Why Do Some People Get OCD? Understanding How Anxiety Develops—and How Therapy Can Change It

Why do some minds seem wired for worry—while others float through uncertainty with ease? Why does one child’s shyness fade with age, while another’s grows into obsessive rituals or relentless panic?

Science offers part of the answer: anxiety is learned, but it also begins with what we inherit.

The Seeds: Genes, Temperament, and Early Learning

Each of us is born with a temperament—a biological rhythm to our reactivity. Some nervous systems are simply more sensitive, finely tuned to detect threat. Research suggests that these traits, combined with certain genes and early learning experiences, form the soil in which anxiety can take root. When stressful or chaotic environments pair with that biological sensitivity, the brain learns to expect danger.

In obsessive-compulsive disorder (OCD), this learning becomes exaggerated: the mind learns that intrusive thoughts are dangerous, and rituals are the only way to feel safe. It’s not a choice or a flaw—it’s the nervous system doing its best to protect against an imagined catastrophe.

Etiology vs. Maintenance: The Two Stories of Anxiety

Psychologists distinguish between how anxiety begins (its etiology) and how it keeps going (its maintenance). We can’t change the genes we inherit or the early experiences that shaped our vigilance. But we can change the patterns that maintain it.

Therapy, especially exposure-based treatments, doesn’t target the origins of fear—it rewrites the rules that fear obeys. It helps the brain discover, through experience, that feared outcomes rarely occur and that distress can be tolerated.

In OCD treatment, for example, a person might resist washing their hands after touching a doorknob—not to prove bravery, but to teach the brain that anxiety fades even without ritual. Each time this happens, new learning takes place. Over time, the brain rewires its prediction: “I can handle this.”

The Hope: What Can Change

Therapists can’t edit a person’s genes or childhood. But they can guide clients toward new learning—teaching the mind that uncertainty isn’t synonymous with danger. They can help weaken the old patterns that fuel fear and strengthen new ones that foster resilience.

From a scientific view, this is called inhibitory learning. From a human view, it’s courage—the quiet, repeated act of staying present with what scares us until it no longer holds the same power.

Anxiety may be written into our biology, but recovery is written into our capacity to learn.