Biological and psychological vulnerabilities may explain why some people are more likely than others to develop an obsessive-compulsive or related disorder (OCRD). However, a key concept in understanding the development of OCRDs, is the role that social experiences play. According to Albert Bandura (1977), the principal founder of social learning theory, individuals learn how to think and act by observing others. More specifically, social learning theory proposes people can learn how to behave vicariously, without ever having direct experience with a particular situation themselves. In other words, we learn how to respond to a particular situation simply by observing how others respond. This concept, that learning can take place without any direct experience, has important implications for the formation of OCRDs.
According to social learning theory, people with OCRDs may have learned to be anxious through prior contact with other people. A child's caregivers may have communicated, via their actions or the information they provided, that certain situations or objects are dangerous and subsequently must be avoid at all costs. For instance, people with obsessive-compulsive disorder may have been provided information that germs are everywhere and will positively make them very sick (omitting the important fact that the body is fairly well protected against germs). Therefore, the way early role models handled their own anxiety may directly, or indirectly, teach a child to respond in a similar manner.
The family forms a social environment that provides many opportunities for learning. By observing family members, children learn how to think and act. These observations provide a guide for understanding their world, and demonstrate various ways of coping with life stressors. One's social environment is also a key factor in the development of certain beliefs about oneself and one's abilities. Thus, our social environment influences our cognitive appraisals and further illustrates the importance of social influences in the development of OCRDs.
While the role of the family is important, it is not the only type of social influence. The norms of the larger culture also influence people's values and beliefs. For example, the media and entertainment industry influence popular culture. These influences contribute to cultural standards about the importance of physical appearance and the perfection of that appearance. It is not difficult to imagine how these cultural influences can affect the development of a disorder such as body dysmorphic disorder (BDD).
Likewise, positive or negative attention from other people about one's appearance contributes to the beliefs, attitudes, and body perception people maintain about themselves. It is hypothesized that individuals with BDD may have experienced aversive experiences during childhood involving their physical appearance. For example, a youth might be subjected to relentless teasing about acne. Of course teasing of this sort can lead to uncomfortable emotions such as anxiety, disgust, or shame. Unfortunately, these emotions may become paired with, or associated with, the physical attribute that brought about the teasing. In this example, shame may become paired with acne blemishes. In the future, because of this pairing, the mere presence of a single, tiny blemish may resurrect feelings of shame. This occurs even in the absence of teasing. This is called "evaluative conditioning." It is a powerful social factor influencing the development of many OCRDs.