Obsessive Fears Arise in Response to Compulsions in OCD

By Rick Naurert PhD
October 21st, 2021
Medically reviewed by Paul Sietes, MD.

Obsessive Fears Arise in Response to Compulsions in OCDThe chicken-and-egg question regarding obsessive-compulsive disorder (OCD), for the most part, is usually answered by identifying obsessive fears as driving the behaviors such as repetitive hand-washing.

A new study effectively reverses the order, finding that the repetitive behaviors themselves (the compulsions) might be the precursors to the disorder, and that obsessions may simply be the brain’s way of justifying these behaviors.

New research suggests performance of repetitive behaviors may lead to obsessive-compulsive disorder (OCD). This interpretation goes against popular beliefs that behaviors  found that in the case of OCD the behaviors themselves (the compulsions) might be the precursors to the disorder, and that obsessions may simply be the brain’s way of justifying these behaviors.

The study, conducted at the University of Cambridge and the University of Amsterdam, provides important insight into how the debilitating repetitive behavior of OCD develops and could lead to more effective treatments and preventative measures for the disorder.

Funded by the Wellcome Trust and published in the American Journal of Psychiatry, the study tested 20 patients suffering from the disorder and 20 control subjects (without OCD) on a task which looked at the tendency to develop habit-like behavior.

Subjects were required to learn simple associations between stimuli, behaviors and outcomes in order to win points on a task.

The team, led by Claire Gillan and Trevor Robbins at the University of Cambridge MRC/Wellcome Trust Behavioral and Clinical Neuroscience Institute and Sanne de Wit at the University of Amsterdam, found that patients suffering from the disorder had a tendency to continue to respond regardless of whether or not their behavior produced a desirable outcome.

In other words, this behavior was habitual. The discovery that compulsive behavior – the irresistible urge to perform a task – can be observed in the laboratory, in the absence of any related obsessions, suggests that compulsions may be the critical feature of OCD.

This finding is consistent with the recognition that cognitive behavioral therapy (CBT) is one of the most effective treatment for OCD. In this therapy, patients are challenged to stop compulsive responding, and learn that the feared consequence does not occur, whether or not the behavior is performed.

The effectiveness of this treatment is compatible with the idea that compulsions, and not obsessions, are critical in OCD. Once the compulsion is stopped, the obsession tends to fade away.

“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 Claire Gillan, a Ph.D. student at the University of Cambridge.

“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.”

Source: University of Cambridge

Dr. Rick Naurert has over 25 years experience in clinical, administrative and academic healthcare. He is currently an associate professor for Rocky Mountain University of Health Professionals doctoral program in health promotion and wellness. Dr. Naurert began his career as a clinical physical therapist and served as a regional manager for a publicly traded multidisciplinary rehabilitation agency for 12 years. He has masters degrees in health-fitness management and healthcare administration and a doctoral degree from The University of Texas at Austin focused on health care informatics, health administration, health education and health policy. His research efforts included the area of telehealth with a specialty in disease management.