Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by obsessions and related compulsions. Obsessions are intrusive, repetitive thoughts and images that appear uncontrollable. For instance, one might repeatedly experience an idea of germs lurking everywhere. The forms of obsessions include wishes, impulses, images, and ideas. Common themes of obsessions are dirt or contamination, orderliness, violence, aggression, and sexuality. because obsessions are persistent and upsetting, people with OCD commonly experience distress and anxiety that impairs their daily functions. One’s efforts to ignore or reduce these thoughts frequently results in increased anxiety. Despite their failure to ignore repetitive thoughts, people with OCD are usually aware of the unreasonable and excessive characteristics of their obsessions.

Compulsions are irresistible impulses to repeat a ritualistic act or acts. Though minor compulsions like washing one’s hands regularly are common in many people’s lives, people with OCD spend a great amount of time engaging in compulsive behaviors. The recurring and rigid behaviors are performed to prevent or reduce anxiety caused by obsessions, and anxiety does typically decrease after performing the acts. However, the activity may not be a realistic manifestation of its apparent purpose. For instance, a person may feel it is necessary to count to 50 to purify her food before eating it. Compulsions take various forms. Some examples of compulsions are cleaning, checking (checking items over and over to make sure they are right such as checking that the doors are locked), touching (touching or avoiding the touching of certain objects), and counting.

Most people with OCD experience both obsessions and compulsions, though some experience only one of these symptoms. It is estimated that about 1 to 2 percent of adults in the United States have OCD (Kessler, Berglund, Demler, Jin, & Walters, 2005). OCD is equally common in men and women. The onset of OCD usually happens in young adulthood.

Explanations for OCD are varied. Abnormally low activity of serotonin (a chemical messenger in the brain) may be associated with OCD. The finding by researchers (e.g., Julien, 2007) that antidepressants such as clomipramine and fluoxetine (Anafranil and Prozac) reduce the symptoms of OCD supports this view because thes antidepressants increase serotonin activity. Another promising line of research from the biological perspective focuses on two areas of the brain, the orbitofrontal cortex (above each eye) and the caudane nuclei, part of the basal ganglia. The theory that these regions are too active in people with OCD is supported by research indicating that symptoms of OCD either originate or diminish after damage to one of these areas (e.g., Coetzer, 2004). Another perspective on causal explanation comes from cognitive theorists. Their view is that while most people have obsessive thoughts, people with OCD interpret them in maladaptive ways; they may believe that their recurring thoughts are somehow “bad” — perhaps morally wrong or dangerous (e.g., Salkovskis, 1985). To alleviate the obsessive thoughts, they perform compulsive behaviors. The compulsions reduce the anxiety and are therefore reinforced. Eventually, a pattern develops.

OCD is commonly treated with some antidepressant medications, particularly ones that increase serotonin activity and that regularize activity in the orbitofrontal cortex and caudate neuclei (Baxter et al., 2000). The success of these medications is moderate or better. Another helpful treatment is exposure with response prevention (a behavioral technique), in which clients are exposed to anxiety-producing situations related to their obsessions and compulsions. Some research suggest that combinations of effective treatment lead to better success than does using a single treatment.

  • Bell, J. (2007). Rewind, replay, repeat: A memoir of obsessive-compulsive disorder. Center City, MN: Hazelden.
  • Colas, E. (1999). Just checking: Scenes from the life of an obsessive-compulsive. New York: Washington Square Press.
  • National institute of Mental Health. (2009), Obsessive-compulsive disorder. Retrieved from http://www.nimh.nih.gov/health/publication/anxiety-disorders/complete-index-shtml#pub3
  • Baxter, L.R., Jr., Ackermann, R.F., Swerdlow, N.R., Brody, A., Saxena, S., Schwartz, J.M., et al. (2000). Specific brain system mediation of obsessive-compulsive disorder responsive to either medication or behavior therapy. In W.K. Goodman, M.V. Rudorfer, & J.D. Maser (Eds.), Obsessive-compuslive disorder: Contemporary issues in treatment (pp. 573 – 608). Mahwah, NJ: Lawrence Erlbaum Associates.
  • Coetzer, B.R. (2004). Obsessive-compulsive disorder following brain injury: A review. International Journal of Psychiatric Medicine, 34, 363 – 377.
  • Julen, R.M. (2007). A primer of drug action (11th ed.). New York: Worth.
  • Kessler, R.C., Berglund, P., Demler, O., Jin, R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distribution of DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 62, 593 – 602.
  • Since cognitive science Opens in new window has taken on board this commonsense view of the mind, an important question is how such a relationship to a proposition can be implemented.

