PSYCHOLOGICAL EXPLANATIONS OF OBSESSIVE COMPULSIVE DISORDER
To read up on the psychological explanations of obsessive compulsive disorder, refer to pages 529–536 of
Eysenck’s A2 Level Psychology.
Ask yourself
 How would the psychodynamic approach explain obsessive compulsive
disorder (OCD)?
 How would the behavioural approach explain OCD?
 How would the cognitive approach explain OCD?
What you need to know
PSYCHODYNAMIC
EXPLANATION


BEHAVIOURAL
EXPLANATION
Psychodynamic
explanations,
beginning with
Freud
Evaluation

Research
evidence
and
evaluation
COGNITIVE
EXPLANATION

Research
evidence
and
evaluation
SOCIAL
EXPLANATION


Life events
Research
evidence
and
evaluation
Psychodynamic explanation
Psychodynamic explanations of obsessive compulsive disorder originate with Freud, but have since been
developed by other psychodynamic theorists. The ego (the conscious, rational mind) of patients with OCD
is disturbed by their obsessions and compulsions, and this leads them to use ego defence mechanisms
including isolation, undoing, and reaction formation.
 Isolation: patients regarding their unwanted thoughts as being alien and not


belonging to them.
Undoing: an undesirable impulse can be cancelled out by performing certain
acts, e.g. patients who have undesirable sexual impulses may clean
themselves to undo this impulse.
Reaction formation: the patient adopts a lifestyle that is completely
opposite from that suggested by their undesirable impulses. For example,
practising celibacy to repress obsessive sexual desires.
Freud argued that OCD is linked to the anal stage of development, which occurs at about 2 years of age,
because during this stage children are toilet trained. A major conflict within the child between wanting to
soil his or her clothes and wanting to retain faeces can occur if parents are too harsh and make the child feel
dirty and ashamed. The child may deliberately soil his or her clothes as an act of rebellion. This conflict
over cleanliness can lead to OCD. Freud (1949, see A2 Level Psychology page 530) also argued anxiety
was linked to sexual restriction.
EVALUATION OF THE PSYCHODYNAMIC EXPLANATION
 No scientific evidence. The explanation that conflicts over toilet training
escalate into OCD has no empirical evidence to support it. This is due to the
fact that Freud’s concepts cannot be operationalised because we cannot
measure how much anxiety comes from sexual restriction or anger over
potty training. This means none of these ideas can be tested and supported
with evidence, and so the explanation lacks scientific validity.
 Generalisability. The explanation only seems relevant to certain obsessions
and compulsions. It lacks relevance for checking or orderliness compulsions
as it is not clear how these relate to toilet training or sexual constraints.
Cause and effect. Any link between toilet training and OCD is just that, an
association, so we cannot establish causation and we cannot say that toilet
training causes OCD. Instead there could be other factors, such as personality
type, that affect both toilet training and OCD.
Behavioural explanation

