A Cybernetic Model of Obsessive-Compulsive

Psychopathology
Roger K. Pitman

Analysis of various kinds of obsessive-compulsive psychopathology (perfectionism, doubt, indeci-

sion, omnipotence, overspecification, obsessions and compulsions, tics) from a control systems
standpoint reveals that all have in common persistent high error signals that cannot be eliminated by
behavioral output. Possible causes include conflict, intrinsic comparator defect, and attentional
disturbance. The cybernetic approach offers the possibility of eventual neuroanatomical structural
correlation, and it is suggested that the limbic system and basal ganglia together form a behavioral
control system, dysfunction in which may be manifest as obsessive-compulsive disorder.
@ 1987 by Grune & Stratton, Inc.

I N 1903, Pierre Janet wrote that obsessive-compulsive (OC) patients experience

their mental activity as incomplete and asked what the psychological imperfec-
tion could be that continually torments them.‘,* He described how OC patients may
feel that an action wasn’t done well or completely or that it didn’t produce the
sought for satisfaction. Janet considered that obsessions and compulsions, doubting,
manias of perfection, and tics all arose from feelings of incompleteness. He
expressed the hope that reduction of OC symptoms to their lowest common
psychological denominator would eventually allow their understanding by a neuro-
science unavailable at his time. One component of modern neuroscience unavailable
to Janet was cybernetics.3 The purpose of this article is to expose aspects of
obsessive-compulsive disorder (OCD) and related psychopathology to a cybernetic,
or control systems, analysis.

THE CYBERNETIC APPROACH TO BEHAVIOR

Powers has observed that the behaving organism constitutes a complex control
system which attempts to control not its behavioral output, as one might naively
assume, but rather its input or perception, through a negative feedback process.4

A Simple Control System

The principle of a control system is illustrated by the thermostat. The core of the
thermostat, as of any control system, is the internal “comparator” mechanism. This
functions to compare a “perceptual” signal (in the case of the thermostat, the
ambient temperature reading) with a “reference” signal (in the case of the
thermostat, the setting), and to generate an internal “error” signal representing the
difference between the reference and perceptual signals, i.e., the degree of
“mismatch.” A non-zero error signal causes the activation of behavioral output (in
the case of the thermostat, turning on the furnace) in an effort to change the

From the Behavioral Neurology Unit, Beth Israel Hospital, Boston, and the Harvard Medical
School. Boston.
Address reprint requests to Roger K. Pitman. M.D.. Research Service (151). Veterans’ Administra-
tion Medical Center, 718 Smyth Rd. Manchester, NH 03104.
o 1987 by Grune & Stratton, Inc.
0010-440X/87/2804-0007$03.00/0

334 Comprehensive Psychiatry, Vol. 28, NO. 4 (July/August), 1987: pp 334-343

CYBERNETIC MODEL OF OCD 335

perceptual signal in the direction of the reference signal, until the error signal
becomes zero and behavior stops.

A Human Control System

An example of a human control system is provided by a person adjusting a
thermostat. The person’s comparator calculates the difference between an internal
comfort perceptual signal and an internal comfort reference signal and generates an
internal error signal, which represents his discomfort. This error signal then
generates the external behavior of adjusting the thermostat’s setting. When the
error signal is brought to zero, behavioral output ceases, i.e., the person stops
adjusting the thermostat when he feels comfortable. In this example, the person and
the thermostat constitute a hierarchy of control systems, because the output of the
higher system (person) represents the reference signal for the lower system
(thermostat). Although the occupant’s comfort mechanism is treated here as a
single control system, in the brain the situation is certain to be more complicated,
with this system constituted by and located within a complex of interrelated
hierarchical and branching control systems4

Conflict of Control Systems

Conflict exists when two control systems set different reference levels for the
same controlled quantity. As behavioral output reduces the error signal in one
system, the error signal in the conflicting system grows larger. Conflict can occur
between individuals or between control systems within the same individual. A
person is said to be “in conflict” when he wants two incompatible goals realized at
once. In such a situation, there may be avoidance of the reference level of either
system, with a “dead zone” between reference levels within which little or no control
exists.4 Because the error signal of each system remains at non-zero, each is
operating, but the systems are neutralizing each other. We may make inferences
regarding the subjective experiences of persons harboring conflicted control
systems. There is likely to be a general sense of unfulfillment and dissatisfaction
(and possibly clinical anxiety and depression) due to the continued presence of
non-zero error signals.

