The psychophysiology of obsessive compulsive disorder

This review of the literature on obsessive compulsive disorder (OCD) presented diagnostic, epidemiological, and conceptual features of the disorder. It highlighted the heterogeneity of OCD by discussing the various symptom subtypes, spectrum disorders and comorbid conditions. Consideration of the prevalence, severity, chronicity, intensity, complexity and pervasiveness of OCD demonstrated it to be a significant clinical problem. Biological, psychological and environmental aetiological and maintenance factors were presented, establishing that no single theory can account for the onset and maintenance of the disorder in all cases. A dominant hypothesis arising from cognitive and behavioural conceptualisations, as well as phenomenological accounts of OCD, was that of anxiety reduction. Cognitive, affective, behavioural and psychophysiological components of anxiety reduction were discussed in relation to obsessions and compulsions. Research into the anxiety reduction processes associated with these phenomena was deemed to be useful in clarifying the maintenance mechanisms underlying the disorder. However, such research has been limited by insufficient or desynchronous response components and the methodology to measure actual obsessive-compulsive episodes. Of the anxiety disorders, OCD presents as one of the most complex and diverse forms of psychopathology, both to treat and to investigate.