The chicken and egg dilemma once again surfaces with OCD.  Does a person develop OCD because their brain is damaged?  If so then drug treatment or brain surgery is a viable option.  Alternatively, is the brain loop activation simply a pattern of overactivity that has become persistent and frantic because it has been practiced or used so often, and so develops into an automatic learned behaviour?  Can the environment we grow up in lead us to make illogical associations that can reduce our general anxiety, e.g. my anxiety is due to my hands being dirty and my hands will not be clean unless I wash them 7 times?  I believe so, and present a number of psychosocial factors that have been reported by people with OCD below.  

The brain naturally makes and maintains patterns that become automatic, that is how we learn as a species.  The unconscious brain, the home of automatic programming, cannot however, readily distinguish between a pattern that is helpful or unhelpful.  It simply keeps running until a conscious choice is made, to commit to putting the effort into stopping an identified unhelpful pattern, whether this is an addiction or OCD.  Another option is that the areas of the OCD brain loop are faulty genetically, and so the person is predisposed and so more likely to develop OCD, whether through genetics or in response to psychosocial factors.

Ultimately we are unlikely to be able to definitively pinpoint the cause, nobody knows the true cause of OCD we can only theorise. The good news is that we do not need to know the cause, however interesting this may be, for us to manage or cure our OCD.  With the scientific evidence now available it is highly unlikely that OCD is due to some uncorrectable damage to the brain, otherwise how would people manage to beat OCD?  Neuroscience also shows us that the adult brain maintains plasticity, it has the ability to change, to reduce the space given over to an old pathway if we stop using a skill, and to grow and strengthen new pathways as we practice current, or learn new skills.  We also know that therapy such as Dr Schwartz’s four-step programme presented in the book Brain Lock, produces changes in the brain on a neurological level, with brain scans showing a reduction in activity throughout the OCD loop after treatment.  Therefore, whatever the cause of the OCD overactive loop, we can change it through therapeutic non-invasive treatment.


  Change in energy use in the brain of an OCD client, before and after Dr Schwartz’s drug-free four-stem treatment programme.  The red arrow points specifically to the caudate nucleus.




Parental or carer behavioural patterns that are commonly reported by those with OCD are discussed below:




Parents who rarely communicate how they feel directly, or ask for what they want.  A child who is regularly met with an angry, moody or sulky parent, who offers no explanation for their emotions, may begin to look to themselves as the source of irritation.  With a natural desire to please their parents some begin to try to work out how to keep their parents happy, and to determine what they are doing to CAUSE the emotional response in their parent.  Parents may also blame their children directly for making them angry or upset and the family dynamics are often rife with guilt and emotional manipulation.  A child in this situation would naturally develop a state of high alert, and have an overactive error detection system as they are on constant look out for anything they have done that might cause themselves or a loved one upset.  They will also be learning to detect even slight differences in body language and early warning signs of a parent’s mood. 




This occurs when a child’s behaviour on one occasion receives a dramatic and negative response from their parents, but the same behaviour on another occasion is met with a chuckle or ignored depending on their parent’s mood at the time.  Confusion may result in this environment as we naturally look for associations between our behaviour and the reactions of others, so that we might experience some control over our world.  If this control is heavily lacking due to regular inconsistencies in the responses we receive, we will look for other ways that we can control our world e.g. ‘if I wash my hands 5 times I am a good boy and will be loved’ or ‘if I keep my room tidy and ordered nothing bad will happen and I will be safe and secure.  This environment may provide the perfect atmosphere to begin making the illogical associations that are common in OCD. 




Control of some element in the world is a major underlying factor in OCD.  Parents are often reported as being too controlling and involved, so that their child has little opportunity to take personal responsibility for the events in their lives.  At the other end of the scale parents put too much responsibility on their children, they take little interest in their child’s wants and needs and fail to set healthy boundaries.  Both situations result in a need for personal control due to feelings of insecurity and overwhelming pressure, whether venturing into the outside world unprepared, or taking on too much responsibility without a guiding hand to keep them safe.  




