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Obsessive-Compulsive Disorder – OCD A TV series called "Monk" fashioned a story line around a San Francisco police officer with Obsessive-Compulsive Disorder (OCD). "Monk" was consumed by peculiar obsessions and wracked with hundreds of phobias, including germs, heights, and feeling compelled to have everything unreasonably neat and orderly. "Monk" struggled with even the simplest everyday tasks but was the city's top crime solver because of his attention to detail. In real life, however, many people with OCD often are not as well understood or appreciated. One in 50 adults has OCD.[1] Children with autism often experience OCD symptoms – lining up toys, banging their heads against the wall. Other children may be cognitively present, and yet completely dysfunctional because of their obsessions.[2] Some spend their entire lives battling the condition.[3] Some get relief with pharmaceutical medication or cognitive-behavioral therapy. Many others get no relief. People with obsessive-compulsive disorder have intrusive and persistent thoughts, images or activities that cause great anxiety. The obsessions are a product of the mind, and are recognized as being far beyond simple worries about real issues. Nevertheless, the affected individual is unable to escape these thoughts. Their life revolves around, and is controlled by, these obsessive thoughts or actions. These are the people who are unable to leave the house because they cannot check often enough that they have turned off the water faucet in the bathroom. They are unable to leave the driveway because they have to keep checking that they have locked the front door. They are arrested – or hospitalized – because they cannot stop thinking about that cute girl that lives next door and following her everywhere she goes. They wash their hands raw. They run around in circles, bang their heads on the wall, line up their toys, or stuff themselves with food. They know that they are being irrational and unreasonable. They know that their lives are disrupted. And yet, they are unable to help themselves. TWO MODELS OF THE DISORDERThe biological model shows that the disorder is caused by abnormal neurotransmitters, or abnormal neural circuitry in the brain – particularly in the frontal/prefrontal cortex and limbic systems. Treatment in the conventional medical world involves using medications – generally serotonin reuptake inhibitors – to increase brain levels of serotonin.The cognitive-behavioral model proposes dysfunctional beliefs, and treatment involves altering those belief systems by unlearning them, and replacing them with more functional belief systems. This is also known as "talk therapy." Let's walk through the brain of a person with OCD. The big stop on this tour is the frontal cortex, the area typically involved in planning, organization and verification of previous activities. In the frontal lobes, we find areas involved in the reward/punishment circuitry. And when we get to the white matter - the insulated neurons or "nerve highways" - we'll see some evidence for abnormalities and lesions.[4,5] Not everyone with brain lesions actually suffers from OCD, so there is most likely some environmental influence - toxic, heavy metal, life experience, etcetera - which causes the condition to develop in susceptible individuals. Studies show that different areas of the frontal cortex are involved with different aspects of OCD.[6] The midline areas relate to the reward value – how good it feels to know that we have locked the door, turned off the gas, etc. The lateral areas relate to how badly we will be punished if we make a mistake – whether a burglar can get in through the unlocked door, whether the house will blow up if we forget to turn off the gas, etc. Also, the more anterior part of the orbito-frontal cortex is in charge of more complex reinforcers like monetary gain or loss where the posterior part is associated with simpler reinforcers like taste or pain.[7] Scientists have discovered that people with OCD and their close family members show under-activation of brain areas responsible for stopping habitual behaviour. (Credit: Adam Hampshire) – ScienceDaily (July 18, 2008) qEEG studies have shown abnormalities of brain waves frequencies and power in the frontal lobes and the right hemisphere in general. