OCD in Pop Culture

Hopefully by now you realize that OCD is a fairly common dissorder. It effects a wide range of people everyday, in all sorts of situations. Below are some examples of OCD in Hollywood and on your TV.

The hit HBO TV series "Girls" latest episode evolves around the main character Hannah's relapse into  OCD:
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The movie "The Aviator" staring Leonardo DiCaprio is the story of Howard Hughes and his life with OCD:

Going back even further in time to the iconic movie "As Good As It Gets" which was released in 1997. This movies stars Jack Nicholson, and portrays his complications with the disorder:

There are so many other examples not mentioned above, but Hollywood and TV are doing a good job at making their viewers aware of this disorder (in my personal opinion).

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New Research in the Differences Between Grey Matter and White Matter in a Patient with OCD

Research is being done all over the world in order to better understand the symptoms of obsessive-compulsive disorder (OCD). Recently Peng et al. stated that there might in fact be a difference in the amount of grey matter in the brain of a patient with OCD. They performed a meta analysis of current research and came to the conclusion that they are some differences. The following image was taken from the article and best represent the differences (Peng et al, 2012).

Fig. 2. Regional differences in grey matter and FA between OCD patients and healthy controls. (a) Blue indicates brain regions with decreased grey matter regions in OCD patients compared with healthy controls. (b) Red indicates the regions with increased grey matter in OCD patients compared with healthy controls. (c) Blue indicates the regions with decreased FA in OCD patients compared with healthy controls. (d) Red indicates the regions with increased FA in OCD patients compared with healthy controls. (For interpretation of the references to color in the figure caption, the reader is referred to the web version of the article.)

So as you can see OCD patients have smaller amunts of grey matter in multiple areas including medial frontal gyrus and anterior cingulate cortex and larger volumes in the following areas: lenticular nucleus, caudate nucleus and a small region in the right superior parietal lobule (Peng et al, 2012).

In order to gain a better understanding of what all this means I did some further research finding an article linking this to mood disorders including depression. Drevets et al discovered that alterations to grey matter volumes within the brain led to malfunctions within the circuit and this led to depressive moods (Drevets et al, 2008).

All of this is new and exciting research on the way to a cure for OCD!

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Drevets, W. C., Price, J. L., & Furey, M. L. (2008). Brain structural and functional

abnormalities in mood disorders: implications for neurocircuitry models of depression. Brain Structure and Function, 213(1), 93-118.

Peng, Z., Lui, S. S., Cheung, E. F., Jin, Z., Miao, G., Jing, J., & Chan, R. C. (2012). Brain

structural abnormalities in obsessive-compulsive disorder: Converging evidence from white matter and grey matter. Asian Journal of Psychiatry.

Don't Worry We Have Solutions

So you might be a little OCD. That's okay! Everyone has their own personal quirks that make them who they are. If, on the other hand, your obsessions start to take over your day-to-day life, then maybe it's time to take some action and seek outside help. Consider the following list of suitable treatments:

Exposure and Response Prevention (ERP)

The most generally accepted form of therapy directly exposes patients to their obsessions and looks to find preventative measures. During the sessions, patients are encouraged to expose themselves to situations that evoke the compulsive act and then abstain from performing the ritual. This can be very stressful to some patients, but you have to remember you'll be with a professional who you can trust. The important characteristic of this therapy is to teach patients how to handle their anxiety of not being able to perform their ritual until the need is extinguished. Patients who are just starting out with this therapy are suggested to attend sessions 15-20 times in the first three weeks to really make a break through.

Cognitive-Behaviour Therapy (CBT)

Cognitive restructuring can help patients that have relapsed before and can eliminate dysfunctional beliefs that potentially impede a patient's obsessions. The cognitive and behavioural methods focus on the idea of "personal responsibility" many patients seem to possess. An example of this would be, "if I don't wash my hands my child will become deathly ill." By narrowing in on those obsessions, therapists can try and help modify dysfunctional beliefs in the hopes of returning the patient's responsibility to a healthy level. When CBT is performed in a clinical setting with a trained professional, the results have proven effective.

Psychoanalytic Therapy

Another form of therapy is psychoanalytic, in which the mode of treatment resembles that prescribed to other patients experiencing phobias or generalized anxiety disorders. Here, the idea is that the therapist wants to help remove whatever is causing the obsession, be it repressed emotions or hidden fears. In this line of treatment, the obsessions are thought to protect the mind from any repressed conflict. This can be very tedious and to date this form of therapy has not yet proven totally effective. That being said, it has worked for some patients. 

