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Automatic compulsions may be the precursors to obsessive compulsive disorder (OCD), and obsessive thoughts arise from a need to justify this seemingly irrational behavior. These are the findings of a study by the University of Amsterdam (UvA) in collaboration with the University of Cambridge, which were recently published in the prestigious 'American Journal of Psychiatry'.

Automatic compulsions may be the precursors to obsessive compulsive disorder (OCD), and obsessive thoughts arise from a need to justify this seemingly irrational behavior. These are the findings of a study by the University of Amsterdam (UvA) in collaboration with the University of Cambridge, which were recently published in the prestigious American Journal of Psychiatry. This new scientific evidence challenges a popular conception that behaviour characteristic of OCD, such as repetitive hand-washing, are a response to obsessive fears.

OCD is characterised by anxious obsessive thoughts and repetitive, ritualistic compulsions that interfere with daily life and cause severe suffering. Until now, it was assumed that compulsive behaviours result from obsessive thoughts. Excessive washing or cleaning by patients was considered a targeted action to reduce the fear of contamination or infection. The researchers from the UvA and the University of Cambridge have doubts about this prevailing view. Their research results suggest that the relationship is the other way around: automatic compulsions are the precursors to the disorder, and obsessive thoughts arise from a need to justify this seemingly irrational behavior.

Habit-like behaviour

The research was led by Sanne de Wit, a researcher at the Cognitive Science Center Amsterdam and the Developmental Psychology programme group at the UvA, and Gillan and Claire Trevor Robbins of the University of Cambridge’s MRC/Wellcome Trust Behavioural and Clinical Neuroscience Institute. The team examined 20 OCD patients and 20 control subjects (without OCD) performing a task which looked at the tendency to develop habit-like behaviour. Subjects were required to learn simple associations between stimuli, behaviours and outcomes in order to win points in a task. The researchers found that patients suffering from the disorder had a tendency to continue to respond regardless of whether or not their behaviour produced a desirable outcome. In other words, this behaviour was habitual. The discovery that compulsive behaviour – the irresistible urge to perform a task – can be observed in the laboratory, in the absence of any related obsessions, suggests that compulsions may be the critical feature of OCD.

Effective treatment

The study provides an important insight into the development of compulsive behavior and could lead to more effective treatment and preventive interventions. One of the most effective current treatments is cognitive behavioral therapy (CBT), which involves a method known as ‘exposure and response prevention’. This therapy focuses on preventing compulsive behaviour (e.g. excessive hand washing) challenging patients to see that the feared consequence does not occur, whether or not the behaviour is performed. The efficacy of this treatment is consistent with the idea that compulsions, not obsessions, are the critical component of OCD. Once the compulsion is stopped, the obsession normally fades away.

Publication Details

C.M. Gillan, M. Papmeyer, S. Morein-Zamir, B.J. Sahakian, N.A. Fineberg, T.W. Robbins, S. de Wit: ‘Disruption in the Balance Between Goal-Directed Behavior and Habit Learning in Obsessive-Compulsive Disorder’, in: American Journal of Psychiatry (mei 2011).