OCD and the Brain

Megan Kneipp
Obsessive-Compulsive Disorder

 affects almost 3% of world’s population

 Start anytime from preschool to
adulthood
 Typically between 20-24
 many different forms of OCD – differ
from person to person
 cause of OCD is still unknown
 Better when diagnosed early
Definition
 Specific criteria to be clinically diagnosed
 Anxiety disorder with presence of obsessions
or compulsions
 ego dystonic – realize thoughts and actions
are irrational or excessive
 Must take up more than 1 hour a day
 Must disrupt daily routine
 Symptoms can’t result from effects of other
medical conditions or substances
Obsessions

 repetitive and constants thoughts, images, or

impulses that cause anxiety or distress
 thoughts, images, or impulses not about real-
life problems
 Try to ignore or counter act thoughts, images,
or impulses
 thoughts, images, or impulses “recognized as
a product of one’s own mind and not imposed
from without”
Compulsions

 Repetitive behaviors or mental acts

person does in reaction to obsessions
 behaviors or mental acts done to avoid
or decrease distress
 behaviors or mental acts are clearly
excessive or not realistic
History

 14th & 15th century thought people were

possessed by the devil and treated by
exorcism
 17th century thought people were cleansing
their guilt
 18th century finally considered medical
issue
 20th century began treating with behavioral
techniques
Theories

 Scientist split into 2 groups

 Psychological disorder where people
are responsible for feelings they have
 Abnormalities in the brain
Causes
 Serotonin is involved in regulating anxiety
 Abnormality in the neurotransmitter serotonin
 In order to send chemical messages serotonin
must bind to the receptor sites located on the
neighboring nerve cells
 OCD suffers may have blocked or damaged
receptor sites preventing serotonin from
functioning to full potential
 Possible genetic mutation
 Some people suffering have mutation in the
human serotonin transporter gene
OCD and the Brain
 PET scans show people with OCD have
different brain activity from others
 Another theory: miscommunication between
the orbital frontal cortex, the caudate nucleus,
and the thalamus
 Caudate nucleus doesn’t function properly and
causes thalamus to become hyperactive and
sends “never-ending” worry signals between
OFC and thalamus  OFC responds by
increasing anxiety
PET scans indicate differences in brain activity of OCD
patients versus normal
Comorbidity

 Has excessive comorbidity with other diseases

 Common diseases: Depression, Schizophrenia,
Tourette Syndrome
 Depression is the most common
 Many people with OCD suffered from depression first
 2/3 of OCD patients develop depression  makes
OCD symptoms worse and more difficult to treat
 People with OCD common diagnosed as
Schizophrenic  hard to separate obsessions from
delusions
Treatment
 Only completely curable in rare cases
 Most people have some symptom relief with
treatment
 Treatment choices depend on the problem
and patients preferences
 Most common treatments:
 Behavioral Therapy
 Cognitive Therapy
 Medication
Cognitive-Behavioral Therapy
 Cognitive: change the way they think to deal with
their fears
 Behavioral: change the way they react to “anxiety-
provoking” situations
 Exposure and Response Prevention
 Slowly learning to tolerate anxiety associated with
not performing ritual behavior
 Psychotherapy
 Talking with therapist to discover what causes the
anxiety and how to deal with symptoms
 Systematic Desensitization
 Learning cognitive strategies to deal with anxiety
then gradual exposure to feared object
Cognitive-Behavioral Therapy

 Should be done when people are ready for it

 Must be customized for each person’s specific form
of OCD and their needs
 No side affects except increased anxiety with
exposure to fear
 Often lasts about 12 weeks
 Positive effects off CBT last longer than those of
medication
 If OCD returns can successfully treat again with
same therapy
 Best treatment approach for most is CBT combined
with medication
Medication
 Anxiolytic benzodiazepine such as chloradiazepoxide or
diazepam  give temporary relief from anxiety but not really
effective on obsessions and compulsions
 Antidepressants because of common depression
 Selective Serotonin Reuptake Inhibitors (SSRIs): alter the
levels of neurotransmitter serotonin in the brain which helps
brain cells communicate with one another
 Prevents excess serotonin from being pumped back into
original neuron that released it
 Then can bind to receptor sites of nearby neurons and send
chemical message that can help regulate anxiety and
obsessive compulsive thoughts
 Most effective drug treatment helping about 60% of patients
 Ex: Prozac, Zoloft, Lexapro, Paxil
Conclusion

 OCD is a complicated issue

 Most cases are incurable
 Best form of treatment is CBT in combination
with medication
 Most important thing that can be done to
discover more about OCD and its treatments
is to research the brain