Have you found yourself asking why certain thoughts or actions keep manifesting themselves over and over again despite your attempts at suppression, avoidance or stopping the thoughts or behaviors? This is the reality of living with Obsessive-Compulsive Disorder (OCD).Â
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What actually happens in the brain that yields this dynamic? The scientific realm of OCD is complex in terms of the processes involved within the brain circuitry; particularly, the brain areas involved in decision-making, memory, and emotional regulation.Â
In this blog, we will take an overview of what happens in the brain for those with OCD, we will also consider brain chemistry functions, along with effects on individuals living with OCD.Â
What Is OCD?
Obsessive-Compulsive Disorder (OCD) is a mental health condition which has two essential parts, obsessions and compulsions.Â
- Obsessions are repetitive, intrusive, and distressing thoughts, images, and urges that come into a person’s mind again and again.Â
- These obsessions can involve troublesome thoughts such as fear of contamination, fear of causing harm or mistakes, and it is the effect of the obsession that is most troublesome.Â
- No matter how much a person tries to ignore or suppress the thought, it intrudes again and again, often leading to high anxiety.Â
- To manage anxiety caused by obsessions, individuals with OCD will engage in compulsions. Compulsions are actions or mental rituals that a person feels driven to do.Â
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For example, washing their hands repeatedly, checking locks, or counting numbers in their head. Compulsions can relieve anxiety that is created by obsessions, but they do not have any realistic causal connection to the dreaded event that person fears. This disconnect reinforces the cycle of OCD making it a chronic disorder.
What Happens in the Brain of Someone With OCD?
1. Basal Ganglia
The basal ganglia are an important group of structures located deep in the brain that contribute significantly to movement and behavior regulation, as well as learning and reinforcing particular behaviors.Â
- In OCD, structural abnormalities in the basal ganglia, especially striatum lead to compulsive behavior.Â
- The striatum is the brain’s integration center for afferent inputs involving multiple regions of the cortex, whereby it exerts integration in a way that is more relevant for motor control and decision making.Â
- In the case with OCD individuals, the striatum becomes exaggeratedly hyperactive to reinforce repetitive behavior.Â
- This hyperactivity could provide some explanation as to why individuals with OCD experience an inadvertent need to repeat the actions, even when they are aware this is irrational and not necessary.
2. Prefrontal Cortex
The prefrontal cortex is involved in executive function, which include planning, decisions and holding back inappropriate responses.Â
- Research on OCD has revealed there is often dysregulation on the activity of this part of the brain, particularly on the OFC (orbital frontal cortex). The OFC evaluates the rewards and risks of our decisions, collects information regarding risk and uncertainty, and judges the potential danger of events.Â
- In OCD, the OFC is hyperactive when we perceive possible threats, resulting in increased states of confusion and anxiety.Â
- Furthermore, noise caused from hyperactivity in the OFC may lead us to intrusive (or undesired) thoughts.Â
- Typically, what we forecast as being likely to cause harm is overestimated, and we notice this high level of uncertainty more intensely.Â
- Consequently, we experience this anxiety and are compelled to perform compulsive behaviours to alleviate anxiety, thus reinforcing this problem of OCD. Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â
3. Anterior Cingulate Cortex
The anterior cingulate cortex (ACC) is important for emotional processing, noting errors, and eventually regulating responses to uncertainty or conflict. Think of the ACC as a monitor or supervisor.Â
- When intended actions do not match the corrected actions, the ACC seems to cranial snowboarding on your mistakes.Â
- People with obsessive-compulsive disorder (OCD) often have ACC activity that is overactive, and consequently are caused both a recurrent sense of doubt and the overwhelming necessity for reassurance.Â
- Increased activity can also be a major factor in maintaining compulsive behaviors. When the ACC detects potential threats or inconsistencies, it sends signals that it is a-time for corrective action, which can be measured with compulsions—for example, repetitive behaviors or mental acts done to reduce the presence of da nger
What Causes OCD?
