OCD: Obsessively Obsessing over the things you obsess about?

Updated: Jun 30, 2021

Pop culture and unhealthy social media trends have reduced mental disorders into “quirks”. Obsessive-Compulsive and related disorders are no exception to this. In a world where people assume that liking to stay clean and stepping over sidewalk cracks makes them OCD, it is important to understand that phrases like “I am so OCD” is not to be thrown around carelessly. According to the Diagnostic and Statistical Manual of mental disorders-5 (DSM 5) Obsessive Compulsive and its related disorders along with OCD include body dysmorphic disorder, hoarding, excoriation (skin picking), and trichotillomania(compulsive hair-pulling). For clarification, only Obsessive Compulsive Disorder will be covered in this essay.


For clarification, only Obsessive-Compulsive Disorder (OCD) will be covered in this essay.


Obsessive-compulsive disorder is characterized by the presence of obsessive or intrusive thoughts, and compulsions that involve behaviors that are aimed at reducing the distress or preventing some dreaded event from occurring. People with OCD actively try to suppress their obsessive thoughts which are almost always experienced as disturbing, inappropriate, and uncontrollable. The compulsions on the other hand can be overt(like putting things in order) or covert(like counting or praying). Most people with OCD, over 90 percent, experience both obsessions and compulsions.(Foa & Kozak, 1995; Franklin & Foa, 2007).


Although almost all of us have experienced some minor obsessive thoughts or engaged in repeated, stereotyped behavior (like wearing clothes of certain colors while giving exams), for people with OCD their obsessions and compulsions go far beyond, debilitating them and taking away huge chunks of time from their day. The individual gives meaning to their obsessions and interprets their thoughts as problematic and significant, it causes these thoughts to increase in frequency, and overtime to become stuck on repeat mode, generating anxiety. To eliminate this anxiety and discomfort the individual engages in certain behaviors which give them temporary relief. But their obsessions soon take over again and their compulsive behavior also gets reinforced and they become dependent on them. This is the vicious cycle of OCD.


Since mental disorders are unique to the person experiencing them, the nature and intensity of obsessions and compulsions vary from person to person. But some themes are quite consistent cross-culturally and across the life span (Pallanti, 2009; Steketee & Barlow, 2002). Obsessive thoughts consist most often of contamination fears, fears of harming oneself or others, and pathological doubt. Other fairly common themes are concerns about or need for symmetry, sexual obsessions, and obsessions concerning religion or aggression. There are five primary types of compulsive rituals: cleaning (handwashing and showering), repeated checking, repeating, ordering or arranging, and counting (Antony et al., 1998; Mathews, 2009), and many people show multiple kinds of rituals. For a smaller number of people, the compulsions are to perform various everyday acts (such as eating or dressing) extremely slowly (primary obsessional slowness), and for others, the compulsions are to have things exactly symmetrical or “evened up” (Mathews, 2009; Steketee & Barlow, 2002).


As it is evident, OCD is an extremely complex and multifaceted disorder and the possible biological underpinnings of this disorder will be explained in the subsequent section. Rigorous scientific studies have been conducted to understand the biology behind this disorder in the past 25 years and it can roughly be divided into three sections- genetic factors, brain abnormalities, and neurotransmitter imbalances.


Unzipping the Genes: Insights into the genetic predisposition


Many studies on OCD have found it to be linked to faulty genes. Twin studies have found that identical twins are twice as likely as non-identical twins to develop OCD, that is, the concordance rate of OCD between monozygotic twins is moderately higher than that for dizygotic twins. Family studies have also shown that the closer you are to a family member who has OCD the more likely it is that you also might develop OCD. The rates of OCD are 3-12 times higher in first-degree relatives. An important point to be noted is that early-onset OCD has a greater genetic loading than late-onset OCD. (Grisham et al., 2008; Mundo et al., 2006).


Recent studies have also been done to find out whether there is a specific gene responsible for OCD but haven’t found one indicating that OCD is polygenic i.e. a result of the combination of multiple variations(alleles) of genes. Around 230 separate genes have been identified and there is evidence that particular versions or alleles of certain genes may signal greater vulnerability. Needless to say, genes do not explain OCD in its entirety and we have to turn to other factors as well.


Isn't OCD about the mind? Assessing Brain Abnormalities


Hyperactivity of the cortical and subcortical regions of the brains of individuals with OCD has been a consistent finding in research. PET scans have shown that people with OCD have increased activity in two parts of the frontal cortex- the orbitofrontal cortex and the cingulate gyrus. They also have increased activity in the subcortical caudate nucleus of basal ganglia (basal ganglia is a group of structures in the brain that control movements, posture, balance along with reward and reinforcement, addictive behaviors and habit formation).