    The representation theory of mind (RTM; Field, 1978; Fodor, 1978) assumes that a propositional attitude consists in holding a representation of the proposition and that this representation plays a certain functional role in the economy of mental states. This can be best illustrated with the two core concepts: belief and desire.

    These are core concepts, since knowing what someone believes (thinks) to be the case (e.g., Max thinking the chocolate is in the cupboard and thinking that going there will get the chocolate into his possession) and what that person desires (wants) (e.g., Max wanting the chocolate to be in his possession) allows us to make a behavioral prediction that Max will approach the cupboard. This kind of inference is known since Aristotle as the practical syllogism.

    Searle (1983, after Anscombe, 1957) points out that these two states are mirror images in terms of causal direction and direction of fit. The function of a belief is to be caused by reality and the believed proposition should match reality.

    For instance, the chocolate being in the cupboard should be responsible for Max’s believing that the chocolate is in the cupboard (world to mind causation) and the proposition “the chocolate is in the cupboard” should thus match the relevant state of affairs in the world (mind should fit world).

    The function of desire (want) is to cause a change in the world (mind to world causation) so that the world conforms to the desired proposition (world should fit mind)—for example, if Max wants the chocolate to be in the cupboard, then this desire should cause action leading to a change of the chocolate’s location such that it conforms to what Max desires.

    This trivial-sounding example does highlight the important distinctions.

    Three Important Distinctions

    1. First vs. Third Person

    One important distinction is between first-person and third-person attribution of mental states. A third-person attribution is an attribution to another person and a first-person attribution is one to myself.

    For instance, if Max erroneously believes that the chocolate is still in the cupboard (because he didn’t see that it was unexpectedly put into the drawer), then a third-person observer will attribute a false belief to Max. In contrast, Max himself will make a first-person attribution of knowledge to himself.

    The observer can capture this difference between her own and Max’s subjective view by the second-order attribution that Max thinks he knows where the chocolate is. This is useful to keep in mind when it comes to false memories. Since a memory can only be a recollection of something that actually occurred, a false memory is not a memory by third-person attribution, although it is by first-person attribution.

    1. Sense and Reference

    A related second point has to do with Frege’s (1892/1960) distinction between sense and reference. Since mental states involve representations, they connect us to objects and events in the real (or a possible) world.

    Famously, Oedipus knew and married Iocaste (referent: a particular person), but he did not know or marry her as his mother but as an unrelated queen (sense: how Iocaste was presented to Oedipus’ mind).

    Thus, in third-person parlance we can say that Oedipus married his mother if we use the expression “his mother” to pick out (refer to) the individual whom he married without implying that he knew Iocaste under that description. In first-person description of the event Oedipus would not have used the descriptor “my mother.”

    These distinctions are useful to keep in mind when discussing infants’ ability to remember particular events: Whenever a memory trace of a unique event can be demonstrated then one can conclude (in first-person parlance) as a particular event—that is, that the infant makes cognitive distinctions that represent that event as a particular event.

    1. Having vs. Representing a Mental State

    The third important distinction is that between being in a mental state (or having an attitude) and representing that mental state.

    For understanding or knowing that a person is in a mental state, or to reflect on one’s own mental states, one has to be able to represent that state. In order to be able to represent a state, one needs a concept of that state—that is, a rich enough theory of mind.

    The study of how children acquire the requisite theory of mind is therefore essential for our understanding of how children come to understand memory. Furthermore, since some memorial states are reflective or self-referential, children need a theory of mind for being in such states or having such memories.

