Obsessive-Compulsive & Related Disorders (College Board AP® Psychology): Study Guide

Symptoms of OCD & related disorders

• This category of disorders is characterized by obsessions and/or compulsions:

  • Obsessions are intrusive, unwanted, and persistent thoughts, or images that cause marked anxiety

    • The person recognizes the obsessions as products of their own mind but cannot easily dismiss them

  • Compulsions are repetitive behaviors or mental acts performed to reduce the anxiety from obsessions

    • Compulsions provide temporary relief, but the obsession returns and the cycle continues

• Two disorders include:

  • Obsessive-compulsive disorder (OCD)

  • Hoarding disorder

Obsessive-compulsive disorder (OCD)

• OCD involves recurring obsessions and/or compulsions that:

  • are time-consuming (more than 1 hour per day)

  • cause significant distress or impairment

• Common obsessions include:

  • Contamination: intrusive fears of germs, dirt, or illness

  • Symmetry and order: distressing feelings when things are not perfectly aligned or ordered

  • Harm: intrusive thoughts about harming oneself or others

    • These thoughts are ego-dystonic, as the person does not want to act on them and is distressed by them

  • Forbidden or taboo thoughts: intrusive sexual, religious, or violent thoughts

• Common compulsions include:

  • Cleaning and washing: repetitive handwashing, showering, or cleaning of surfaces

  • Checking: repeatedly checking that doors are locked or appliances are off

  • Counting and ordering: arranging objects in a specific way or counting to specific numbers

  • Mental compulsions: silently repeating words, prayers or reviewing events

• The person often recognizes that their obsessions and compulsions are excessive but feels unable to stop

  • E.g. a person who knows intellectually that their hands are clean but still washes them 50 times a day because of uncontrollable contamination fears

Hoarding disorder

• Hoarding disorder is characterized by persistent difficulty discarding or parting with possessions, regardless of their value

  • This leads to the accumulation of items leads to cluttered, unusable spaces

• Hoarding is driven by:

  • a perceived need to save items

  • significant distress at the thought of discarding them

• Unlike OCD, hoarding is not typically driven by obsessions/compulsions, but by cognitive and emotional difficulties around attachment to possessions and decision-making

  • E.g. a person whose home is so filled with newspapers, clothes, and objects that they cannot use their kitchen, bathroom, or bedroom for their intended purposes. They will also experience intense distress at the idea of throwing anything away

Causes of OCD & related disorders

• OCD is best explained by interacting behavioral, cognitive, and biological factors

Behavioral causes

• OCD can be learned and maintained through conditioning:

  • Classical conditioning: obsessions become associated with anxiety until, over time, these thoughts alone trigger distress

    • E.g. a person has an intrusive thought about contamination and begins to associate everyday objects (e.g. door handles) with danger

  • Operant conditioning: compulsions are negatively reinforced as avoidance reduces anxiety, reinforcing the behavior

    • E.g. washing hands reduces anxiety about contamination, making the behavior more likely to be repeated

  • This creates a self-reinforcing cycle:

    • obsession → anxiety → compulsion → temporary relief → obsession returns

    • The cycle persists because the person never learns that the feared outcome would not occur without the compulsion

Cognitive causes

• OCD is associated with maladaptive thinking patterns, such as:

  • overestimation of threat: exaggerating the likelihood and severity of feared outcomes

  • inflated responsibility: believing one is personally responsible for preventing harm

  • thought-action fusion: believing thoughts are equivalent to actions or that or that thoughts make and outcome more likely to happen

    • E.g. "If I think about harming someone, I must be a dangerous person"

Biological & genetic causes

• Genetic factors: OCD is heritable

  • Twin studies show higher concordance in identical than fraternal twins, and OCD runs in families

• Neurochemical factors: OCD is linked to serotonin dysregulation

  • SSRIs (selective serotonin reuptake inhibitors) are an effective treatment for OCD, supporting the involvement of serotonin in the disorder

• Brain circuitry: OCD is associated with overactivity in the orbitofrontal cortex-striatum circuit

  • Neuroimaging studies that this circuit normalizes with successful treatment