Obsessive-compulsive disorder: Psychological explanations

Freud

In the early 1910s, attributed obsessive-compulsive behavior to unconscious conflicts which manifested as symptoms.[3] Freud describes the clinical history of a typical case of “touching phobia” as follows:

“ After it has started, in early childhood, the patient shows a strong desire to touch, the aim of which is of a far more specialized kind than one would have been inclined to expect. This desire is promptly met with an external prohibition against carrying out that particular kind of touching. The prohibition is accepted, since it finds support from powerful internal forces, and proves stronger than the instinct which is seeking to express itself in the touching. In consequence, however, of the child’s primitive physical constitution, the prohibition does not succeed in abolishing the instinct. Its only result is to repress the instinct (the desire to touch) and force it into the unconscious. Both the prohibition and instinct persist: the instinct because the disorder has only been repressed and not abolished, and the prohibition because, if it ceased, the instinct would force its way through into consciousness and into actual operation. A situation is created which remains undealt with—a psychical fixation—and everything else follows from the continuing conflict between the prohibition and the instinct.[5] ”

Cognitive-

This model suggests that the behaviour is carried out to remove anxiety-provoking . Unfortunately this only brings about temporary relief as the thought re-emerges.

Each time the behaviour occurs it is negatively reinforced (see Reinforcement) by the relief from anxiety, thereby explaining why the dysfunctional activity increases and generalises (extends to other, related stimuli) over a period of time.

For example, after touching a door-knob a person might have the thought that they may develop a disease as a result of contamination. They then experience anxiety, which is relieved when they wash their hands. This might be followed by the thought “but did I wash them properly?” causing an increase in anxiety once more, the hand-washing once again rewarded by the removal of anxiety (albeit briefly) and the cycle being repeated when thoughts of contamination re-occur. The distressing thoughts might then spread to fear of contamination from e.g. a chair (someone might have touched the chair after touching the door handle).

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May 10, 2008 | Filed Under Mental Disorders 

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