Picture originally adapted from Baxter LR Jr, et al: Local cerebral glucose metabolic rates in obsessive-compulsive disorder: a comparison with rates in unipolar depression and in normal controls, Arch Gen Psychiatry 4[3]:211-218, 1987. As published in Schwartz JM: Obsessive-compulsive disorder, Sci Med 4:16, 1997.


The orbitofrontal cortex controls our primary urges like sex, aggression, hygiene, and danger. The caudate nucleus or corpus striatum filters out these urges making sure that only the strongest urge is passed on to the thalamus. Zooming in, we find there is an important neural pathway in the brain called the cortico-basal-ganglionic-thalamic circuit (the caudate nucleus is a part of this circuit since it belongs to basal ganglia) connecting the orbitofrontal cortex to the thalamus. The thalamus is an important relay station that receives nearly all sensory input and passes it back to the cerebral cortex.


Now, how is this concerned with OCD? This cortico-basal-ganglionic-thalamic circuit is normally involved in the preparation of complex sets of interrelated behavioral responses used in specific situations such as those involved in territorial or social concerns. Dysfunction in this circuit can lead to inappropriate behavior including repeated sets of behaviors stemming from territorial and social concerns (e.g., checking and aggressive behavior) and from hygiene concerns (e.g., cleaning).


As we already got to know that orbitofrontal cortex controls our primitive urges, overactivation of this part in combination with faulty communication between the orbital frontal cortex, the corpus striatum or caudate nucleus, and the thalamus (which is downstream from the corpus striatum). According to Baxter’s theory, the dysfunctions in this circuit, in turn, prevent people with OCD from showing the normal inhibition of sensations, thoughts, and behaviors that would occur if the circuit were functioning properly. Impulses that other people can normally keep under control, leak through as obsessions in individuals with OCD due to this dysfunction. Evidence suggests that at least part of the reason that this circuit does not function properly may be due to abnormalities in white matter in some of these brain areas; white matter is involved in connectivity between various brain structures (Szeszko et al., 2004; Yoo et al., 2007). All this shows that there are actual structural and functional differences in the brains of patients with OCD.


Let's blame the Neurotransmitters? Investigating Balance & Imbalance


The neurotransmitter serotonin ( a complex chemical engaged in a wide range of functions like mood regulation, memory, sleep, digestion, blood clotting, and others) has been found to be linked to OCD. Although the exact nature of serotonergic dysfunction in OCD is not yet known( a lot of research still needs to be done on serotonin itself), current evidence suggests that increased serotonin activity and increased sensitivity of some brain structures to serotonin are involved in OCD symptoms. Indeed, drugs that stimulate serotonergic systems lead to a worsening of symptoms. Besides serotonin other neurotransmitter systems (such as the dopaminergic, GABA, and glutamate systems) also seem to be involved, although their role is not yet well understood (Dougherty et al., 2007; Stewart et al., 2009) However, it is not clear whether these neurochemical changes cause OCD symptoms or whether they come about as the result of experiencing OCD symptoms.


Conclusion


Although biological factors make it easier to understand this complicated illness, they are not the whole picture. According to the diathesis-stress model of mental illness, an individual needs to have a genetic or biological predisposition for that illness (diathesis) combined with stressful conditions that play a precipitating or facilitating role. In simpler terms, Socio-cultural factors and environment play a key role in the development of an illness, the ever permeating debate of nature vs nurture in psychology. Moreover, there is still a mine of knowledge that needs to be uncovered in terms of biological factors for the development of Obsessive-Compulsive Disorder.


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A friendly reminder: We've done our research, but you should too! Check our sources against your own and always exercise sound judgment.


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About The Author


Priyambada Kashyap

Program Trainee, The Aryabhata-Shankara Neurotech Society (Unwired India)


Hailing from Assam, India, Priyambada Kashyap is a neurotech aspirant, who feels her life should have a perfect balance of everything in the universe from dance to academics. Pursuing her major in Psychology, every step of the way, she wonders about the various ways humans are influenced in their daily lives, as well as how embedded we really are in our social context. Her fascination lies in researching various psychological phenomena around counseling psychology, social psychology, biopsychology, educational psychology, political psychology, and even a tad bit of philosophy.


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