OBSESSIVE-COMPULSIVE PSYCHOPATHOLOGY
The study of OCD has been plagued by the failure of any psychological theory to
satisfactorily explain the complex and varied array of OC symptomatology. This
may be because behavioral theories that are uninformed by cybernetics do not
adequately consider the systematic interaction of perception, purpose, and overt
action that characterizes OC (and in fact all) behavior. Explanations of OCD
rooted in traditional stimulus-response (S-R) psychology have enjoyed limited
success. For example, the characterization of checking and cleaning rituals as active
avoidance behavior’ is revealing, but it has been noted that active avoidance alone
does not explain these symptoms’ intrusive and repetitive nature.6 Some aspects of
OCD appear totally inexplicable from an S-R standpoint, e.g., psychological
imperfection and feelings of incompleteness. Control systems theory, however,
which treats behavior not simply as learned or innate responses to instigating
stimuli, but rather as the process of matching perceptual input to internal reference
336 ROGER K. PITMAN

signal, represents a radical departure from S-R psychology and offers unique
explanatory possibilities for OCD.
We propose here that, from a control systems standpoint, the core problem in
OCD is the persistence of high error signals, or mismatch, that cannot be reduced
to zero through behavioral output. Mismatch find its subjective manifestation in
the pervasive sense of incompleteness and doubt that characterizes the disorder.
Obsessive-compulsive behavior is repetitive and stereotyped because behavioral
programs are executed over and over again in a vain effort to reduce error signals.’
This formulation offers a unifying explanation for the following various, and
sometimes seemingly disparate, aspects of OC symptomatology.

Perfectionism
Perfectionism may be characterized as an excess of control behavior. Many
perfectionistic OC behaviors are variations on the theme of matching. For example,
in attempting to make a picture hang perfectly straight on the wall, one attempts to
make its side parallel to, i.e., match in direction, the line of the wall. A patient
described in the classical OCD literature”* reported that if he saw a red object on his
right after arising, he felt a compulsive need to seek out a red object on his left. Such
symmetry compulsions have been described in many other OCD cases.8*9
Case 1. A 30-year-old woman with OCD, who always had felt a strong need
to keep things in order, dated the onset of her difficulties to putting together a jigsaw
puzzle with her child. Several of the pieces couldn’t be found. She was unable to get
the missing pieces out of her head and spent hours a day searching for them. She
told herself, “this is stupid, stop it,” but could not. She finally threw the puzzle
away, but the rumination continued, along with panic attacks and depression, until
she was hospitalized.
Case 2. A 23-year-old OC woman became distressed over the observation
that “nothing could be the same twice.” She worried that if she spilled something on
the floor, no matter how many times she might try to spill it again, it would never
form exactly the same pattern. She stopped cleaning her floor and also quit her job
as a nurse because the patterns of soiling on the linen always varied and could not be
duplicated.
Case 3. A 21-year-old OC male reported that it sometimes took him 15
minutes to adjust the water temperature before showering. He made repeated
minute adjustments in the dial setting in an attempt to get the water “just right.”
His family complained that he was “like a snail.”
These clinical vignettes (Cases 1, 2, and 3) illustrate the exaggerated need and
difficulty experienced by the OC patient in matching perceptual to reference
signals. Case 3 throws light on the puzzling OC phenomenon designated “primary
obsessional slowness,” whose origin has been called obscure.’ From the cybernetic
standpoint, this patient’s slowness may be seen as secondary to his excessive
matching behavior.

Indecision
Indecision implies that two control systems within the individual are in conflict.
The same patient (Case 3) was asked by his friend to go to a baseball game. The
patient agreed, even though he had wanted to spend the evening at the racetrack. As
CYBERNETIC MODEL OF OCD 337

