Usually I do not get enough time to read all latest research papers in the field of OCD, but I always make it a point to read any paper published by the group at Tel Aviv University. I find their work very interesting as most of their experiments are about improving our understanding of OCD at a fundamental level. Their papers are eminently readable and that works out as a bonus! Recently they published a paper in The Journal of Behaviour Therapy and Experimental Psychiatry which seems to give us some more clues about the development of OCD. This research seems to suggest that healthy childhood rituals (like regular schedules for meal, bath, and bed times) when combined with oral and tactile sensitivities (such as discomfort at the dentist or irritation caused by specific fabrics) could potentially be an early warning sign of adult OCD. Before you jump to any premature conclusions as I did initially, this work is not about pathologising normal behaviour. If still in doubt, do read the paper firsthand.

Prof. Reuven Dar of Tel Aviv University’s Department of Psychology suspected this particular link from astute clinical observations. This comprehensive study, only one of its types so far, followed and provided a proof of “direct correlation” (always with a pinch of salt! See my posts on the correlation fallacy in medicine) between our sensory processing and ritualistic behaviours. Their hypothesis is that when children experience heightened levels of sensitivity, they develop ritualistic behaviours to better cope with their environment. When children are extremely sensitive to certain types of touch or smell, they can feel that they are being attacked, or that their environment is threatening them. Ritualism could develop as a defence mechanism, helping these children to regain a sense of control, which is also a symptom of adults with OCD. So in the long term, this is one “potential” pathway to OCD. Simplistic, but a logical hypothesis. Always a good sign.

To prove this hypothesis this group devised two studies to map the connection between sensory processing, rituals, and OCD. In the first, parents of kindergarten children were asked to complete three questionnaires on their child’s behaviour:

1. Their level of ritualism, such as the need to repeat certain acts or to order objects in a particular way.

2. Their level of anxiety, with questions relating to reaction to strangers, worrying about outcomes of events, and attachment to family members.

3. Their reactions to everyday sensory events such as being touched or exposed to unusual tastes or smells.

In the second study, 314 adults answered an online survey of their OCD tendencies, their anxiety levels, and their past and current sensitivity to taste or touch.

In children, hypersensitivity was an indicator of ritualism, whereas in adults it was related to OCD symptoms. However all children have particular habits and preferences, and they’re not all precursors to OCD. Also, age is a factor. A habit exhibited by a five or six-year-old is not necessarily a predictor of OCD. If the same behaviour continues to the ages of eight and above, it could be a warning sign, especially if accompanied by anxiety or distress. As a whole, these findings provide preliminary support for the idea that such sensitivities are a precursor to OCD symptoms.

Obviously, this is just a single study supporting a lone idea and there are plenty of ideas doing their rounds in the field of pathogenesis of OCD. I would wait for validation from future longitudinal trials before drawing my conclusions. However this study did provide me with a lot of food for thought. It made me to focus on some fundamental but unanswered questions in the development of OCD i.e. what are the factors which would tip a ritual into compulsion, could there be a way to identify the turning (tipping) point in development of OCD and when/how does it happen in the lifecycle of OCD? As a clinician, I think that now I would be more inclined to explore such areas in a greater detail while assessing someone’s OCD. And for the budding researcher inside me, it highlighted just how important it is to keep research work rooted in direct clinical observations. Not doing that would run the risk of alienating the ordinary clinicians like me, who is trying to deal with the ever-growing burden of information by learning to ignore the stuff that isn’t a systematic review of meta-analyses!

Also published on Medium.