Highly anxious parents teach their children how to be anxious, whether they try to hide their anxiety or not.  The extent and frequency of some type of anxiety in childhood again would explain why the brain is often in a high alert state.  The need to feel secure and free of anxiety is high, and people with OCD can rarely cope with the uneasy feeling of guilt.  If as children they frequently felt guilt and anxiety they may even be more sensitive to those experiences, as their brain and body is practiced in feeling this way, and so may produce these feelings to a higher degree than normal.




People with OCD often have high levels of self-doubt and are sometimes unsure of their own perceptions, ‘did I check …... before?’ ‘Is the tap really off?’ 



A quick change of representational systems can often be of use here.  If clients look to see if a door is locked or a tap is on for example, ask them to listen to the locking mechanism or to the silence or dripping of a tap, and make auditory distinctions.  I have no idea why one representational system fails to register an event whilst another will, but this has worked for the majority of clients I have worked with.


A lack of self-trust may result from an environment where true perceptions were challenged or dismissed.  A child who is constantly met with a quizzical stare or brusque ‘nothing’ when they ask their parents what is wrong having just observed that they were upset, angry or sulking, might be led to question their own perceptions rather than see the flaws in their own parents.



Honesty is usually acutely important to a person with OCD, who will often go to extreme lengths not to cause anyone to be misled in any way.  Words that are commonly used so as not to say something that might be proved incorrect include, ‘I think’, ‘maybe’ or I’m pretty sure’, ‘I saw …….’ or ‘………….. happened’.  Clients often report that as children they were brought up in a family that demanded honesty from them.  Lying resulted in emotional or physical punishment, and they were often unfairly accused of dishonesty, and not believed when they tried to defend themselves.  The majority also observed their parents being dishonest on a regular basis, particularly in areas of denial or when they were ‘wearing a mask’ or ‘putting on an act’ for the outside world. 



People with OCD crave certainty, and fear uncertainty which results in a high anxiety response.  In seeking certainty and therefore safety, it is no surprise that many are attracted to a religion or sect that offers a strict set of values where there is little room for doubt, together with security and acceptance within a group.


Please note that the patterns of behaviour discussed above are fairly common in our society, and none will immediately result in a child developing OCD.  It is more the case that these typically unhealthy behavioural patterns, require a child to find some form of coping mechanism and whether this results in OCD, anxiety, addiction, depression etc will depend on both internal and external factors.  Also, it must not be forgotten that children also take positive qualities out of these environments such as, determination, motivation and desire to succeed in life.






OCD stems from a need for protection and survival that has spiralled into overdrive.  We do need to protect ourselves from germs that may harm us by cleaning our homes and ourselves.  We all want to protect our homes from fire or flood and prevent someone entering our homes that might harm us, by ensuring appliances are off and doors are locked.  Survival is also at the root of wanting others to like us, if early humans were rejected by a tribe they were more likely to be attacked and to die, and this genetic need is still alive in all of us today to some extent.  We all flourish if our loved ones show us acceptance and approval for being ourselves, because we feel safe and secure.  For those with OCD, that need to be liked and accepted is in overdrive, so they might fear taking responsibility for anything that may possibly go wrong or cause harm to others.  Locking up the home, driving, cleaning, completing work for others and the natural process of having automatic thoughts might all become problematic.




OCD basically means that we can be obsessive or compulsive about certain things in our lives.  We are all obsessive and compulsive to some level and these thoughts and behaviours can be extremely useful.  For example, an obsession about getting the best qualifications so that we might be able to have the career we want, together with a compulsion to study would be useful to anyone.  An obsession for fitness and sports not taken to extremes would also be highly advantageous to a professional athlete.  However, the brain is a complex organ that sometimes forgets to realize what is truly important in reality, and although every behaviour has a purpose and is trying to assist us in some way, we sometimes have to point the brain in the right direction.  A compulsion to check every piece of electrical equipment five times before we leave home may prevent us from burning down the house for example, but is also taking up far too much of our time and not truly necessary.  An obsession with cleaning meanwhile may prevent us from picking up germs and becoming unwell on the odd occasion, but the extremes of cleaning can cause more illness than one is attempting to prevent.