the patient and friend neared the ballpark in the patient’s car, the patient’s wish to
be at the racetrack intensified to the point that he announced to his friend’s
disappointment that they were changing destinations, turned the car around, and
drove towards the track. As they neared the track, however, the patient felt
increasingly guilty over not taking his friend to the ballgame. This guilt grew to the
point where he again turned the car around and headed back towards the ballpark.
This did not last long, however, as the patient’s desire to be at the track rekindled as
soon as he began to drive away from it. After several such oscillations, in an agitated
mental state, the patient parked the car midway between ballpark and track, unable
to drive in either direction. The friend drove them home.
This type of situation has been termed a “double approach-avoidance” conflict.”
In cybernetic terms, two control systems in the patient were in conflict because they
were attempting to set different reference levels for the same controlled quantity,
i.e., the location of the car. As the error signal in one system was reduced, the error
signal in the other system grew larger, until that system took control of the
behavioral output and changed the direction of the car, but only temporarily until
the first system regained control. Behavior fluctuated within the dead zone between
ballpark and track, until the patient’s power to act became paralyzed. The behavior
of the patient in this example has direct analogs in the naturally occurring conflict
behavior of stickleback fish” and in experimentally induced conflict behavior of
rodents.” Psychodynamic psychiatrists have long suggested a role for conflict in
0CD.1Z9’3
This patient (Case 3) also described the difficulty that he had ordering from a
menu when he saw two dishes that he liked. After he managed to choose one, as soon
as the waiter left the table he would begin to desire the other. This would lead to his
calling the waiter back to change his order, but as soon as this was done, he would
again desire the first dish, call the waiter back again, etc.
It is useful to note the role played by attention in this patient’s psychopathology.
A healthy person after making a choice would remove his attention from the
unchosen option and look forward to enjoying the chosen one. With this patient, it is
just the opposite; as soon as the choice is made, his attention switches to the
unchosen option.

Need for Control (Omnipotence)

The universal recognition of the role played by the need for control in 0CD14
supports the face validity of a control systems model. The compulsive personality is
defined, in part, by attempts to control others.15 The persistence of mismatch in the
obsessive-compulsive may be expected to fuel the need to engage in controlling
behaviors, in attempts to reduce error signals.

Overspecijcation
This interesting OC phenomenon, which denotes the tendency to require more
classes to classify the items in a given array, has hitherto defied theoretical
understanding.16 However, from the cybernetic standpoint, the explanation is
straightforward. In order for the subject to assign two items to the same class, it is
necessary for him to recognize a match between them. Because the OC patient tends
to sense mismatch, he will be less likely to do so.
338 ROGER K. PITMAN

Obsessions and Compulsions

Obsessions are unwanted, persistent ideas, thoughts, images, or impulses, while
compulsions are repetitive and seemingly purposeful behaviors performed in a
stereotyped fashion (American Psychiatric Association,‘5 p. 234). The concept of
purpose is a cybernetic one, in that it implies that behavior is performed in order to
effect some referenced change. The purpose of compulsions often is to eliminate
distressful perceptions associated with obsessions, e.g., repetitive handwashing may
be an attempt to end the perception that the hands are contaminated, or checking
that the knives are put away may be an attempt at reassurance against the impulse
to stab someone. Compulsions are repetitive because they are unable to accomplish
their purpose, i.e., to reduce mismatch between reference and perceptual signals.
No matter how much the compulsive washes his hands, he still feels that they are
contaminated. The compulsion does not succeed in eliminating the obsession. While
compulsions are by definition enacted, obsessional impulses rarely are, because they
are in conflict with the reference signals of other systems. There is nothing terribly
objectionable about spending hours checking the knives, although checking can be a
very disabling symptom. Stabbing someone, on the other hand, is likely to conflict
with other standards for behavior within the individual. The performance of
compulsive behavioral routines, themselves conflict-free, may, therefore, point to
the presence of underlying conflicted control systems. The extreme nature of OC
impulses, e.g., to utter the foulest obscenity or commit the most heinous crime, may
be understood as reflecting the tendency of control systems to escalate their output
when met with resistance.’

Tics
Tics are frequent concomitants of OC psychopathology,‘*2317and a high incidence
of OCD has been reported in patients with Tourette syndrome (TS), the most severe
tic disorder.” A genetic relationship between the two disorders has been demon-
strated.18,19Tics are currently defined as “recurrent, involuntary, repetitive, rapid,
purposeless motor movements” (American Psychiatric Association,” p. 76). This
characterization of tics as purposeless suggests that they cannot be understood from
a cybernetic standpoint. However, Janet suggested that tics are a form of forced yet
purposeful volition arising out of an obsessive need for perfection or compensation.‘,’
Such a formulation of tics readily lends itself to the cybernetic approach utilized to
explain perfectionism. One TS patient concluded that “bodily sites become sensi-
tized, and the movements (however bizarre) are intentional acts aimed at satisfying
unfulfilled sensations and urges” (Bliss,“’ p. 1343). This description amounts to a
psychopathological restatement of the tenet that behavior is the control of percep-
tion.
Case 4. A 27-year-old male TS patient was described verbatim in the medical
record by his neurologist as follows:
. he will build the urge to make a certain type of noise, the noise will appear in his mind, he will
produce it and if the sound does not match what he had in mind, he will have to continue making a
sound until it matches his intention. This causes him to keep making noises with widely varying
pitches.

