Obsessive Compulsive disorder affects one in fifty adults and twice that have suffered from it at some point in their lives (1). The Obsessive Compulsive Disorder Foundation describes OCD as "the brain getting stuck on a particular urge". Obsessive Compulsive Disorder (OCD) is made up of obsession and compulsion. Obsessions are thoughts, images, and impulses that occur over and over again in the brain. They cause the sufferer to feel out of control of their behavior. The sufferer performs compulsions to control their behavior and to try and make the obsession go away. (1). Some of the most common obsessions are obsessions with germs and cleanliness that cause some people to bathe 14 time a day or compulsively wash their hands, obsessions with order that cause sufferers to organize their belongings because of a fear of losing them, and fear of causing harm to self or others that can result in obsessive checking of stoves etc. and obsessive worry about others well being. These obsessions take up time, OCD is categorized by compulsions that take up more than one hour a day, and cause the sufferer great distress. According to the research, most OCD sufferers are aware that they are being irrational and that their behavior is disruptive. This is part of the disorder that I found most interesting.
If in fact brain = behavior, then in the case of OCD the patient's brain is controlling a behavior that the "I" knows is irrational and self destructive. Both the upsetting activity and the knowledge that the activity is wrong are coming from the same place. The research I found stated that it was very uncommon for sufferers to not recognize that their compulsions were disruptive. Like many other mental illnesses like depression, Turette's and tic disorders, serotonin is looked to as the cause and the cure. The neurological cause for OCD is said to be poor communication between neurons in specific parts of the brain that cause the brain to become "stuck" on particular behaviors and thoughts (2). Brain scans have shown that the orbital cortex in patients with OCD is overactive which can cause a "worry circuit" that includes the caudate nucleus which is part of the basal ganglia that allows the brain to "switch" from one thought to another, the cingulate gyrus which causes the physical and emotional responses to great anxiety and high emotion, and the thalamus which receives and process sensory inputs from the body (2). Low levels of serotonin have been thought to cause this "worry circuit" and many patients have had great success with drug therapy including serotonin reuptake inhibitors (SRI's) (1).
There are two main methods of treatment for sufferers of OCD. The first is, as mentioned, the use of drug therapy, mainly SRI's, to increase levels of serotonin in the brain and allow for better communication within the brain that keeps it from getting "stuck" on certain behaviors. The other method is Cognitive Behavior Psychotherapy (CBT). In CBT the patient learns to internalize structures for resisting obsessive behavior. They learn to change their thoughts and feelings by changing their behavior (1).. This is very interesting in the argument that brain = behavior because it seems that in this case behavior changes the brain. Brain scans showed the effect of CBT is the same of that of drug therapy on the activity of the orbital cortex (2). So it seems that CBT teaches the "I" to take control of the brain and by modifying their behavior they are able to actually modify the behavior of neurons in the brain. CBT basically forces people who suffer from OCD to face their fears by exposing them to it and then preventing them from carrying out their response ritual. The example given was to have someone who has a germ obsession touch money then not allow them to wash (1). Another site referred to this as systematic desensitizing action, flooding, saturation and thought stopping. It was pointed out that this type of therapy cannot be attempted until the person learns relaxation techniques because the damage done by the therapy can be worse than the treatment (3). Thought stopping is a concept where people with OCD learn to stop their obsessive thoughts by recognizing them and then stopping them with a verbal command (Stop!) or with something like a snap of a rubber band on the wrist (3).
This type of behavioral treatment is advocated and studied by Dr. Schwartz from UCLA. He states "The beauty of being human and not a rat or a monkey is that you don't have to listen to your brain every single time" (2). I think this has some interesting implications to the concept of the self. If brain = behavior and brain is the self then how can the brain participate in a behavior that the self recognizes as wrong? If the self is contained in the brain then how does the self decided not to "listen" to the brain and actually modify the action of the brain by modifying behavior? I do not have the answers, but it is something to continue to think about.
2) All about Obsessive Compulsive Disorder" , - scroll down to "Shake in the Mind"
3)Obsessive Compulsive Disorder Treatment,
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This paper reflects the research and thoughts of a student at the time the paper was written for a course at Bryn Mawr College. Like other materials on Serendip, it is not intended to be "authoritative" but rather to help others further develop their own explorations. Web links were active as of the time the paper was posted but are not updated.