What is the theory of compulsions

Obsessive-compulsive disorder: causes

Dr-Elze.deDr. Elze

The question of the causes the Obsessive-compulsive disorder has occupied psychologists and psychiatrists for over a hundred years. In the course of the process, various explanatory models were developed which are intended to explain the emergence and maintenance of the constraints.

The best-known theories include the Psychoanalytic and depth psychological models based on Sigmund Freud, Josef Breuer et al. as well as the Cognitive-behavioral models, such as the Two factor theory to Orval Hobart Mowrer and the Cognitive model according to Paul Salkovskis.

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Psychoanalytic and depth psychological models

According to psychoanalytic theory, obsessive-compulsive disorders are a part of it conflict in the Anal phase underlying. In the anal phase, i.e. in approx. Year of age, the child strives for autonomywhich can lead to (external) conflicts with the parents. If these strivings of the child for autonomy are repeatedly restricted or punished by “deprivation of love”, this can, according to the psychoanalytic theory, lead to one very strict and over-moralAbout me to lead.

This can lead to a so-called Dependency versus conflict of autonomy develop. Emerging sexual or aggressive Drive impulses are condemned by the strict superego, so that the ego can no longer adequately fulfill its role as mediator between the superego and the id.

As a result, obsessive-compulsive symptoms emerge as a neurotic problem solution, in which the Drive impulses neutralized by the compulsory rituals become.

Typical defense mechanisms of the sick are e.g. affect isolation, intellectualization, rationalization, undoing and reaction formation.

Read more: Psychodynamic Psychotherapy

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Cognitive and behavioral models

Mowrer's two-factor theory

The Two factor theory was written in 1947 by the American psychologist Orval Hobart Mowrer set up to describe the development and maintenance of anxiety disorders.

Mowrer postulates that mechanisms of the classical conditioning contribute to the development of anxiety symptoms, while factors of operant conditioning are responsible for maintaining the anxiety disorder.

The effects of conditioning described by Mowrer in relation to anxiety disorders can also occur in obsessive-compulsive disorder. However, there are many sufferers in whom, in addition to factors of classical conditioning, other mechanisms have also contributed to the development of the obsessive-compulsive disorder.

In contrast, many patients know the influence of operant conditioning postulated by Mowrer on the maintenance or fixation of the obsessive-compulsive disorder from their own experiences.

Read more: Mowrer's two-factor theory

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Cognitive model according to Paul Salkovskis

Paul Salkovskis tried in his Cognitive model of obsessive-compulsive disorder to explain how the so-called “normal obsessions” can develop into an obsessive-compulsive disorder.

Normal obsessions

Every human being experiences thoughts that come to mind again and again, the so-called Normal obsessions. These thoughts usually do not result in obsessive-compulsive disorder because the thoughts do not cause fear and therefore also from those affected no neutralization required do.

When such a thought comes to mind, the healthy handling of these thoughts is not to judge them but to ignore them, the so-called Internal deletion.

However, people with obsessive-compulsive disorder often experience their thoughts as very threatening or fearful. This emotional, “Affective” evaluation of intrusive thoughts can lead to the fact that the sufferer is put under pressure to put their thoughts through one Neutralize compulsory ritual to have to.

This apparent neutralization of thoughts leads - at least in the short term - to one Reduction of tension. As with anxiety disorders, a vicious circle can develop from this, which can ultimately lead to increasing obsessive-compulsive symptoms.

Paul Salkovskis describes this connection in his Cognitive Model of Obsessive Compulsive Disorder as follows:

  • A person becomes with a potentially obsessive-compulsive stimulus faced. This can be a real external situation or an internal situation such as a memory. It intrudes him thought (e.g. “I could have hit the passer-by ...!”, “Something could have happened to my mother ...!”, “I could do something to my family ...!”).

  • The person concerned consciously or unconsciously interprets this thought as “catastrophic”, “morally reprehensible”, “unbearable” or the like. rated.

  • This emotional evaluation of the thought leads to the fact that the person concerned is pronounced stressful emotional reactions such as feeling fear, tension and / or restlessness.

  • These emotions are so aversive and stressful that the urge to relieve the stressful feelings and thoughts arises Neutralizeto break away from them again.

  • The sick person leads one Compulsive act or a Thought ritual through, causing him a Reduction of tension reached.