Conflicted control systems may also play a role in TS psychopathology. A TS

CYBERNETIC MODEL OF OCD 339

patient was described as “almost completely paralyzed by his compulsions and

unable to perform even simple life tasks . . . each gesture was a battle in which he
fell victim . . . as he attempted to overcome the inner resistance to any motor
expression” (Cohen et al”, p. 34).

Anorexia Nervosa
4 close relationship has been observed between this disorder and OCD.‘*
Case 5. A 2%year-old very thin, anorectic woman complained that when she
looked in the mirror, she saw “blobs of fat hanging off my thighs.” She utilized
dieting, laxatives, and compulsive exercise in an attempt to reduce her perceived
obesity. She also manifested an intermittent throat-clearing tic.
This woman’s dieting behavior was driven by an error signal representing the
discrepancy between a perceived body image of obesity and a reference (ideal) body
image of thinness. In a sense, the disturbed behavior was secondary to, and logically
followed, the delusional perceptual signal of obesity. However, in-depth psychother-
apy revealed a conflict over her sexuality to the point that she was deeply ashamed
of the normal bodily manifestations of her womanhood, such as fatty tissue on
breasts, hips, and thighs. Her disorder may, therefore, be conceptualized as the
product of a disturbed hierarchy of control systems, in which a higher system
controlling her perceived sexuality set a reference signal of extreme thinness for a
lower system controlling her body weight.
We submit that the above considerations and case examples, and the wealth of
similar supporting clinical material in the OCD literature, are sufficient to
demonstrate the applicability of the cybernetic model to OCD. However, it should
also be possible to devise experimental means of further testing the model. One way
might be to expose OCD and control subjects in the laboratory to paired stimuli
from different classes (visual, auditory, tactile) with varying degrees of similarity
and to elicit subjective reports regarding perceived degree of (mis)match. Psycho-
physiological responses to such stimuli might also be revealing, as might be subjects’
performance on operant tasks designed to effect the degree of mismatch.

POSSIBLE SOURCES OF MISMATCH IN OCD

Three possible explanations for persistent high error signals in obsessive-
compulsives may be entertained: conflict, intrinsic comparator defect, and atten-
tional disturbance.

Conflict
We have already seen how conflict between two control systems with different
reference signals for the same controlled perception may make it impossible to
reduce the error signal in either system. As long as both control systems remain
active, high error signals persist in each. Thus, we might postulate that the problem
in obsessive-compulsives is the presence of intrapsychic conflict. A feature of
conflict behavior in animals is displacement activity, a behavior pattern which arises
in a conflict situation that cannot be attributed to either competing drive.23 In
humans, compulsive rituals and motor tics have been hypothesized to represent
displacement activities associated with underlying conflict.24’5
340 ROGER K. PITMAN

Intrinsic Comparator Defect

In the conflict model, one need not postulate structural abnormality within either
control system; both function properly, but fail because they are in conflict. It is
tempting to hypothesize that all OC psychopathology is caused by underlying
conflict. It could be argued that an OC patient may be in conflict over just about
anything, e.g., childhood Oedipal desires or confronting his boss at the office.
Unable to reduce his error signals effectively, he seeks a displaced means of so
doing, such as perfecting the position of pictures on the wall. However, a causative
role for conflict is difficult to establish in all cases, and, therefore, alternate
explanations must also be entertained. One straightforward one is that the
obsessive-compulsive’s internal comparator mechanism is faulty. No matter what
perceptual input it receives, it continues to register mismatch. It has been observed
that while the obsessive-compulsive often feels that an action wasn’t done well or
completely, to an observer it may appear perfectly well done.‘,’ It may be that in fact
the action was well done, but the defective comparator cannot register this.

Attentional Disturbance
Tourette syndrome patients commonly report that the more they focus their
attention on an unwanted movement or utterance, the more likely it is that it will be
performed. One observed that by directing his attention away from sensitized areas
of his body, tics could be aborted.” Obsessive-compulsives may suffer from a
diminished capacity to withdraw attention from (repress), or to habituate to,
discrepant perceptual signals. Seeing a picture hanging crookedly may bother
anyone a little, but the healthy person seems to have the ability to ignore or get used
to it.
The above alternative explanations of persistent error signals in OCD may
suggest different possible origins for OC psychopathology. One person with intact
comparator and attentional mechanisms may only become symptomatic when
circumstances place him in a severe conflict situation, e.g., as may occur in
traumatic stress. A second person may develop obsessions and pathological doubt
out of a sense of mismatch associated with the onset of a depressive disorder. In a
third person, an innate comparator defect may produce symptoms in benign
circumstances and in the absence of affective disorder. Or these factors may
interact; inability to disattend to competing reference signals may make internal
conflict and its consequences inevitable.