    Why We Need a Theory of Mind for Memory

    We probably do not need a theory of mind for implicit (nondeclarative Opens in new window) memory, but for explicit (declarative Opens in new window) memory we do, since “explicit memory is revealed when performance on a task requires conscious recollection of previous experiences.” (Schacter, 1987).

    To be conscious of a fact one requires to be also aware of the state with which one beholds that fact. The higher-order-thought theories of consciousness make this their core claim (Armstrong, 1980; Rosenthal, 1986).

    For instance, if one sees a state of affairs X (e.g., that the chocolate is in the cupboard), then this seeing is a first-order mental state (attitude).

    To be conscious of this state of affairs means, according to theory, that one entertains a second-order thought about the seeing—that is, the second-order thought represents the first-order seeing.

    A weaker version does not require that one has to entertain the second-order thought, but only that one has to have the potential for having the second-order thought (Carruthers, 1996). That some such condition must be true can be seen from the following consideration:

    “Could it ever be that I can genuinely claim that I am consciously aware of the chocolate being in the cupboard, but claim ignorance of the first-order mental state by which I behold this state of affairs—that is, by claiming that I have no clue as to whether I see, or just think of, or want the chocolate being in the cupboard?”

    The important point of these conceptual analyses is that to be conscious of some fact requires some minimal concept of knowledge or of some perceptual state like seeing.

    Unfortunately, there is no clear evidence when children understand a minimal state of this sort. There is some evidence of understanding (mother’s) emotional reactions and seeing (direction of gaze) in the first year of life (see Perner, 1991, chap. 6; Baldwin & Moses, 1996; Gopnik & Meltzoff, 1997, for summaries and discussion of problems of interpretation).

    There is also some recent evidence that between 8 and 12 months children might be inferring people’s intentions to grasp an object from where that person looks (Spelke, Philips, & Woodward, 1995) and even between 5 to 9 months from how a person touches an object (seemingly intentional or accidentally).

    And by 18 months (where children’s understanding of mental phenomena seems to flourish in general) children imitate people’s intended actions even when they observe a failed attempt (Meltzoff, 1955a) and they understand differences in preferences (e.g., that someone else can prefer cauliflower over biscuits, Repacholi & Gopnik, 1997).

    Evidence that children distinguish their knowledge from ignorance is available at a relatively late age. Povinelli, Perilloux, and Bierschwale (1993) asked children to look for a sticker under one of three cups.

    Children were first trained to look under the cup at which the experimenter had pointed. After some training even the youngest were able to do this.

    When asked to look without the experimenter pointing, an interesting developmental difference emerged. Children older than 2 years and 4 months acted without hesitation when they knew which the cup the sticker was under, but hesitated noticeably when—in the absence of the experimenter’s poining—they had to guess where it was.

    Interestingly this is also the age at which children start using the phrase “I don’t know” (Shatz, Wellman, & Silber, 1983). In contrast, children younger than that showed no comparable difference in reaction time. This may indicate that young 2-year-olds do not yet reflect on what they do and do not know.

    So, theory of mind research is not yet able to give a guideline for when infants might develop explicit, conscious memories. Memory development may help out on this point.

    Meltzoff (1985, 1995b) demonstrated that 14-month-old infants can reenact a past event (e.g., they imitate the experimenter leaning forward to touch a panel with forehead so that panel lights up) after several months. Recently this has been demonstrated in 11-month-olds with a delay of 3 months.

    Since this is achieved from a brief observational period and does not require prolonged learning, and since patients with amnesia cannot do this (McDonough, Mandler, KcKee, & Squire, 1995), it is tempting to conclude that such enactment demonstrates explicit, conscious memory.

    One should, though, keep in mind that delayed imitation that is based on a single event (third-person view) is not to be equated with a memory (knowledge) of that event as a single, past event (first-person view).

    Keep on learning:
      Adapted from: The Oxford Handbook of Memory. Authored by ENDEL TULVING (ED.), Fergus I. M. Craik