Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder (OCD) is an anxiety disorder which can afflict a person throughout his/her lifetime: "The individual who suffers from OCD becomes trapped in a pattern of repetitive thoughts and behaviors that are senseless and distressing but extremely difficult to overcome" (http:www.nimh.nih.gov/publicat/ocd.htm). Obsessions and compulsions are the two main components of this disorder. The former are often highly negative such as an ever-present fear of germs. Compulsions such as repetitive handwashing are rituals designed to lessen anxiety produced by obsessions. Depending on the severity, OCD can have an adverse effect in every aspect of that person's life. The outlook is optimistic, however, because research has shown that even people suffering from severe OCD may benefit from medication, behavioral therapy, or a combination of the two.

Researchers have gained much insight into the cause of the disorder by comparing OCD brains with "normal" brains. There is continued debate about whether OCD is caused by neurobiological factors, environmental influences, or both. There is at least evidence to show that the brains of OCD sufferers differ from "normal" brains in systematic ways: "Recent preliminary studies of the brain using magnetic resonance imaging showed that the subjects with OCD had significantly less white matter than did normal control subjects, suggesting a widely distributed brain abnormality in OCD" (http://www.nimh.nih.gov/publicat/ocd.htm). The white matter, which lies beneath the cerebral cortex, contains axons which connect neurons in the cerebral cortex to neurons in other parts of the brain. Lowered white matter content seems to suggest that there is less intracranial communication in the brains of OCD patients. Another study showed that "persons having OCD often exhibit abnormal rates of metabolic activity [in direct correlation with the severity of the disorder] in the frontal lobe and the basal ganglia [more specifically in the orbital cortex] of the brain" (http://www.mhsource.com/hy/naf-ocd.html). It has been suggested that the orbital cortex is responsible for stimulating a "worry circuit" consisting of the "caudate nucleus, a part of the basal ganglia that helps in switching gears from one thought to another; the cingulate gyrus, which wrenches the gut with dread, and the thalamus, which processes the body's sensory inputs" (http://www.schizophrenia.com/ami/diagnosis/ocd.html). It is hypothesized that in OCD, these 3 respective brain areas become linked in action. Susan Swedo and her colleagues at NIMH have hypothesized that because OCD behaviors have been connected with antibodies attacking the basal ganglia, repeated strep throat infections in childhood may lead the formation of the fused "worry circuit."

Other researchers have suggested that OCD results from "an imbalance of a chemical [(neurotransmitter)] in the brain called serotonin [(note: other NT's such as dopamine and norepinephrine have also been implicated in OCD)]" (http://www.ocdresource.com/whatcausesocd.html). Studies have shown that OCD patients tend to have lower levels of this neurotransmitter (NT). Evidence which supports this hypothesis is the fact that drugs which increase serotonin output reduce symptoms of OCD. Because serotonin is essential for nerve cell communication, perhaps these lower levels of NT in OCD patients account for the fewer axons comprising their white matter. Medication and behavioral therapy are best when used in conjunction with one another. Both can actually produce a similar alteration of brain chemistry over time. Schwartz and Baxter of UCLA and the U. of Alabama have proposed that the 3 brain parts involved in the "worry circuit" can become unlinked with either Prozac or 10 weeks of behavioral therapy (http://www.schizophrenia.com/ami/diagnosis/ocd.html). Evidence for the breakup of the "worry circuit" comes from PET scans which show less activity in the right caudate nucleus after effective pharmacological or psychological therapy.

Medications and Psychotherapy are treatments for OCD. Unfortunately, once the medication is discontinued the symptoms often reappear.

One very effective form of behavioral therapy involves teaching the patient "exposure and response prevention techniques": how to deal with obsessions and compulsions without rituals (http://www.mhsource.com/hy/j61.html). In order to confront a fear of germs a patient might be asked to touch a garbage can and then to refrain from washing his hands. The patient's anxiety would mount initially, but after a long enough period of time it would subside in a process known as extinction. If this process was performed continually over