What Causes OCD?

By Dr Sasha Mitrofanov, Ph.D.

As an OCD and anxiety treatment specialist, I am often asked what causes obsessive-compulsive disorder. For many people, OCD can feel confusing and isolating, especially when intrusive thoughts and repetitive behaviours appear to defy logic. In this article, I will explain what we currently understand about the causes of OCD, based on both clinical research and my experience working with clients over the years.

There Is No Single Cause

OCD is a complex condition. It does not arise from one specific cause, but rather from a combination of biological, psychological, and environmental factors. Everyone’s experience with OCD is unique, which is why a personalised approach to treatment is so important.

Brain Function and Structure

Scientific research has shown that individuals with OCD often have differences in how certain parts of the brain function, particularly in the areas responsible for decision-making, emotional regulation, and managing habitual behaviours. The cortico-striato-thalamo-cortical (CSTC) circuit has been shown to be involved in the obsessive-compulsive cycle.

This is not to suggest that OCD is caused by a simple chemical imbalance, but rather that there are patterns in brain activity that can help us understand the condition better. Imaging studies have found increased activity in regions such as the orbitofrontal cortex and the anterior cingulate cortex, which are involved in error detection and threat perception.

Many clients find it reassuring to learn that their symptoms have a neurological basis. Understanding this can help reduce the shame often associated with intrusive thoughts and compulsions. These are not reflections of someone’s character or morality, but symptoms arising from how the brain is functioning.

Genetic Influences

There is evidence that OCD can run in families, suggesting a genetic component. If a close family member has OCD, the likelihood of developing it is slightly increased. However, this is not a certainty. Genetics may influence how the brain responds to stress or processes certain chemicals such as serotonin, which plays a role in mood and anxiety.

In my clinical work, I have supported siblings with OCD who show completely different symptoms. This underlines the fact that while there may be a genetic predisposition, individual experiences and environments play a significant role in how OCD develops.

Early Life and Attachment

Attachment theory informs much of my therapeutic approach. I often explore how early life experiences and emotional environments may contribute to patterns of anxiety and self-monitoring. Some individuals with OCD describe growing up in settings where there was a strong emphasis on being well-behaved, avoiding mistakes, or earning approval through compliance.

This is not about placing blame on parents or caregivers, but recognising that heightened responsibility, perfectionism, or fear of doing something wrong can take root early in life. These patterns often continue into adulthood, becoming embedded in obsessive-compulsive behaviours.

Clients have told me they remember feeling intense guilt or fear as children over small incidents. These early experiences can set the stage for intrusive thoughts and compulsive behaviours later on, particularly when they are not addressed or processed.

Stressful or Traumatic Events

OCD symptoms often become more noticeable or intense during periods of stress. Life transitions such as starting a new job, becoming a parent, or experiencing a loss can all act as triggers. For some, OCD symptoms begin after a specific traumatic incident.

I have worked with individuals who developed contamination fears following a health scare, or intrusive thoughts after a deeply unsettling emotional event. These responses are not uncommon. In such cases, the compulsions may be attempts to regain a sense of control or safety when life feels unpredictable.

Therapeutically, this is where integrating techniques like Exposure and Response Prevention (ERP) and Emotional Freedom Techniques (EFT) can be helpful, as they address both the behavioural patterns and the underlying emotional distress.

Thinking Styles and Personality Traits

Certain cognitive styles are more common in people with OCD. These include:

• Difficulty tolerating uncertainty

• Perfectionism

• An inflated sense of responsibility

• Believing that having a thought is morally equivalent to acting on it

These thinking patterns are often well established by the time someone seeks help, and they can be exhausting to live with. Through Cognitive Behavioural Therapy (CBT), combined with elements of NLP and EFT, I help clients gently challenge these beliefs and learn new ways of relating to their thoughts without fear or judgement.

It is important to emphasise that these traits are not faults. Many people with OCD are highly conscientious and sensitive. These same qualities, when better understood, can become strengths in the recovery process.

My Approach to Treating OCD

OCD can be effectively treated using Cognitive Behavioural Therapy (CBT) with Exposure and Response Prevention (ERP) at its core. While highly effective, ERP can feel emotionally intense, as it involves confronting the fears that drive compulsive behaviours. That’s why I integrate energy psychology methods into the process, particularly Emotional Freedom Techniques (EFT).

EFT offers tools such as the Tearless Trauma technique and the Movie Technique, which can significantly reduce the distress experienced during exposure. I often liken it to going to the dentist, treatment is necessary either way, but EFT can serve as the emotional anaesthetic that makes the process much more manageable.

EFT also includes self-soothing practices that clients can use between sessions, enhancing self-care and building personal empowerment. In combination with Neuro-Linguistic Programming (NLP), EFT provides ways to resolve past trauma and reconsolidate painful memories so they no longer carry the same emotional weight. As the overall trauma load lightens, anxiety decreases, and obsessive-compulsive symptoms often reduce in intensity.

This trauma relief work runs alongside the exposure-based treatment, making the entire recovery process more efficient and sustainable.

Final Thoughts

There is no single cause of OCD, and there is no one-size-fits-all solution. However, with the right approach, it is entirely possible to reduce symptoms and begin building a more peaceful and fulfilling life.

I offer a safe, compassionate space as well as a very practical and clear approach to OCD treatment, where we can develop a plan tailored to you, one that helps you move towards a life free from OCD and deeply worth living.