Since the sufferers achieve a (short-term) relief of their fear or restlessness by performing the compulsive ritual, the compulsions are initially (unconsciously) experienced as a “helpful” strategy in dealing with worries and fears.

In the course of the obsessive-compulsive disorder, however, the compulsions increasingly lose this tension-reducing function, so that the sick then have to practice more and more elaborate compulsive rituals in order to achieve a tension reduction. This can create a kind of addictive effect through which the compulsions spread further and further.

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Prien am Chiemsee / Rosenheim, www.Dr-Elze.de

Dysfunctional cognitions

A major influence in the development and maintenance of obsessive-compulsive disorder is the so-called Dysfunctional cognitions attributed to. Various so-called Thought traps can be distinguished, e.g .:

  • Overestimating the consequences of one's own actions: Those affected overestimate the consequences of their actions, e.g. "If I leave the stove on, the house will burn down!" (or “... I will bring catastrophic calamity to myself and my family!”).

  • Overestimate probability of occurrence of events: Those affected overestimate the likelihood that a feared event will occur, e.g. “If I don't lock the door, the house will be robbed!”.

  • Overestimate your own responsibility: Those affected overestimate their own responsibility for certain consequences, e.g. "If I haven't wiped the doorknob, I'll be responsible if someone else becomes infected with it!"

  • Overestimate the importance of obsessive-compulsive thoughts: Those affected overestimated the importance of their obsessive thoughts, e.g. “If I just think about ..., ... will happen!”.

  • Strive for security or control: Those affected try to achieve “100%” security or control, e.g. “If I have sorted the books, I can pass the exam!”).

  • Create magical shortcuts: Those affected develop magical connections such as “If I touch the fence post, nothing will happen to my wife!”.

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Prien am Chiemsee / Rosenheim, www.Dr-Elze.de

Neurobiological Models

It will be different neurobiological models discussed regarding possible causes of obsessive-compulsive disorder. In particular, changes in serotonin metabolism and abnormalities in certain brain structures are discussed in connection with obsessive-compulsive disorder.

Neuroanatomical Models

In the neuroanatomical models In the case of obsessive-compulsive disorder, a disorder in the orbitofrontal cortex or in the area of ​​the basal ganglia is discussed. Overactivity of the orbitofrontal cortex and / or impaired modulatory function of the caudate nucleus is suspected. This assumption is supported by the observation that neurological diseases associated with damage to the basal ganglia (e.g. chorea minor, Gilles de la Tourette syndrome) can lead to the occurrence of obsessive-compulsive symptoms in those affected.

Serotonin hypothesis

Based on studies of the effectiveness of various drugs, it was hypothesized that the Serotonin reuptake inhibition (e.g. by SSRI or clomipramine) can bring about an improvement in the obsessive-compulsive symptoms. Substances such as the 5-HT1A partial agonist buspirone also seem to have a positive effect on obsessive-compulsive symptoms. In contrast, noradrenaline reuptake inhibition does not appear to have any relevant influence on the obsessive-compulsive disorder.

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Prien am Chiemsee / Rosenheim, www.Dr-Elze.de

Compulsions as a drug side effect

The above hypothesis that neurobiological factors can be a possible cause of obsessive-compulsive disorder is also confirmed by the fact that certain drugs can trigger obsessive-compulsive symptoms as a side effect. Corresponding side effects have been described for certain neuroleptics such as clozapine and olanzapine.

© Dr. Sandra Elze & Dr. Michael Elze

Prien am Chiemsee / Rosenheim, www.Dr-Elze.de


Obsessive-compulsive disorder: reference books

  • Baer L (2001). The Imp of the Mind. New York: Plume / Penguin.
    German translation: Baer L (2016). The leprechaun in your head. 4th edition. Göttingen / Bern: Hogrefe.
  • Hyman BM, Pedrick C (2013). Obsessive Compulsive Disorder workbook. Lichtenau: Probst.
  • Moritz S, Hauschildt M (2016). Successful against obsessive-compulsive disorder. Heidelberg: Springer.
  • Winston S, Seif M (2017). Overcoming Unwanted Intrusive Thoughts. Oakland: New Harbinger.

Obsessive-compulsive disorder: guidelines

Last update: 03.01.2021

Article authors: Dr. Sandra Elze & Dr. Michael Elze

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© Dr. Sandra Elze & Dr. Michael Elze

Prien am Chiemsee / Rosenheim, www.Dr-Elze.de