Intrusive thoughts can lead to schizophrenia

Psychiatry, Psychosomatics & Psychotherapy

According to current knowledge, several factors always play a role in the development and maintenance of an obsessive-compulsive disorder - psychological and biological. It differs from person to person as to which of the individual factors are relevant to what extent.

Genetic predisposition

Studies show that genetics play a role in some of those affected, although the hereditary component is less pronounced than in schizophrenia, for example. Gene and environmental effects (e.g. life events) show diverse interactions. A familial accumulation has been observed several times, 3 to 12% of the first-degree relatives (siblings, parents or children) also suffer from an obsessive-compulsive disorder, between 8 and 30% show at least certain obsessive-compulsive symptoms or compulsive behaviors.

Organic brain / neurobiological factors

There are several indications that organic brain factors are involved in some of those affected. For example, some patients with neurological diseases in which certain areas of the brain (basal ganglia) are involved - such as tic disorders - also show obsessive-compulsive symptoms. Imaging studies indicate a change in brain metabolism and brain activity in certain areas. It is still unclear whether the changes in brain metabolism and activity are a cause of the obsessive-compulsive disorder or just a side effect. But what is well documented: the abnormal brain activities normalize again when the person concerned has been treated successfully.

Psychological explanatory models

Various psychological influencing factors can play a role, in particular: upbringing, unsettling and / or traumatizing experiences in childhood, later negative life events and also the personality of the person concerned are among them. The upbringing to be very clean or too little freedom for the child to make their own decisions can contribute to later constraints. Even unfavorable ways of dealing with initial constraints can lead to them being maintained. This includes, in particular, strong avoidance behavior, which prevents those affected from finding out that nothing bad happens even without performing the compulsory rituals. Over time, the compulsions (generalization) spread more and more, so that the compulsive rituals often persist for years or decades without adequate therapy.

A well-known psychological explanatory model emphasizes the aspect of evaluating and processing intrusive thoughts (cognitive model). After that, unpleasant and intrusive thoughts, such as the fear of running over a pedestrian while driving, are not problematic in themselves. They occur occasionally in most people, but are ignored and therefore have no consequences. In people who react particularly strongly to this, e.g. with feelings of fear and guilt, such thoughts can solidify and determine actions. For example, the same route is then traveled several times to check whether the fear could be true. Obsessive-compulsive patients often have a high sense of responsibility, greatly exaggerate risks and / or doubt whether they can trust their own perception at all ("Did I really see that the iron was off when I left the house?" Wasn't there someone lying on the side of the road? Wasn't there still dirt on my skin after all? "). So-called neuropsychological deficits may play a role here; For example, some obsessive-compulsive patients have a weakness in visual memory, i.e. in remembering what one has seen.