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Diagnosis and Treatment of ADHD, Learning Disabilities, Migraines, and Traumatic Brain Injury

Obsessive Compulsive Disorder (OCD)

Overview

Obsessive-Compulsive Disorder (OCD) is one of the most debilitating anxiety disorders. It is marked by the presence of obsessions (recurrent, intrusive thoughts) and/or compulsions (ritualistic behavior to reduce anxiety).  Besides psychological and behavioral symptoms, individuals with OCD may experience cognitive problems, which may be explained by brain dysfunction.  OCD is typically treated with medications and psychotherapy. Other treatment options include deep brain stimulation (DBS) and neurofeedback.

 

Symptoms

OCD is a condition characterized by the presence of obsessions, compulsions, or both. An obsession is a persistent, unwanted thought that causes the experiencer significant distress and therefore to have an urge of performing a compulsion. A compulsion is a repetitive action (e.g., hand washing, counting, and checking) that a person engages in to reduce anxiety (1). OCD is a highly heterogeneous condition, and people differ in symptom severity and the nature of their obsessions/compulsions.

OCD is sometimes associated with cognitive problems of memory, attention, processing speed, and executive functions (i.e., higher-order cognitive abilities such as planning, inhibition, and cognitive flexibility) (2,3).  This may be because someone may have perfectionism in understanding whatever material is being processed, thus slowing down completing the task at hand.

 

Neuroimaging

Studies have shown volume and connectivity abnormalities in the frontostriatal circuits, or neural pathways connecting the frontal lobe regions (particularly the orbitofrontal cortex in this case) to the striatum of the basal ganglia. These circuits affect cognition, behavior, and motor functioning and are implicated in other psychological and neurological conditions, such as schizophrenia and ADHD. Functional imaging studies have also demonstrated activations in these regions during symptom provocation (using individually tailored stimuli) compared to the baseline condition (neutral stimuli) (4-6).

 

Prevalence

According to the National Comorbidity Survey Replication (NCS-R), the lifetime prevalence of OCD among U.S. adults is 2.3%.  Half of these individuals have severe impairment in their everyday life.  Rates are higher among women than in men (7). OCD is highly comorbid with depression, other anxiety disorders, tic disorders, and ADHD (4).

 

Treatments

OCD is typically treated with medications (e.g., serotonin selective reuptake inhibitors or SSRIs) and psychotherapy. The most effective psychological method is exposure and response prevention therapy, which exposes the individual to the provocative stimuli and helps them gradually learn to not engage in the compulsive behavior (8). Deep brain stimulation and neurofeedback (noninvasive method to train brain circuits to regulate more effectively) are alternative treatment options for individuals who are resistant to traditional techniques (9-10).  Neurofeedback has the advantage of not having the side effects which are common with medication as well as the benefits being permanent (10).

— M. Chen & J.L. Thomas

 

References

  1.  American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (DSM-5). American Psychiatric Pub.
  2.  Abramovitch, A, Abramowitz, J & Mittelman, A (2013). The neuropsychology of adult obsessive–compulsive disorder: a meta-analysis. Clinical psychology review, 33(8), 1163-1171.
  3.  Greisberg, S, & McKay, D (2003). Neuropsychology of obsessive-compulsive disorder: a review and treatment implications. Clinical Psychology Review, 23(1), 95-117.  https://www.ncbi.nlm.nih.gov/pubmed/12559996
  4.  Chamberlain, S, Blackwell, A, Fineberg, N, Robbins, T & Sahakian, B (2005). The neuropsychology of obsessive compulsive disorder: the importance of failures in cognitive and behavioural inhibition as candidate endophenotypic markers. Neuroscience & Biobehavioral Reviews, 29(3), 399-419.
  5.  Whiteside, S, Port, J & Abramowitz, J (2004). A meta–analysis of functional neuroimaging in obsessive–compulsive disorder. Psychiatry Research: Neuroimaging, 132(1), 69-79.
  6.  Menzies, L, Chamberlain, S, Laird, A, Thelen, S., Sahakian, B & Bullmore, E (2008). Integrating evidence from neuroimaging and neuropsychological studies of obsessive-compulsive disorder: the orbitofronto-striatal model revisited. Neuroscience & Biobehavioral Reviews, 32(3), 525-549.
  7.  National Institute of Mental Health (2017). Obsessive-Compulsive Disorder. Retrieved from https://www.nimh.nih.gov/health/statistics/obsessive-compulsive-disorder-ocd.shtml
  8.  Abramowitz, J (1997). Effectiveness of psychological and pharmacological treatments for obsessive-compulsive disorder: a quantitative review. Journal of consulting and clinical psychology, 65(1), 44.
  9.  Lakhan, S & Callaway, E (2010). Deep brain stimulation for obsessive-compulsive disorder and treatment-resistant depression: systematic review. BMC Research Notes, 3(1), 60.
  10.  Hammond, D (2003). QEEG-guided neurofeedback in the treatment of obsessive compulsive disorder. Journal of Neurotherapy, 7(2), 25-52.
    https://www.tandfonline.com/doi/abs/10.1300/J184v07n02_03
Obsessive Compulsive Disorder

Obsessive Compulsive Disorder OCD