NEUROANATOMICAL CONSIDERATIONS
A valuable feature of cybernetic theory is that it lends itself to the correlation of
function with the structure of the nervous system. Unfortunately, precise specifica-
tion of the anatomical locations of disturbed functional mechanisms in OCD
appears to be out of present reach. The remainder of this article will illustrate how
the cybernetic approach may be applied to current neuroanatomical hypotheses of
the disorder.26
Powers has presented the case for considering the brain as an analog computer,
with input, comparator, and output functions subserved by anatomical areas; and
input, reference, error, and output signals represented by paths of neural activity.4
CYBERNETIC MODEL OF OCD 341

Evidence7*27*28 points to the striatum as an area of the brain involved in the assembly
and execution of behavioral output programs of varying complexity. A role for this
structure, along with some supporting evidence, has been suggested in the produc-
tion of tics and compulsions.29 However, it is unclear how disturbance of behavioral
output alone can explain such perceptual OC phenomena as incompleteness and
overspecification. Moreover, the cybernetic model indicates that a disturbance in
behavioral output does not necessarily have to originate in the output system; a
healthy output system may generate repetitive stereotyped behavior as long as it is
driven by persistent high error signal. It, therefore, also seems necessary to consider
possible perceptual and comparator systems in an attempt to understand OC
psychopathology. In this regard, Gray6 has reviewed evidence suggesting that the
septohippocampal system (and associated limbic areas) functions to compare
predicted to actual sensory events, focuses attention on stimuli associated with
mismatch, and takes control of behavioral output when mismatch is detected. (Gray
has expressed ideas about OCD similar to those expressed herein, although his
emphasis on predictions or expectations differs from the emphasis here on intentions
as reference signals for behavior.) There is some evidence to support a role for the
limbic system in OCD.26 Along a somewhat different line, Douglas3’ has proposed
that the hippocampus plays a role in Pavlovian internal inhibition, which gives the
animal the capacity to disattend to stimuli associated with confficting drives,
thereby allowing avoidance of the deleterious behavioral effects of conflict. Douglas
emphasizes that the process of choice involves disattention to competing stimuli, not
inhibition of competing responses. Obsessive-compulsive patients, even TS
patients,3’ are able to inhibit their symptomatic actions, or behavioral outputs, but
only with effort. What they do not seem to be able to inhibit is the need to perform
the actions, i.e., the error signal.
Nauta3* has directed attention to the anatomical connections between limbic
system and basal ganglia (between “motivation and movement”) as possibly critical
to an understanding of TS (and by extension OCD), observing that essentially all
the impulse traffic between these structures runs in one direction, from former to
latter. It is tempting to speculate that these two brain areas together constitute a
behavioral control system, the limbic system performing a comparator function and
transmitting error signal to the basal ganglia, where it is translated into behavioral
output. Disturbances in this system may underlie OCD. Both limbic system and
basal ganglia are strongly, and possibly simultaneously, influenced by the ascending
nonspecific monoaminergic tracts, and a role for each of the major monoamine
neurotransmitters has been suggested in the pathophysiology of OCD and TS.17,29
Current knowledge suggests that noradrenalin may play a role in the system’s
heightened sensitivity and attention to mismatch,6 while dopamine and serotonin
may play roles in the facilitation of behavioral outputs attempting to reduce
mismatch, or to avoid an increase in mismatch, respectively.6 Finally, if high error is
subjectively experienced as an absence of satisfaction, then the brain’s pleasure/
unpleasure mechanisms may be involved in OCD. Double-blind administration of
naloxone has been reported to increase pathological doubting in OC patients,
possibly by interfering with opiate-mediated pathways underlying satisfaction.33
Involvement of the pleasure/unpleasure mechanisms could offer a means of
approaching the relationship frequently noted between OCD and depression.25
342 ROGER K. PITMAN

ACKNOWLEDGMENT
Michael Jenike, Roger Masters, and William Powers provided helpful suggestions.

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