way, it would be pretty much constant.....however, a change in thought and reaction would demonstrate this pattern

[Guest Tricia]

Have you got stuck in the belief that your OCD brain is different to a normal brain and can't be fixed?

Or do you agree that CBT (working to change your thoughts and behaviours) can cure OCD?

While looking through books on OCD (checking what terms are used, in order to respond to Polar's thread) I noticed that only one professional (Paul Salkovskis) uses the word 'cure'. (I dare say there are a few others, but not in the books I have).

Most psychologists and psychiatrists speak of 'management', not 'cure'. In fact, many stress it is a lifelong condition. (I accept these statements and my one problem with positive thinking and the belief that CBT will always work is the same as for positive thinking in all walks of life - it casts blame, where blame should never be).

Many professionals also refer to OCD as a neurobiological condition/illness.

I have been told (by several professionals) that my brain is different and that the condition is genetic and inherited. I might not have willingly accepted this view, but for the very obvious symptoms displayed by so many of my relatives (and the relatives of friends with OCD). I also feel there may be other causes. For example, I think it's clear that epilepsy and strokes can cause OCD in some people. I believe that group A Beta-Haemolytic Streptococci can trigger OCD - but only in those who are predisposed.

Does the cause matter? Currently, for us, right now, no. CBT is the best treatment we have and seems to work well for most people. However, it is essential to look for the cause, to enable scientists to find a cure. A permanent one.

Damiaan Denys had this to say on the recent Horizon programme. (He is a psychiatrist in Holland. I know many are opposed to surgery for OCD, but his comments are still worth repeating.)

On DBS: "I think it changes our perspective of the neurobiology of psychiatry in general... because we never knew before DBS that we could change anxiety within seconds, it's unheard that you can induce or reduce anxiety with stimulation within a few seconds. And that's something that's related to electrical phenomena..."

"So deep brain stimulation ...changes our view on psychiatry, the pathophysiology of the disorders..."

And when asked whether this could have implications for illnesses like depression and schizophrenia, Denys responded, "Sure. Yes, of course."

At present, Denys is saying that, after DBS, 60 percent are helped and 10 to 15 percent are symptom free.

I am sure that such procedures will seem crude in a few years (as they clearly do to many on here now!). Obviously, I have no idea exactly what science will reveal (my psychologist has assured me that when all the genes involved are identified a cure will be on the horizon) but I am confident that no one will have any mental conditions in 20/30 years' time. This was the belief of my GP in 1980. Alas, he was too optimistic with the dates. (Particularly distressing that he was wrong, as he took his own life due to mental illness.)

Goodness, on the news this morning they were saying in the not too distant future we'll be able to have the mind (and body) of our choosing! Initially, I thought 'wonderful', but actually it's more frightening than OCD...

Edited September 14, 2015 by Tricia

[Sodovka]

I'm sorry you're having a bad day, Sodovka.

I'm genuinely just trying to generate discussion and get people thinking, not trying to peddle CBT as though it's a miracle cure or anything. (Gosh it used to annoy me when people on the forum did that and it wasn't only not working for me but was making me worse.) I'm open-minded to the idea of physical cures as much as the next person. I'm just thinking about ''thinking'' a lot myself at the moment and that's whats driving these discussions. It helps me put my thoughts in order as much as anything else.

Reading it again I see I worded my reply badly, perhaps putting you on the defensive when I didn't mean to. Sorry for bringing up any hostile feelings on a day you really don't need it. :hug:

Thanks, SnowBear. So far, CBT has been the most effective treatment for me, though meds seem to be the foundation that allows me to not fall into a deep depression. So there are a few things going on in my brain. But I really am open to what causes OCD, insofar as it helps me deal with it.

[bruces]

So basically it's something you have for life and learn to live with not get rid of ?

[Raffles]

I thought cognitive restructuring/reprocessing was inherently part of CBT. As in, it's bedrock. It's just unfortunately CBT can't be prescriptive. It has to be tailored to each individual. And on top of that, a strong therapeutic relationship needs to grow between patient and practitioner. Often there probably isn't time to carry CBT through comprehensively, tackle related issues that uphold maladaptive thinking but aren't obviously bothering, and treatment will vary with the therapist's experience...

I imagine we can all agree it's a mix of nature and nurture, and there are so many variables at play that could contribute to the development of OCD. Heck, there could be many mechanisms that result in OCD

Our brains do have high plasticity and ability to adapt/restructure, but, and not to sound defeatist, it's my understanding that this declines with age (although it's still remarkably flexible!) and there's evidence that there are developmental "windows" in childhood that, if missed, can never be completely recovered from. For instance, in studies of "feral" and neglected children, they can learn words, but if they missed the window for grammar, it's unlikely they'll ever get the hang of it. Bit of a disclaimer - my understanding is limited to Psychology A-level done... seven years ago now? So I'm likely out of date, and just seeing this as thinking practice!

I think, in OCD embedded since early childhood, management of symptoms and self-monitoring and self-care to avoid relapses is the best CBT can provide. And probably takes years of effort. I personally struggle to relate the things I've learned in therapy to new OCD experiences that come along. Or rather, I lack confidence in myself still to decide that, yes, this really is OCD, and I need to park the thoughts and try to carry on. I recognise I need to make a concerted effort to try and integrate more CBT and mindfulness practices into my life to get the most out of them.

[Guest Tricia]

I imagine we can all agree it's a mix of nature and nurture, and there are so many variables at play that could contribute to the development of OCD. Heck, there could be many mechanisms that result in OCD

When children develop OCD at a very young age, it is quite possible that nature alone is responsible for the condition.

Edited September 14, 2015 by Tricia

[Raffles]

When children develop OCD at a very young age, it is quite possible that nature alone is responsible for the condition.

Yes, good point! I'd forgotten that I wanted to muse about us all starting out with different levels of neuroticism, introversion, extroversion, etc... depending on the propensity of our nervous systems to stimulation! Those sort of base levels/sensitivities.

[Sodovka]

So basically it's something you have for life and learn to live with not get rid of ?

At this point, yes. that is my belief. But you can live quite well with it using available methods.

[bruces]

At this point, yes. that is my belief. But you can live quite well with it using available methods.

Not what I wanted to hear !!!