Biology 202, Spring 2005
Third Web Papers
On Serendip

Some common obsessions include wanting objects to be lined up correctly or symmetrically, being afraid of catching a disease due to a lack of cleanliness, or worrying about whether the stove was turned off. In order to make oneself feel better about the problem, people become involved in compulsions such as activities or rituals (1). There is an important difference between an "activity" and a "ritual," however. Rituals often include people washing their hands to the point where the skin becomes dry and breaks or checking numerous times to make sure locks were closed. There is another class of disorder called Obsessive Compulsive Personality Disorder (OCPD), which tends to focus more on perfectionism, especially for those who are characterized as workaholics or those who keep to strict religious or moral guidelines (2). Still, in many cases there is no clear-cut difference between OCD and OCPD. In the case of hoarding, in which individuals are unable to discard objects which seem to have no real value, it is undecided as to whether this is an OCD or an OCPD. A type of OCD in which the obsessions and compulsions only happen in the mind is commonly called Pure O (3). With Pure O, insecurity about a certain aspect of oneself causes the person anxiety. This seems to be something that all people go through, but for people with Pure O it leads to long periods of rumination over the thought, which causes further anxiety and panic. Pure O is characterized as a type of OCD, whereas OCPD is explained as totally separate, but they both seem to fall within the OCD spectrum of disorders, which are not exactly OCDs (2).

After reading about these disorders, it has occurred to me that I have been afflicted by all of them at different points in my life, which would lead me to believe that the disorders are simply different ways of dealing with a common problem, namely insecurity. As a child I had an obsession with balance where, for example, if I would touch my right leg, I would also have to touch my left leg. When I would ask myself why I would do this, I would simply reply that, "I didn't want to make the other leg feel bad." At present I have minor issues with hoarding and the ability to trust people. It is not difficult to make the case that all people have faced insecurity, and therefore it is not too far-fetched to say that perhaps some people deal with their general insecurity by trying to bring balance into other areas of their life that can be controlled. The idea that drawing symmetrical houses can make you feel more secure is more unconscious than conscious, and therefore it is important to recognize the functions in the brain that are related to OCD.

Brain scans have shown that OCD affects the frontal cortex and the basal ganglia (clusters of neurons located inside the brain). There is increased activity in these areas, which normally work together by the frontal cortex sending information to the basal ganglia, which then transports this to other parts of the brain (4). The frontal cortex seems to be involved in memories and decision-making, and it can also control inhibition. Because the frontal cortex and basal ganglia transmit seratonin as one of their functions, it has become important to look at the ways that chemicals in the brain affect OCD. When the neurotransmitter seratonin is being sent back and forth to neurons in the brain, it often happens, especially in people who suffer from neurological disorders, that seratonin does not stay in gap (synapse) between the two neurons for long enough (5). Because of this, too much reuptake of the neurotransmitter occurs before seratonin can show its full effect. SSRI (Selective Seratonin Reuptake Inhibitor) medication seems to help some patients with OCD. With SSRIs, this reuptake is blocked so more seratonin can build up in the brain. It is postulated that the frontal cortex controls what is remembered, what is learned, and has general inhibition power. In a person with OCD, the frontal cortex has lost some connection ability with the rest of the brain and so it cannot control whether the brain will learn a repetitive activity or concentrate on a certain rule (4).

It is also important to note that it is not only the increase in seratonin, but also the ability of the brain to use that seratonin, that functions in improving patients with OCD (4). The cells themselves often need several weeks before the are able to change to the extent that they will allow the SSRIs to have an effect on the receptor cells. In my case, the SSRI that I was given, fluvoxamine, produced adverse side-effects and did not help the OCD, but perhaps if I had continued with the medication a few more weeks, my receptor cells would have been able to evolve in order to allow the SSRI to function. Still, many people with OCD see no changes at all with any of the medications, showing that perhaps seratonin is not the only chemical in the brain that is affected. Another cause for OCD could be streptococcal infections in children. In some children, the immune system creates antibodies for the infection, but the system then starts to recognize cells of the basal ganglia as foreign, which is known as an autoimmune response (6). It has been shown that some children with OCD have these antibodies in their system, so perhaps the problems with the basal ganglia made it so that the frontal cortex was unable to communicate with it properly (4).

In addition to medication, there are other psychosocial treatments that have been effective for OCD, including Cognitive Behavior Therapy (CBT) (7). Behavior Therapy involves exposure and response prevention (E/RP). In this treatment, the patient is first given cognitive reasons as to why their fears are unfounded or unreasonable. Then they are exposed to what they are afraid of because it has been shown that with time, the exposure makes the fear seem less frightening. After exposure, the ability to perform ritual responses is blocked. Of course, not all OCDs follow this pattern of being afraid of something, so other therapies are used, especially in the cases of OCPDs and Pure O. These can sometimes be helped with thought suppression and habit reversal, where you find another, non-OCD behavior (7). OCPDs are especially difficult to subdue because the patient's entire personality revolves around perfectionism (2). These treatments help to change the behavior, but they do not explain why a certain behavior began, so medication continues to help with the neurological root of the problem. Changing a behavior also includes reversing a neural pathway in the brain, so it would seem that both therapies have a biological basis.

If there is evidence that OCD is caused by problems in the brain, then how could the disorder possibly have to do with subconscious psychological problems, such as the need for security? As one article put it, "It wouldn't be too presumptuous to postulate that OCD evolved out of a basic human need [for order and purity] and somewhere along the way, ultimately became the need itself (4)."

References

1)Obsessive Compulsive Foundation, Website explaining the disorder

2)Obsessive-compulsive personality disorder, Article about OCPD and its differences from OCD

3)Pure Obsessional OCD, Article about Pure O and how it differs from OCD

4)As Good As It Gets?, Article about OCD and its causes in the brain

5)Selective serotonin reuptake inhibitor, Article on the ways the SSRIs function

6)PANDAS The OCD/Strep Connection, Website about the immune system's role in OCD

7)Cognitivie Behavioral Therapy For OCD, Website about CBT other therapies for OCD


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