The precise cause of obsessive-compulsive disorder (OCD) is still not completely understood, but it is thought to be a complex interplay of genetic, environmental, neurochemical and cognitive-behavioral variables.Â
- Genetics is thought to play a significant part because individuals with a family history of OCD or other anxiety disorders are considered to be at higher risk for developing OCD.Â
- While multiple genes may contribute to increased risk, investigators continue to study how genetic variables may be affecting brain function and behavior.Â
- Environmental factors, including a history of trauma, chronic stress or significant life changes may also play a role in the triggering of OCD symptoms, especially in those who may be genetically susceptible.
- Disruption to neurotransmitters such as serotonin, dopamine, and glutamate is thought to underlie the condition on a neurochemical level. These neurotransmitter imbalances alter the brain circuitry that regulates compulsive behaviors and obsessive thinking.Â
- In addition to biological theories, cognitive theories suggest that people with OCD tend to catastrophize intrusive thoughts as being dangerous, which leads to anxiety and prompts the irrational belief that performing a ritual will somehow neutralize that which is threatening.Â
- Behavior accounts of OCD stress negative reinforcement: compulsive actions, which relieve anxiety temporarily, increase the likelihood of that behavior, thus maintaining the cycle of OCD.
Manage the OCD with Right Approaches
Obsessive-compulsive disorder (OCD) can be managed with a combination of therapy, medication and supportive strategies.Â
- Cognitive Behavioral Therapy (CBT) is known to be the most effective therapy with Exposure and Response Prevention (ERP) to reframe the negative thoughts with positive thoughts
- ACT, individuals are encouraged to accept the presence of the thoughts they fear and learn to refrain from using compulsions.Â
- A number of medications, the most common being selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs), are used to manage symptoms—SSRIs include fluoxetine, fluvoxamine and sertraline.Â
- Mindfulness practices, including meditation and deep breathing can help to reduce anxiety.Â
- Support groups are another important part of treatment, since they support the feeling of community and working through shared challenges while using shared management strategies.Â
Many experienced OCD therapists in NYC and specialized for evidence-based OCD treatment and some examples of group support.
Final Thought
OCD is a complex mental condition, affected by different areas of the brain, neurotransmitters that function improperly.Â
- Knowing the science behind your OCD is beneficial in understanding why intrusive, unwanted thoughts and compulsive behaviors occur and persist.Â
- Fortunately, with the proper combination of therapies, including CBT with ERP, medications, such as SSRIs, mindfulness techniques, and support groups, people can learn to manage their OCD and improve their quality of life.Â
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If you are struggling with OCD and looking for the process of managing OCD, finding an experienced OCD specialist in NYC can provide you with effective evidence-based treatment and the tools to live with OCD.Â
References
- Welter, L., Burbaud, P., Fernandez-Vidal, S., Bardinet, E., Coste, J., Piallat, B., Borg, M., Besnard, S., Sauleau, P., Devaux, B., Pidoux, B., Chaynes, P., Bastian, A., Langbour, N., Teillant, A., Haynes, W., Yelnik, J., Karachi, C., & Mallet, L. (2011). Basal ganglia dysfunction in OCD: Subthalamic neuronal activity correlates with symptom severity and predicts high-frequency stimulation efficacy. Translational Psychiatry, 1(5), e5. https://doi.org/10.1038/tp.2011.5
- Ahmari, S. E., & Rauch, S. L. (2021). The prefrontal cortex and OCD. Neuropsychopharmacology, 47(1), 211–224. https://doi.org/10.1038/s41386-021-01130-2
- Van de Veerdonk, M. M., Bouwens van der Vlis, T. A., Ackermans, L., Schruers, K. R., Temel, Y., & Leentjens, A. F. (2023). The role of the dorsal anterior cingulate cortex in obsessive-compulsive disorder. Deep Brain Stimulation, 3, 1-7. https://doi.org/10.1016/j.jdbs.2023.07.001
- Obsessive-compulsive disorder (OCD) – Symptoms and causes. (n.d.-c). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/obsessive-compulsive-disorder/symptoms-causes/syc-20354432
- Website, N. (2024a, April 17). Overview – Obsessive compulsive disorder (OCD). nhs.uk. https://www.nhs.uk/mental-health/conditions/obsessive-compulsive-disorder-ocd/overview/
