People with obsessive-compulsive disorder often tend to be overconscientious. This may express itself in the form of an excessive fear of harming other people, or even oneself. This is a good example of how OCD is contrary to sociopathy, where a lack of sound moral judgment is present. The patient with OCD can be said to ’empathize too much’ (at the cost of taking care of one’s own interests), whereas the sociopath lacks feelings of empathy.
This condition is related to what is nowadays called: a sense of inflated responsibility: an all too intense perception of a pivotal role in causing misfortune to oneself or others. A vicious circle occurs, take the OCD dimension of checking: increased checking causes increased feelings of responsibility, and the latter in their turn cause an increase in checking behaviours.
Salkovskis et al (1999) proposed five pathways in child development that potentially can lead to onset of OCD:
- heightened responsibility as a child. A child may grow up in a dysfunctional family, and it can assume the role of a parent, for instance in taking care that a younger sibling gets a proper breakfast and will be in school in time;
- rigid and extreme codes of conduct being imposed in a child;
- overprotective and critical parenting toward a child. In such an upbringing, a child is not able to get a right notion of what ‘sound’ responsibility actually is; it does not get the opportunity to learn step by step what normal responsibility constitutes, e.g. going to school on its own at a certain age, or how choose friends on its own;
- a child may have caused serious misfortune in reality, e.g. in passing on influenza to a younger sibling;
- actions/inactions/thoughts influenced some serious misfortune in a child’s fantasies.
These five items are interrelated; and it is suggested that the speed of onset of OCD in children may depend on which of these occur. If a child infects a sibling with a disease, onset may be quite sudden; whereas having been subject to overprotective parenting, it may rather be a gradual process.
Berle and Starcevic (2005) wrote a review article about a phenomenon that is known as ‘thought-action fusion’ (TAF). This is the assumption that certain thoughts imply the immorality of one’s character, or increase the chance for catastrophic events occurring. The concept of TAF is useful in researching the connection between obsessions and compulsions in depth; hitherto I only mentioned compulsions as having the function to alleviate the fears caused by continuous obsessive thoughts. Psychologists nowadays recognize the importance of underlying beliefs and appraisals in OCD patients. A ‘misguided’ belief may be: if I don’t skip every second row of tiles in the sidewalk, something terrible will occur to me, or to someone else. This is a good example of a wrong appraisal; it is TAF, and in this form it has been studied for a very long time now by anthropologists, psychoanalysts, and psychiatrists. A former term was ‘magical thinking’, and although this description is still in use, its boundaries are unclear.
Berle and Starcevic discern ‘moral TAF’ from ‘likelihood TAF’. The former means simply the conviction that immoral (‘bad’) thoughts equal overt, unacceptable actions; and the latter is the idea that thoughts cause events, with oneself or others as subjects.
These characteristics, which are frequently present in OCD patients, can be the cause of enormous distress and fear, of guilt, and of isolation. Everyone can have ‘bad thoughts’ from time to time, e.g. of an aggressive and/or sexual nature. This certainly does not imply that these thoughts will be transformed into real actions. Normal persons will experience them as fleeting, undesirable, yet unimportant, and direct their attention to other things. Patients, however, may appraise them otherwise: as proof that they are bad, evil persons, who perhaps have a criminal character and maybe even don’t deserve to enjoy life, or to live at all.
A special and dramatic form of fear of harming others can occur in young mothers. Brockington (2004) listed the characteristics of OCD in the puerperium (childbed period, and also shortly thereafter) as follows:
- the young mother may harbour obsessions about infanticide (killing the newborn);
- impulses to attack the child may be present;
- but the above is not equal to the pathological anger that precedes child abuse;
- the mother is gentle and devoted;
- her fantasies may extend to the family situation after the death of the child: funeral, family gatherings, period of mourning, and so on;
- and the medical advice is that she should not avoid contact with her child, and that cuddling it, and playing with it should be encouraged, to increase the positive feelings of motherhood;
- remarkably, a study cited by this author noted 42 cases of OCD in young mothers in a total of 1317 child deliveries – which amounts to 1 in about 30 births, or 3%, and that is equal to the general prevalence of OCD in all people.
I wrote ‘dramatic’ just prior to the above list, and the reader will understand what I meant: a loving and caring young mother may be overwhelmed by these terrible and intrusive thoughts and fantasies. She won’t act them out; but fear and guilt may lead her to avoid contact with her child. This in turn can predispose the newly born to develop mood disorders later in life, e.g. in adolescence and adulthood (researchers call the effects of mother/child separation ‘maternal deprivation syndrome’).