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2006 Second Web Paper
The National Institute of Health characterizes OCD obsession as "recurrent and intrusive thoughts, feelings, ideas, or sensations (1)" and compulsion, the counterpart to obsession as "a conscious, recurrent pattern of behavior a person feels driven to perform (1)". While in some cases, exhibiting either obsessions or compulsions comprises an OCD diagnosis, many people experience the obsessions and compulsions concurrently. Obsessions often come about as a barrage of unwanted, disturbing, and fear-invoking thoughts, and the person often feels that the only way to assuage the fear is by fulfilling the compulsion. However, a unique component of OCD is ego dystonia. Researchers and clinicians alike have observed that in the middle of an OCD cycle, many patients are fully aware that their obsessions and compulsions have no bearing in reality. This separation, this internal voice of reason, is termed ego-dystonia, and is a defining characteristic of OCD (2). It is notable that the term is rarely used in reference to any other neurological disorder. However, this internal voice of reason is often not enough to overrule the intense fear sparked by the obsessive compulsive cycle, making the disease incredibly debilitating for many Americans (4). Interestingly, this characteristic also forms the basis for new and controversial treatment for OCD as well as new understandings of the structure and the function of the brain.
Currently, many kinds of treatment are available for OCD sufferers, each resulting from a different hypothesized source of the disorder. These causalities range from an overused neural pathway in the forebrain (2), to a serotonin imbalance (1), to some mysterious autoimmune mechanism (3). Due to so much dissent within the medical community as to the origin of the disorder, researchers disagree about the best way to treat OCD. To exaggerate this dissent, many of the psychiatric studies published have generated frustrating results due conflicting clinical significance determinations between research groups (5). That said, there are few reliable and easily comparable numbers to back up whether pharmacology offers the best treatment option, as compared to aggressive exposure therapy, or talk therapy, etc. This paper will not go into depth on these treatment options, however, it will examine the possibility that the very component of this disorder that makes it so frustrating may also unlock the secret to curing it and a whole host of other neurological disorders: the involvement of the I-function.
Based on research conducted on the disorder, OCD appears to have ties on many levels to the I-function. First of all, obsessions clearly link to I-function processing as the very definition implies that obsessions are at the forefront of consciousness. However, these obsessions cannot be simply dismissed as other thoughts can. This complication makes the obsessive compulsive cycle very difficult to treat.
As is the case with obsessions, ritualistic compulsions involve the I-function in different ways than the actions do in people who do not have OCD. Dar and Katz's study on Obsessive Compulsive washers suggests that the compulsion of washing in OCD patients takes on a much higher level of identification than the act of washing does with non OCD suffers (6). One theory used to explain this phenomenon, the Action Identification Theory (AIT) says that low levels of identification of a specific action often are automatic; in other words, they can be performed with limited I-function processing (7). However, high levels of identification, as seen in OCD patients, take on a ritualistic quality so that the performing of the action uses the I-function to a much larger extent. Therefore, OCD patients identify with their obsessions and their compulsions on a high level, which closely involves I-function processing.
Furthermore, the very nature of ego dystonia has interesting implications for the role of the I-function in OCD thought processes. Going back to the definition, ego dystonia is a separate voice inside of the nervous system that recognizes the mind tricks that the brain is playing on itself. While documentation of this mental separation is less empirical and based more on interviews, it is still a valid observation. So valid, in fact, that one researcher and clinician, Jeffrey Schwartz, has used it to the patient's advantage. In his work, Schwartz teaches patients about what he believes is the major cause of the disorder, an imbalance in the firing of two pathways in the caudate nucleus, and has them practice resisting the obsessive compulsive cycle without the use of SSRIs or physical restraints (2). The mere fact that there are any numbers at all to support this treatment option seem to me to be quite in line with the power and involvement of the I-function in OCD. Patients employ reasoning and choice, all attributed to the I-function, to deal with an onset of the obsessive compulsive cycle and find that they can deal with the problem effectively.
The case of OCD offers a great deal of insight into the enormous power the I-function and its role in neuroplasticity. The nature of obsessions and compulsions, as well as ego dystonia, a defining characteristic of OCD, are closely related to the I-function. While this close connection between the disorder and the I-function often make OCD inaccessible and difficult to cure, by properly harnessing the power of the brain's power to change, new and effective treatment options emerge. On a larger scale, if the brain has the power to reduce the negative effects of OCD, what else is in its power to change?
1) Medline Plus,
2) Schwartz, Jeffrey M. M.D. and Sharon Begley. The Mind & The Brain. New York: Harper Collins, 2002.
3)Obsessive Compulsive Foundation,
4)National Institute of Mental Health,
5)Proquest Research Library, "How effective are cognitive and behavioral treatments for obsessive-compulsive disorder?"
6)Proquest Research Library, "Action Identification in Obsessive-Compulsive Washers".
7)The National Academies Press, Workload Transition
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