Obsessive compulsive disorder and attachment

Introduction: Emotional attachment arises between the child and the primary caregiver in early childhood and fundamentally affects the child's self-esteem and their perception of the world as a safe place. The aim of this review is to present the current state of knowledge about the relationship between attachment and obsessive-compulsive disorder (OCD), the course of the disorder and the effectiveness of the treatment.

Method: A literature search was performed using PubMed, Web of Science, Google Scholar, and ScienceDirect databases using key search terms. Scientific texts were extracted for the period from January 1990 to the end of March 2020.

Results: An insecure attachment reduces a personal sense of self-worth and can lead to perfectionism and compulsive behavior, which becomes a means of trying to secure and stabilize the value of self-concept and control the surrounding events. Both characteristics are common in patients with OCD. Uncertain attachment is further associated with maladaptive cognitive processes (such as excessive sense of responsibility, perfectionism, and mind control), which are also associated with OCD. Of the two dimensions that define uncertain adulthood attachment (anxiety and avoidance), attachment anxiety is more closely related to OCD. No research has been described in the articles we found to prove a direct link between the attachment and the severity of OCD. Insecure emotional attachment and OCD is complicated by frequent comorbid depression.

Conclusions: Anxious emotional attachment is common in patients with OCD and interconnects with basic OCD symptomatology. From this perspective, strategies that promote feelings of safety, acceptance, and appreciation within a therapeutic relationship may be important in the treatment of OCD.

Keywords: obsessive compulsive disorder, aversive childhood experiences, childhood trauma, emotional attachment.