OCD: Lived & Research Experience on Attachment and Recovery

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Amidst growing discourse surrounding mental health, there is one condition that, I feel, has been left out. That condition is obsessive-compulsive disorder (OCD). The condition has been discussed previously on Inspire the Mind, both in regard to avoidance and reproductive care and first-hand, lived experience. I strongly recommend reading these pieces to get a fuller understanding of the condition.

For the purposes of this piece, I will say that broadly speaking, OCD is associated with significant anxiety caused by intrusive thoughts and significant disruption to day-to-day life, through compulsive behaviours that people engage in to reduce their anxiety. Moreover, there are strong links between OCD and depression; this understanding is hierarchical in that OCD causes depression, not the other way around. As such, for the majority of people, when OCD symptoms improve, depression appears to lift. However, for many others, depression lingers. This piece explores why that might be.

I'm a researcher with a background in mental health. I am currently working within King's College London’s Social Genetic Developmental Psychiatry Centre on large-scale studies of anxiety, depression, and eating disorders, using people’s survey responses and biological data from blood and saliva samples to understand what causes poor mental health. Alongside this, I also live with OCD. Over the past few years, I have led an independent research project exploring how OCD is experienced in real life, including surveys and interviews with people living with OCD and clinicians working in the field.

What has become increasingly clear is this: while we know a lot about OCD symptoms and treatments, we know far less about why some people recover fully from comorbid depression, while others continue to struggle even after treatment. This gap is the core focus of my recent paper. 

OCD and Depression: A more complicated relationship than it looks

The relationship between OCD and depression is not always consistent, and the reasons for this remain unclear. One idea explored in the literature is attachment style - blueprints established during early childhood that shape the way we engage and relate to others. Some studies suggest that a person's attachment style may influence how OCD and depression interact, and how recovery unfolds. One such study found that attachment style moderates the relationship between OCD and depression. What this means is that a person’s attachment style has an effect on how likely someone is to develop depression as a result of their OCD. The more secure your attachment style, the less likely you are to develop depression.

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This makes logical sense as insecure attachment styles are already associated with depression and anxiety, so someone living with OCD would understandably be more vulnerable to depression that lasts.

It was this finding that my research sought to replicate. While I did not find exactly the same thing, I did uncover a particularly interesting finding: a mediatory effect of attachment style on the relationship between OCD and depression.

Contribution vs Cause

The previous study found that attachment style moderated the relationship between OCD and depression. This meant that attachment exists as a trait independent of a person's OCD or depression, and a naturally secure attachment style acts as a buffer against the depression that OCD can bring about. The key point: attachment is external and constant.

My findings identified a mediatory effect. Rather than being an external force, my findings indicate that OCD causes insecure attachment, which in turn increases the likelihood of experiencing depression.

Two things follow this.

First, similar to the previous paper, attachment style does play a role - but rather than as an external force, our model suggests that living with OCD erodes secure attachment, leaving people more vulnerable to both depression and insecure attachment, even after OCD lifts.

Second, this adds to emerging literature suggesting that significant life stressors, such as living with a chronic condition like OCD, can, in fact, shift a person's attachment style - something previously understood to be fixed across the lifespan.

This work is at an early stage, and further longitudinal research is needed. But the findings do raise a meaningful question: for people who complete OCD treatment and still experience depression, has the condition reshaped how they relate to others? And could addressing that help? What’s more, if attachment styles are more open to change, how many people could benefit from interventions, such as those outlined by The Attachment Project, which seek to encourage secure attachment?

Why I Want to Develop This Further

These findings point towards something broader: OCD recovery is not only about symptom reduction. It may also involve changes in emotional regulation, attachment, and depressive vulnerability over time.

As such, I am seeking funds and collaborators for a longitudinal study that follows people with OCD over time, exploring how state vs trait attachment style, developmental history, and symptom change interact to shape outcomes like depression and recovery. The aim is not only to understand OCD better, but to understand why recovery looks different for different people.

If we can better understand why depression persists for some people with OCD, we may be able to improve how treatments are tailored, identifying people at higher risk of persistent depression earlier, refining how therapy is delivered, and moving from "does treatment work?" to "for whom does it work, and under what conditions?"

Final Thoughts

OCD is not a static condition, and neither is recovery. My own experiences have been one of ups, downs, and perseverance. The hope is that by combining quantitative research, qualitative insight, and lived experience, we can move towards a more complete picture - one that reflects the reality of the people living with this condition every day.