According to the behavioural explanation, fear in individuals with obsessions and compulsions is triggered
by fear associated with stimuli (e.g. unwashed hands, obsessional thoughts) that are very unlikely to cause
real harm. The compulsive rituals (e.g. hand washing) reduce fear and so this behaviour is reinforced or
rewarded by fear reduction.
RESEARCH EVIDENCE FOR BEHAVIOURAL EXPLANATIONS
 Mowrer (1947, see A2 Level Psychology page 531) developed a two-process
theory: the first process involves classical conditioning whereby a neutral
stimuli becomes associated with threatening thoughts or experiences and
this leads to the development of anxiety, e.g. associate shaking hands with
contamination. The second process involves operant conditioning whereby
the individual discovers that the anxiety is reduced by a particular behaviour,
and so this becomes the compulsion.
 Rachman and Hodgson (1980, see A2 Level Psychology page 531) provide
support for Mowrer’s theory. They found that when patients with OCD were
exposed to situations triggering their obsessions this did result in a high level
of anxiety, and when they performed their compulsive rituals this decreased
their anxiety.
EVALUATION OF BEHAVIOURAL EXPLANATIONS
 Face and scientific validity. The theory that the compulsive rituals reduce
anxiety makes sense (face validity) and is supported by evidence (scientific
validity).
 Exposure and response prevention therapy. These therapies are based on
the behavioural explanations and are highly effective. They therefore support
the validity of the explanations. The exposure and response prevention
therapy involves exposing the patient to the feared stimulus while
preventing them from engaging in their usual anxiety-reducing compulsive
rituals. Through exposure they learn from experience that their fears and
anxieties are groundless, and so their compulsive rituals aren’t needed.
 Reductionist. Behavioural explanations are oversimplified because they
only account for learning and ignore other important aspects such as genetic
factors, cognition, and evolved predisposition.
 Don’t explain obsessions. The behavioural explanations do not account for
obsessive thinking because the behavioural approach does not account for
cognition.
 Environmental determinism. The behavioural explanations are
deterministic because they suggest that behaviour is controlled by the
environment, which ignores the individual’s ability to control their own
behaviour.
 Explain maintenance better than cause. Behavioural explanations don’t
really offer a clear account of how the obsessions and rituals of OCD originate
in the first place, and so do not account for cause. The behavioural
explanations do explain maintenance, as they account for why the OCD
persists (because the compulsions reduce anxiety) and so they account for
maintenance better than they account for the cause.
 Nature vs. nurture. Behavioural explanations account for nurture only as,
according to these, behaviour is solely a product of learning as we are born
as a blank slate (tabula rasa). They ignore nature, which is a significant
weakness as the evolutionary explanation suggests certain stimuli are more
likely to be conditioned than others.
 Lack explanatory power. Behavioural explanations don’t explain why so
many of the rituals of obsessive patients relate to washing and checking
rather than to other possible ritualised forms of behavior; as indicated in the
bullet point above, we may need to use evolutionary explanations to account
for this.
 Multi-dimensional approach. As not all forms of OCD can be explained by
conditioning, other processes must be involved, such as biological
preparedness as suggested by the evolutionary approach. So to understand
OCD an interaction of different factors must be considered.
Cognitive explanation
According to the cognitive perspective, OCD patients have an inflated sense of personal responsibility and
so feel they must carry out their compulsive rituals to avoid adverse consequences, and this is their key
cognitive error. Salkovskis (1996, see A2 Level Psychology page 532) explains the compulsions are based
on cognitive errors. He draws from the behavioural approach, in saying that compulsions are rewarded or
reinforced by immediate reduction of distress or anxiety. The carrying out of the compulsive rituals mean
that OCD patients never get to test out their faulty thinking and realise there is not a dire consequence if
they make a mistake. This resembles the behavioural explanation but more emphasis is given to the
cognitive processes involved.
RESEARCH EVIDENCE FOR COGNITIVE EXPLANATIONS
 Buttolph and Holland (1990, see A2 Level Psychology page 532) found that
69% of female patients with obsessive compulsive disorder had the onset or
worsening of symptoms during pregnancy or childbirth, which is consistent
with the inflated sense of personality theory because clearly the birth of a
child is an enormous responsibility for the well-being of their child.
 Neziroglu et al. (1992, see A2 Level Psychology page 532) found that 39% of
female patients with obsessive compulsive disorder with children reported
an onset of the disorder during pregnancy.
Abramowitz’s review (2006, see A2 Level Psychology page 532) of the faulty
cognitions shown by obsessive compulsives also supports the exaggerated
sense of personal responsibility explanation because such cognitive errors
include the belief that thoughts can help to cause events (called thought–
action fusion), e.g. “If I wish someone dead, that increases the chances they
will die”; and the belief that mistakes and imperfection are intolerable and so
they have a responsibility to be perfect, e.g. “I must ensure that I always do
the right thing”.
