Parents don’t cause OCD in their children by some flaw in their parenting abilities. OCD isn’t caused by how you talk with your kids or don’t talk with them, or how you discipline them. And it doesn’t matter whether or not both parents work, there is a stay-at-home Mom or Dad, the parents are divorced or a parent remarries after divorce. Stress may make OCD worse in a child already predisposed to the condition, but your actions didn’t cause the OCD.
Using neuroimaging technologies in which pictures of the brain and its functioning are taken, researchers have been able to demonstrate that certain areas of the brain function differently in people with OCD compared with those who don’t. Research findings suggest that OCD symptoms may involve communication errors among different parts of the brain, including the orbitofrontal cortex, the anterior cingulate cortex (both in the front of the brain), the striatum, and the thalamus (deeper parts of the brain). Abnormalities in neurotransmitter systems – chemicals such serotonin, dopamine, glutamate (and possibly others) that send messages between brain cells – are also involved in the disorder.
The Gene Connection
A study funded by the National Institutes of Health examined DNA, and the results suggest that OCD and certain related psychiatric disorders may be associated with an uncommon mutation of the human serotonin transporter gene (hSERT). People with severe OCD symptoms may have a second variation in the same gene. Other research points to a possible genetic component as well. About 25% of OCD sufferers have an immediate family member with the disorder. In addition, twin studies have indicated that if one twin has OCD, the other is more likely to have OCD when the twins are identical, rather than fraternal. Overall, studies of twins with OCD estimate that genetics contributes approximately 45-65% of the risk for developing the disorder.
It’s difficult to precisely estimate the chances that a parent will pass OCD on (i.e., genetically) to his or her child, even if one of the parents has OCD or has a family history of OCD. In most cases, the chances are small that your children will have OCD. If you’re a prospective parent and have concerns about whether your future children could inherit OCD, it’s best to talk with your doctor. Many major medical centers have genetics counselors on staff or by referral who can discuss this issue with you. The genetics of OCD is an area of active research, and new developments appear frequently.
Other Factors That May Contribute to the Onset of OCD
A number of other factors may play a role in the onset of OCD, including behavioral, cognitive, and environmental factors. Learning theorists, for example, suggest that behavioral conditioning may contribute to the development and maintenance of obsessions and compulsions. More specifically, they believe that compulsions are actually learned responses that help an individual reduce or prevent anxiety or discomfort associated with obsessions or urges. An individual who experiences an intrusive obsession regarding germs, for example, may engage in hand washing to reduce the anxiety triggered by the obsession. Because this washing ritual temporarily reduces the anxiety, the probability that the individual will engage in hand washing when a contamination fear occurs in the future is increased. As a result, compulsive behavior not only persists but actually becomes excessive.
Many cognitive theorists believe that individuals with OCD have faulty or dysfunctional beliefs, and that it is their misinterpretation of intrusive thoughts that leads to the creation of obsessions and compulsions. According to the cognitive model of OCD, everyone experiences intrusive thoughts. People with OCD, however, misinterpret these thoughts as being very important, personally significant, revealing about one’s character, or having catastrophic consequences. The repeated misinterpretation of intrusive thoughts leads to the development of obsessions. Because the obsessions are so distressing, the individual engages in compulsive behavior to try to resist, block, or neutralize them.
The Obsessive-Compulsive Cognitions Working Group, an international group of researchers who have proposed that the onset and maintenance of OCD are associated with maladaptive interpretations of cognitive intrusions, has identified six types of dysfunctional beliefs associated with OCD:
1. Inflated responsibility: a belief that one has the ability to cause and/or is responsible for preventing negative outcomes;
2. Overimportance of thoughts (also known as thought-action fusion): the belief that having a bad thought can influence the probability of the occurrence of a negative event or that having a bad thought (e.g., about doing something) is morally equivalent to actually doing it;
3. Control of thoughts: A belief that it is both essential and possible to have total control over one’s own thoughts;
4. Overestimation of threat: a belief that negative events are very probable and that they will be particularly bad;
5. Perfectionism: a belief that one cannot make mistakes and that imperfection is unacceptable; and
6. Intolerance for uncertainty: a belief that it is essential and possible to know, without a doubt, that negative events won’t happen.
Environmental factors may also contribute to the onset of OCD. For example, traumatic brain injuries have been associated with the onset of OCD, which provides further evidence of a connection between brain function impairment and OCD.
Sudden Onset of OCD Symptoms
Note: The information in this section is adapted from the article “Sudden and Severe Onset OCD – Practical Advice for Practitioners and Parents” by Dr. Michael Jenike and Susan Dailey. The full article is available in the Expert Perspectives section of this web site.
Some parents have reported that OCD symptoms occurred almost overnight, as if a switch were flipped; their child went to bed as the child they knew and woke up a stranger. For many years, this sudden onset of symptoms has been thought to occur in conjunction with a strep infection, which triggers OCD and/or tic symptoms in children who are genetically predisposed to the disorder. This type of sudden-onset OCD came to be known as Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections, or PANDAS.
In the more recent past, researchers and clinicians have found that although strep can be a trigger for OCD, it may not be the only trigger. Non-strep diseases such as Lyme disease, mononucleosis and the flu virus (e.g., H1N1) may also cause similar neuropsychiatric illnesses in vulnerable children. As a result, researchers have changed the name of the disease to Pediatric Acute-Onset Neuropsychiatric Syndrome, or PANS. The two major criteria for PANS are (1) an abrupt and dramatic onset of OCD symptoms that is associated with significant impairment, and (2) the simultaneous, rapid onset of other symptoms from at least two of seven categories: anxiety, emotional instability and/or depression; irritability, aggression, and/or oppositional behaviors; behavioral regression; sudden deterioration in school performance; sensory or motor abnormalities, especially handwriting difficulties; and somatic, or physical signs and symptoms.
Currently, PANDAS and PANS are extremely under researched. Until the time that appropriate treatment targeted specifically at PANS is available, treatments traditionally implemented in the treatment of PANDAS (e.g., antibiotics, exposure and response prevention, selective serotonin reuptake inhibitors) may be beneficial, depending upon the individual needs of the child.
In sum, although the definitive cause or causes of OCD have not yet been identified, research continually produces new evidence that hopefully will lead to more answers. It is likely, however, that a delicate interplay between various risk factors over time is responsible for the onset and maintenance of OCD.
If Your Child Does Have OCD – Next Steps
If your child does have OCD, what matters most is what you do about it rather than dwell on what may have caused it. Your child is suffering, and you can help him or her get relief from OCD symptoms.
Effective treatment is available for your child, and you will need to learn how to help your child manage his or her OCD symptoms. Talk with your doctor about treatment, and also read the information on this web site about choosing a therapist.
There really is light at the end of the tunnel, and many thousands of children who have OCD really do learn to control the “monsters” in their heads.