CDO: OCD in Alphabetical Order

Did I lock the door?  What if I locked the door but I did not shut it all the way? I am only a few blocks from my house, I am sure I will have enough time to turn back around and check the door.

Did I lock my car after I got home today? I am already tucked into bed and the house is set for the night... I just have to double-check one last time that I locked my car. 

These two obsessions and compulsions are only a few from the many that I live with everyday. When I was just a kid I got picked on often for my unusual habits: cleaning my desk every morning, making sure each pencil was sharpened and the same length, labeling everything in my backpack and lunch sac, alphabetizing the small library in the classroom every Friday afternoon, asking to organize the teacher's desk, staying late to make sure every last piece of chalk mark was erased from the board, and asking to design the seating chart each month following some new pattern of organization. As I got older these habits changed a bit; some went away as new ones emerged, and other just became more pronounced. The school psychologist finally asked to speak with me and that was when I was officially diagnosed with Obsessive Compulsive Disorder (OCD).

According to the DSM-5, the reason that people are diagnosed with OCD is because these behaviors seem to cause great distress and take up much of the individual's time. The DSM-5 also reports that in the United States 1-2% of the population suffers from this disorder and of that population only 40% seek treatment. Surprisingly, this disorder is seen as equal in terms of gender and ethnicities. This disorder is typically observed in adolescence and young adulthood and continues for many years thereafter. Someone with OCD can have either obsessions or compulsions, but they likely have both. These obsessions are constant thoughts, feelings, and/or images that occupy one's mind. These obsessions are often intrusive and foreign. Those who are faced with this know that their thoughts are excessive; however, trying to ignore them usually causes more stress and anxiety. Compulsions are recurring behaviors or psychological acts. These become rituals for the individual and are usually performed to reduce the stress and anxiety (Comer, 2009). 

So why does someone think and act this way? The most recent research is now looking at the abnormally low levels of the neurotransmitter serotonin, and five brain regions that are functioning abnormally as well: amygdala, thalamus, caudate nucleus, orbitofrontal cortex, and cingulate cortex. According to Stein and Fineberg (2007), although other neurotransmitters such as glutamate, GABA and dopamine might contribute to this disorder, the use of an antidepressant directed at serotonin has shown improvement in patients with OCD. These serotonergic pathways pass through all of those five structures. The amygdala is a structure with the primary function of processing emotions like fear, anger and pleasure. The thalamus is a structure that receives and relays somatosensory information throughout the brain. Both the caudate nucleus and orbitofrontal cortex are regions of the brain that convert sensory information into thoughts as well as actions (Craig & Chamberlain, 2010). The fifth structure is the cingulate cortex. This brain structure is primarily formed in emotion formation and processing. Many researchers have observed these brain structures in OCD patients and have found that there is a distinct pattern in which they contribute to obsessions and compulsions (Endrass et al., 2011). 

According to Fr. Shelton, the head of the psychology department at Regis University, these brain regions can placed in reference to the obsessions and compulsions many people experience daily. He uses the example of turning the stove off.
 
You fear that you have left the stove on at home ---> the amygdala begins to react to this fear. This sends a signal to the thalamus ---> However, the thalamus cannot register whether or not the stove was turned off ---> Your caudate nucleus detects this and allows you to begin to think that something must happen ---> the orbitofrontal cortex begins to think about what should be done ---> Thanks to your cingualte cortex, these thoughts now become obsessions. 

As mentioned before, these brain structures as well as the serotonergic pathways are functioning abnormally. Nevertheless, according to Comer (2009), anti-depressants that are combined with therapy have been shown to reduce anxieties, obsessions, and compulsions in these individuals. This allows them to live a life that is not so distressing or dysfunctional.





References:

Comer, R. J. (2009). Funadametals of Abnormal Psychology (7 ed.). New York:NY: Worth Publishers.

Craig, K. J., & Chamberlain, S. R. (2010). The neuropsychology of anxiety disorders. Textbook  of anxiety disorders (2^nd ed., pp. 87-102). Arlington, VA: American Psychiatric Publishing.

Endrass, T., Kloft, L., Kaufmann, C., & Kaufmann, N. (2011). Approach and avoidance learning on obsessive-compulsive disorder. Depression and Anxiety, 28(2), 166-172. 

Fr. Shelton. (2013, October 07). Lecture on obsessive-compulsive disorder.

Stein, D.J., & Fineberg, N. A. (2007), Obsessive-Compulsive disorder. Oxford, England: Oxford University Press.