RESEARCH EVIDENCE AGAINST COGNITIVE EXPLANATIONS
 Tallis (1995, see A2 Level Psychology page 532) challenges the inflated sense
of personal responsibility explanation because, if this was the only factor
involved in obsessive compulsive disorder, many more people would suffer
from it.
EVALUATION OF COGNITIVE EXPLANATIONS
 Face and scientific validity. Patients with OCD do have the faulty cognitions
often surrounding their sense of personal responsibility so this explanation
makes sense (face validity). It is also supported by empirical evidence and
therefore has scientific validity.
 Self-report criticisms. Research into cognitive factors relies on self-report,
e.g. the research whereby patients reported their symptoms developing
during pregnancy. Such report is retrospective and so may not be accurately
recalled. Furthermore, the self-report method yields subjective data as it is
vulnerable to bias and distortion as a consequence of researcher effects and
participant reactivity, e.g. patients may prefer to accept pregnancy as an
explanation over other possible origins. Thus, the findings may be biased,
and therefore not true, and so have limited validity.
 Lack explanatory power. The cognitive account does not explain why
patients with OCD accept excessive responsibility for negative outcomes but
not for positive ones. Nor does it explain why most of the compulsive rituals
of these patients revolve around washing and checking, so it lacks
explanatory power.
 Cause or effect? The evidence that negative cognitions precede the disorder
is not convincing. It is entirely possible that having OCD leads to
dysfunctional beliefs, and it may be that having dysfunctional beliefs doesn’t
play any role in the development of OCD. Thus, the direction of effect is not
clear. In addition, cause and effect cannot be established anyway from
correlational evidence.
 Descriptive, not explanatory. The research describes the nature of the
thoughts of OCD patients rather than explaining the development of OCD
because it is not clear what causes the negative cognitions in the first place,
other than that some are triggered by pregnancy, but this is not true of all
cases.
 Reductionism and multi-dimensional approach. To account fully for OCD
it is necessary to consider how cognition interacts with other approaches.
For example, faulty thinking could be due to an interaction of biological and
social factors, which are ignored by the cognitive approach and so it is too
simplistic (reductionist).
Social explanation: Life events
There is some evidence that life events play a role in the development of OCD.
RESEARCH EVIDENCE FOR LIFE EVENTS
 Khanna, Rajendra, and Channabasavanna (1988, see A2 Level Psychology
page 534) discovered that patients with OCD had experienced significantly
more negative life events than healthy controls in the 6 months prior to the
onset of the disorder.
RESEARCH EVIDENCE AGAINST LIFE EVENTS
 McKeon, Roa, and Mann (1984, see A2 Level Psychology page 534) took
account of whether the patient had had an anxious or non-anxious
personality before the onset of OCD. Patients with an anxious personality did
not experience any more life events than healthy controls whereas those
with a non-anxious personality experienced three times as many life events
as healthy controls in the 12 months before the onset of disorder.
EVALUATION OF LIFE EVENTS
 Life events or an anxious personality? These findings suggest that life
events or an anxious personality are possible causes of OCD. The life event
may not immediately precede the disorder. Saunders et al. (1992 see A2 Level
Psychology page 534) found that those who had experienced childhood
sexual abuse were about five times more likely than non-abused individuals
to develop OCD.
 Research on life events is correlational so cause and effect cannot be
inferred. We do not know if the life event(s) triggered the OCD or if the OCD
led to the life event. For example, individuals who are very anxious and
stressed a few months before developing OCD may help to create life events
such as losing their job or marital separation.
 Bias and distorted recall. A further weakness of the research is that it is
based on retrospective self-report so internal validity may be reduced due to
bias and distorted recall.
 Failure to contextualise. A final concern is that the life event research fails
to contextualise. For some people a life event may not be stressful, e.g. a
marital separation that was desired may even reduce stress, so the wider
context of individual patients needs to be considered.
So what does this mean?
Now that we have covered psychological factors, it is no doubt clear there are numerous possible
contributing factors to OCD, which of course makes it all the more difficult to explain the disorder.
The diathesis–stress model offers a more comprehensive account because it combines the influence of
nature (genetic predisposition, personality) and nurture (conditioning, social learning, and stress). For
example, temperament is partly genetically predisposed and this may influence biochemistry, social
learning, and cognitive biases. Further research is needed to understand how the various biological and
psychological factors interact. The interaction of biological and psychological factors in the diathesis–stress
model better accounts for individual differences, particularly in those who share genes in common, such as
identical twins where one develops OCD and the other doesn’t. The diathesis–stress model can explain this
because, whilst both twins will have inherited the genetic component, they may experience different
learning or stressful life events.
Over to you
1. Outline and evaluate one or more psychological explanation(s) of one anxiety disorder. (25 marks)