Obsessive-compulsive disorder (OCD) is usually seen as a problem of irrational fears and repetitive rituals. But a growing body of neuropsychoanalytic research suggests something deeper is at play: a hidden, often unspoken terror of losing the people we depend on most. This perspective, championed by figures like Mark Solms, reframes OCD not as a simple phobia, but as a complex emotional response rooted in childhood attachment and loss.
According to sources at Psytheater, the neuropsychoanalytic model argues that OCD is driven by faulty predictions—automatic, unconscious beliefs formed in early childhood. These predictions often revolve around attachment: If I’m not good enough, I’ll be rejected. If I make a mistake, I’ll be abandoned. These beliefs don’t just shape behavior; they become embedded in the brain’s emotional circuits, especially those tied to panic and grief.
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Beyond Surface Fears
Traditional therapy for OCD often targets the obvious fears: contamination, harm, forgetting to lock the door. But many people with OCD know these fears are irrational. They say, “I know it’s not real, but I can’t stop.” That’s because the real driver isn’t the surface fear—it’s the deeper, less conscious panic about losing connection, being cast out, or failing to protect loved ones.
Neuropsychoanalysis identifies the “Panic-Grief” system in the brain as central to OCD. Unlike the fear system, which responds to physical threats, the panic-grief system is triggered by the threat of losing a vital relationship. When a child senses that a caregiver might leave or withdraw love, the brain encodes this as a life-or-death emergency. If that panic isn’t resolved, it can morph into chronic anxiety and compulsive behaviors later in life.
This helps explain why OCD often overlaps with panic attacks and depression. All three conditions share roots in the panic-grief circuit. The rituals and obsessions of OCD are attempts to manage or avoid the unbearable feeling of loss—even if the person isn’t consciously aware of it.
Why Exposure Therapy Sometimes Fails
Exposure therapy, a mainstay of OCD treatment, works by helping people face their fears without performing rituals. But if the therapy only addresses the surface fear—like germs or fire—it may miss the deeper emotional wound. The panic-grief system remains untouched, and the compulsions persist.
For example, someone who checks the stove repeatedly may not truly fear fire itself. The real terror is being blamed for a disaster, being seen as irresponsible, and ultimately being rejected by family or society. If someone else checks the stove, the anxiety often vanishes. The ritual isn’t about safety; it’s about securing belonging and avoiding shame.
That’s why reassurance from loved ones can temporarily soothe OCD symptoms. It’s not the logic that matters—it’s the emotional message: “You’re still accepted, even if something goes wrong.”
Rewiring Emotional Memory
So how can therapy reach the root of OCD? According to Mark Solms, the answer isn’t just intellectual insight. It’s about creating new emotional experiences that contradict the old, fearful predictions. In psychoanalytic therapy, this often happens through the relationship with the therapist. When a client resists a ritual and the therapist remains supportive, the brain gets a new message: “I can make a mistake and not be abandoned.”
This process isn’t quick. The new experience must be repeated many times to overwrite the old emotional memory. Over time, the client learns—on a gut level—that their worth isn’t tied to perfect behavior or constant vigilance. The rituals lose their grip because the underlying panic fades.
Other therapy models, like cognitive-behavioral therapy (CBT), use techniques such as the “downward arrow” to help clients uncover the core fear beneath their obsessions. The goal is the same: connect the symptom to the unmet need, then create corrective emotional experiences that allow the brain to update its predictions.
Accessing the Core Fear
One challenge is that the fear of losing connection isn’t always obvious. People with OCD may be so focused on their rituals that they never question what’s really at stake. Therapy must help them recognize the link between their symptoms and their deeper needs for attachment, autonomy, and acceptance.
Once this connection is made, the work shifts to helping the client experience—again and again—that they can survive mistakes, tolerate uncertainty, and still be loved. This is the heart of emotional healing in OCD, and it’s why understanding the disorder’s roots in panic and loss can make treatment more effective.
OCD isn’t just a battle with irrational thoughts. It’s a struggle to feel safe in a world where love and belonging once felt fragile. By addressing the hidden panic beneath the rituals, therapy can offer not just symptom relief, but a new sense of security and self-worth.
Obsessive-compulsive disorder is classified as an anxiety disorder, but its symptoms often overlap with depression and panic attacks. Treatment options include cognitive-behavioral therapy, medication, and psychoanalytic approaches. The most effective care plans are tailored to the individual, taking into account the emotional and relational context of their symptoms. Understanding the role of attachment and loss can help clinicians and clients alike find more lasting relief.
