According to clinical statistics, the average age at which symptoms first appear in patients with obsessive-compulsive disorder (not necessarily the age of first visit) is 19.5 years in the United States. In fact, some people may develop the disease earlier (according to statistics, 25% of patients develop the disease before the age of 14); Some people may develop obsessive-compulsive disorder later, but it is relatively rare for them to develop it after the age of 35 in clinical practice. Why does obsessive-compulsive disorder often go against young people?
The combined influence of genes and environment is the cause of obsessive-compulsive disorder. First of all, let’s talk about genes. The incidence rate of comorbidity among the immediate family members of obsessive-compulsive disorder patients is twice as high as the incidence rate of other populations, which is still an adult patient; If a person with obsessive-compulsive disorder develops it during adolescence or childhood, the rate of their immediate family members also suffering from obsessive-compulsive disorder is ten times higher than normal. In addition, because obsessive-compulsive disorder is a kind of anxiety disorder, the incidence rate of anxiety related psychological problems in family members may also be higher than normal, including obsessive-compulsive personality, generalized anxiety, social phobia or other specific phobias.
On the other hand, genes are not decisive. After all, the incidence rate mentioned above is only a few percent, which is still a small probability event. The rest will have to search for answers in this person’s upbringing environment. Stress events in the environment are usually triggers for various psychological problems, and obsessive-compulsive disorder is no exception.
The youthful years may look glamorous on the outside, but the inner psyche is really not easy. The pressure of academic studies, exams, employment, and courtship comes one after another, not to mention that they have to learn and adapt to the rules of adult society in order to become independent in the near future. As a result, there are endless “pits”, “traps” that cannot be drilled through, and “water” that cannot be filled in their minds. Many people who have been through these years often think of the dark years in their hearts and say the most: “If you don’t say anything, if you say too much, it will be tears.
From a biological perspective, what can help us maintain a calm smile and a positive energy in the face of stress, defeat, and frustration? Of course, it is the nervous system centered around the brain, especially the regulation of emotions by the cerebral cortex. The human cerebral cortex can only develop and mature after the age of 25, which is relatively late compared to other organs. Moreover, neurons have strong plasticity, and even after adulthood, the function of the cerebral cortex continues to improve and develop.
From a micro perspective, what important information and emotions do young people around the age of 20 need to process with their relatively immature brains? If we summarize the physical and mental stress mentioned earlier, it is the anxiety caused by “uncertainty”, which is an emotion that the young brain urgently needs to deal with but may not be able to handle. There are many anxieties caused by uncertainty! Almost all the troubles that affect your psychology are probably related to it.
A college student has always been very concerned about the acne on their face, to the point where they have to look in the mirror many times a day and spend most of their pocket money on buying skincare products. Acne is a natural change in the body during adolescence, and its appearance breaks our accustomed self-image. This image may feel perfect and flawless, and more importantly, the past image may have been praised by those around us. Our proud sense of self-esteem is built on our face. Now that my face is rough and uneven, how do others see me? Do you still like me as you used to? Will girls hate me because of this?
All of these are unpredictable, and uncertainty can bring anxiety because the human brain not only responds to the environment according to established patterns, but also constantly searches for patterns in the environment to achieve this. Only by understanding the causal relationship of events that happen to us can we bring a sense of security and control to people.
Another fundamental anxiety is death. A mentally normal elementary school student already knows the meaning of death, but it may not be until around the age of 20 that he can associate death with his brief existence in the universe. When young, the brain has acquired the ability to ‘process’ its experiences into coherent stories, like the embryonic form of autobiography, integrating the past, present, and future together. This can psychologically give people a sense of control over life, but at the same time, it creates illusions that everything is continuous, eternal, and enduring. This creates difficulties in understanding the cruel facts of’ life is small ‘and’ life is short ‘psychologically.
Some young people suddenly realize the truth of their existence in the universe and become depressed, even unconsciously numb themselves to escape the huge anxiety behind death. The ways to numb oneself are not only through sex, alcohol, and drugs, but all uncontrollable behaviors may also have a temporary paralyzing effect, including workaholism. Some people work day and night, but they may just be unable to face the huge emptiness in their hearts when they stop.
Death anxiety also manifests as excessive worry about health issues, easily linking slight physical discomfort with catastrophic consequences, because at this time, the brain cannot tolerate any uncertainty in health issues and must be absolutely healthy and safe, with no discomfort in the body. This itself is an expectation beyond reality.
Having said so much, I just want to say that there are countless anxieties or worries from my youth. If someone is born with a susceptibility gene for obsessive-compulsive disorder, and they are around 20 years old, the onset of obsessive-compulsive disorder is like a gun already loaded with bullets, with fingers on the trigger, just a little bit of accidental external force.
Here, I use the term ‘external force’ to metaphorically refer to certain accidental life events, which can be direct or indirect, causing extreme panic in the already highly anxious physical and mental systems. The previously widespread anxiety content may narrow down and settle down.
The direct event is usually a traumatic experience. If a person who is so anxious just changed schools and was bullied and beaten by a new classmate, and the person who hit him is wearing blue clothes that he will never forget. He is likely to consider all the blue things he encounters in life as inauspicious or disgusting in the future, and avoid them all. If he accidentally touches them, he will forcibly wash his hands.
Indirect events can be experienced by people around them, or even events unrelated to oneself. If the person who is in an anxious state mentioned above accidentally sees someone on TV news who forgot to turn off the gas stove before going out and caused a fire that destroyed the entire house, he may worry about causing such a tragedy as soon as he goes out, and thus the habit of compulsory re inspection begins to form. Other coercive behaviors are similar, often traced back to events that caused the individual to panic.
In short, youth is both beautiful and cruel. For unfortunate people, if they are born with such susceptibility genes, in the face of many unique physical and mental challenges during this period, their immature brain is still unable to process the “surging” panic and anxiety in the body. The stimulation of certain accidental events can trigger the occurrence of obsessive-compulsive disorder. This is also why obsessive-compulsive disorder is almost a lifelong, chronic disease, and why the severity of symptoms is often directly related to the overall anxiety level of patients.