Posttraumatic obsessive-compulsive disorder: A three-factor model

THIS paper presents a three-factor causal model of obsessive-compulsive dis order (OCD), which posits that exposure to long-term traumatic stress gener ates an inordinate degree of anxiety during the psychological development o f the premorbid OCD child. In response to these conditions the child evolve s a distinct cognitive style characterized by exaggerated threat appraisal and magical beliefs, and experiences alterations in brain metabolism. An en tire functional brain system (a basal ganglia-orbitofrontal circuit) enters into a state of enhanced responsiveness following exposure to protracted t hreat. Over time the threshold for stimulation is dramatically lowered, res ulting in a hypersensitivity to cues that signify potential harm. Individua ls adapt to this hypersensitivity through a variety of strategies, which co nstitute OCD.