Biological Treatment

I decided to present this form of treatment last because treating disorders with medication is perceived as a negative approach to many, but it is still a viable option nonetheless. Drugs that increase the serotonin levels in the brain are most commonly given to patients with OCD. As with psychoanalytic therapy, only some patients respond completely to the prescribed medication. Some therapists advise that medication be the last option when treating OCD and it should be well monitored by a professional with some other form of therapy in conjunction. Some of the prescribed medications include:

• Fluoxetine (Prozac)
• Fluvoxamine (Luvox
• Phenelzne (Nardil)
• Sertalin (Zoloft)
• Clomipramine (Anafranil)

More information on medication: http://www.camh.ca/en/hospital/health_information

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Davison, G. Blankstein, K. Flett, G. Neale, J. 2010. Abnormal Psychology (Fourth Canadian Edition). Ontario: John Wiley & Sons Canada. p.188-196

Neurological Basis of OCD

Hi all,

Our previous posts depict various aspects of obsessive-compulsive disorder.   Following the case studies and symptoms outlined below, I would like to present research findings that shed light on the neurological basis of the disorder.  The following list is of several areas in the brain that are understood to be involved in networks that perpetuate the symptomatic behaviours characteristic of this disorder.  The Orbitofrontal Cortex (OFC) is responsible for evaluation of consequences that underlie the decisions we make; the Anterior Cingulate Cortex (ACC) is actively engaged in situations that present a risk of making an error; The Dorsolateral Prefrontal Cortex (DLPC) is involved in cognitive processing of information relevant to making decisions; the caudate nucleus in the basal ganglia exerts control over programs of behaviour;  the Striatum receives input from the cerebral cortex; and the thalamus receives sensory signals from the external environment and relays them to the cortex.[1] Below is a diagram that will help you visualize the areas of the brain discussed.

Image courtesy of: dreamscience.org

So how do these parts of the brain work together to produce such intrusive and impairing symptoms that we associate with OCD?  To begin, let’s admit that everyone makes mistakes.  As it turns out, we have certain brain regions allocated to the evaluation of our potential risk of being wrong.   With the help of measurement devices like the Electroencephalogram (EEG) and functional Magnetic Resonance Imaging (fMRI) researchers have identified that caudal ACC is involved in producing something that is known as Error-Related Negativity. [2]  It has been documented that higher prevalence of OCD symptoms positively correlates with larger ERN.  Thus, an OCD patient may feel compelled to “fix” the error that is signalled by his/her brain, while an outside observer may not notice any cause for concern. [3] Peculiarly, OCD patients do not exhibit a higher level of ERN in all cases.  Whereas a hyperactivity of ERN is observed during a “response conflict task”, such as correctly labelling items, a hypo-activity of ERN is observed during tasks associated with reinforcement learning.  In other words, a person suffering from OCD is in a perpetual cycle of having an exaggerated sense of something being wrong, but not learning to abstain from the behaviours that trigger the distressing emotions he/she experiences, regardless of how irrational they may be.   Moreover, the OFC, striatum, and ACC are known to comprise a circuit, making it difficult for the patient to override the obsessions and compulsions. [4]

Okay, so the presence of brain circuitry and exaggerated error signals contribute to feelings of doubt and insecurity of OCD patients, leading to obsessions, and triggering responses that we label as compulsions.[5]   What is the basis for this inflexible and rigid network?  Rolls, E.T. has examined the relationship between the stability of cortical networks and elevated levels of glutamate in an attempt to get closer to the source of the problem.  There is indication that an increase of the neurotransmitter glutamate is linked to the increase of stability of these networks. Studies suggest that the neocortex and striatum in brains of patients with OCD contain greater levels of glutamate, accounting for increased stability. The glutamatergic activity is thought to cause decreased flexibility of thought about the action and maintain rigid motor activities that do not seem to be affected by cognitive analysis.  Interestingly, excessive levels of glutamate are not limited to specific areas and can be found in various regions of the brain which are associated with symptoms characteristic of the disorder.  It is known that OCD does not produce a uniformity of symptoms, as people seem to be affected differently.  It is therefore likely that the location in the brain affected by hyperglutamatergia (as it is known in scientific language), affects the nature of symptomatic behaviour exhibited by patients.   The cause of hyperglutamatergia is proposed to be linked to genetics, but not well known. [6]

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[1]Aouizerate, B., Bioulac, B., Burbaud, P., Cuny, E., Guehl, D., Rougier, A., Tignol, J. (2004). Physiology of obsessive-compulsive disorder: A necessary link between phenomenology, neuropsychology, imagery, and physiology.  Progress in Neurobiology, 72(3), 195-221.

[2]Allen, J.J.B., Cavanagh, J.F., Grundler, T.O.J., Figueroa, C.M., Frank, M.J. (2009). Task-related dissociation in ERN amplitude as function of obsessive-compulsive symptoms.  Neuropsychologia,  47(8-9), 1978-1987.

[3] Gehring, W., Himle, J., Nisenson, L. (2000). Action-Monitoring Dysfunction in Obsessive-Compulsive Disorder.  Psychological Science, 11(1), 1-6.

[4] Allen, J.J.B., Cavanagh, J.F., Grundler, T.O.J., Figueroa, C.M., Frank, M.J. (2009). Task-related dissociation in ERN amplitude as function of obsessive-compulsive symptoms.  Neuropsychologia,  47(8-9), 1978-1987.

