Anxiety Disorders 305
Psychological Factors
Psychological factors that help to explain OCD focus primarily on the way that op-
erant conditioning affects compulsions and on the process by which normal obses-
sional thoughts become pathological.
Behavioral Explanations: Operant Conditioning and Compulsions
Compulsive behavior can provide short-term relief from anxiety that is produced
by an obsession. Operant conditioning occurs when the behavior is negatively rein-
forced: Because it (temporarily) relieves the anxiety, it is more likely to recur when
the thoughts arise again. All of Howard Hughes’s various eccentric behaviors—his
washing, his precautions against germs, his exerting control over the minute specifi cs
of his memos (in “Notes on Notes”), his hoarding of newspapers and magazines—
temporarily relieved his anxiety.
Cognitive Explanations: Obsessional Thinking
If you’ve ever had a crush on someone or been in love, you may have spent a lot
of time thinking about the person—it may have even felt like an obsession. Such
obsessions arise surprisingly frequently (Weissman et al., 1994), but they don’t usu-
ally develop into a disorder. One theory about how a normal obsession becomes
part of OCD is that the person decides that his or her thoughts refer to something
unacceptable, such as killing someone or, as was the case with Howard Hughes,
catching someone else’s illness (Salkovskis, 1985). These obsessive thoughts, which
the individual believes imply some kind of danger, lead to very uncomfortable feel-
ings. Mental or behavioral rituals arise in order to reduce these feelings. A related
theory is that for some people who develop OCD, a disturbing thought is the moral
equivalent of actually performing the act, which leads to greater distress in re-
sponse to the initial obsession (Rachman, 1997; Shafran, Thordarson, & Rachman,
1996). Both theories contrast a normal response to “unacceptable” thoughts (an
awareness that such thoughts don’t need to be controlled and an ability to let them
fade from consciousness) with the belief of OCD patients that such thoughts must
be controlled—and trying to do so amplifi es the thoughts (Tolin, Worhunsky, &
Maltby, 2006).
Consistent with this theoretical approach, researchers have found that somemental processes function differently in people with OCD than in people without
the disorder. In particular, such patients are more likely to pay attention to and re-
member threat-relevant stimuli, and their processing of complex visual stimuli (as,
for example, is necessary to decide whether an object has been touched by a dirty
or clean tissue among people with contamination fears) is impaired (Constans et al.,
1995; Muller & Roberts, 2005; Radomsky, Rachman, & Hammond, 2001). Such
processing may make threatening stimuli easier to remember and harder to ignore,
which keeps them in the patients’ awareness longer (Muller & Roberts, 2005).
Studies of memory also fi nd that those with the checking type of OCD and those
in a control group had equally accurate memories, but the OCD patients had less
confi dence in the accuracy of their recognition memories (MacDonald et al., 1997;
McNally & Kohlbeck 1993; Muller & Roberts, 2005). Thus, because they are more
likely to doubt their memories, they are more likely to want to go back and check.
Social Factors
Two types of social factors can contribute to OCD. One is stress, which can infl u-
ence the onset and course of the disorder; the other is culture, which can infl uence
the particular content of symptoms.
Stress
The onset of OCD often follows a stressor, and the severity of the symptoms is often
proportional to the severity of the stressor (Turner & Beidel, 1988), which might
range from taking a vacation at one end to the death of a family member at the
other. However, such fi ndings are not always easy to interpret. For example, one
study found that people with more severe OCD tend to have more kinds of family