[5] Falkai, P., Gruber, O., Melcher, T. (2008). Functional brain abnormalities in psychiatric disorders: Neural mechanisms to detect and resolve cognitive conflict and interference.  Brain Research Reviews, 59(1), 96-124.

[6] Rolls, E.T. (2012). Glutamate, obsessive-compulsive disorder, schizophrenia, and the stability of cortical attractor neuronal networks.  Pharmacology, Biochemistry and Behaviour, 100(4), 736-751.

New Moms Prone to OCD?

Recently I was browsing some news articles revolving around Obsessive Compulsive Disorder, I was curious about the latest information regarding this illness. Some how I was not surprised that I found so many articles discussing the increased chances new mothers have in developing this disorder. I say that I am not surprised due to the nature of OCD and how it can sometimes be associated with worrying and the desire to maintain a tight grasp on things.

I decided to read further into these articles so I will provide you a brief summary.

OCD takes the baby blues to a whole new level by Bryony Gordon

http://www.dnaindia.com/health/report_ocd-takes-the-baby-blues-to-a-whole-new-level_1808566

This article is written by a woman previously diagnosed with OCD, she was taking antidepressants however stopped when she was pregnant. Shortly after having her baby her OCD symptoms skyrocketed and she began having very severe compulsions. She had to wash her hands regularly, call her husband often to ensure he was ok and at one point convinced herself of having HIV. Finally she went to a doctor and began taking a low dose of antidepressants, which improved her condition dramatically (Gordon, 2013).

New moms prone to OCD by Jenn Savedge

http://www.mnn.com/family/babies-pregnancy/blogs/new-moms-prone-to-ocd

This article led me to a more scientific answer stating that 11 percent of new moms experience OCD symptoms compared to 2-3 percent of the average population. The good news being that these symptoms tended to fade quite rapidly after about 6 months (Savedge, 2013).

After reading these news articles I decided to do the research to back it up and found a study performed by Forray and colleagues from Yale University School of Medicine. There study involved 126 women who had been diagnosed with OCD and the comparison between the group that had been pregnant previously and those that had not. The results of the study provided evidence that pregnancy did in fact affect the onset or worsening of OCD symptoms in women that had previously been diagnosed with OCD (Forray et al. 2010).  

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 Forray, A., Focseneanu, M., Pittman, B., McDougle, C. J., & Epperson, C. N. (2010).

Onset and exacerbation of obsessive-compulsive disorder in pregnancy and the postpartum period. J Clin Psychiatry, 71(8), 1061-1068.

Gordon, B. (2013, March 7). OCD takes the baby blues to a whole new level. DNA,

Health, http://www.dnaindia.com/health/report_ocd-takes-the-baby-blues-to-a-whole-new-level_1808566 (2013, March 7).

Savedge, J. (2013, March 5). New moms prone to OCD. Mother Nature Network, family,

http://www.mnn.com/family/babies-pregnancy/blogs/new-moms-prone-to-ocd (2013, March 7).

A personal story of OCD

Hi all,

Sometimes the best way to get a good understanding of a disorder is to hear it from someone who deals with it on a regular basis. I found this video which shows a young man who struggles with OCD everyday and his recovery.

Until next time,

T

Signs and Symptoms

Hey guys,

Feeling anxious today? Well, you’re not alone; everyone has their own little obsessive quirks like needing their environment to be clean and organized or being a perfectionist. It’s normal! But sometimes the obsessions are beyond that point and we’re here to equip you with the signs and symptoms of obsessive compulsive disorder so you can live a happy healthy life :)

As evident in the name, there are two components to the disorder: obsessions and compulsions. Obsessions are irrational and uncontrollable recurring thoughts. These thoughts are unwanted, and if severe enough, can interfere with daily life. Common obsessions include washing (fear of germs or contamination) and checking (is everything in order, are electronics/appliances turned off etc.). Compulsions are repetitive behaviours the individual feels compelled to perform in order to ward off anxious feelings about the thoughts they are obsessing over.  People suffering from this disorder may believe that something horrible will happen if they don’t complete these acts.[1]

 Examples include:

-          washing hands many times in a row

-          checking many times that a particular task was done (turn off appliances)

-          Performing repetitive and protective tasks like counting to a certain number, turning on and off the light switch a certain number of times, or lining up shoes in a perfectly straight line.

A key component of this disorder is that it is ego-dystonic (not consistent with the individual’s normal personality). Even if you exhibit some of the symptoms mentioned above, this does not necessarily mean you have the disorder. If you think you fit these symptoms and are feeling in distress, please seek professional help. 

Until next time,

C

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[1] Davison, G. C., Blankstein, K. R., Flett, G. L., & Neale , J. M. (2010). Abnormal psychology. (4th ed., pp. p/ 189-191). New York : John Wiley & Sons Canada Ltd.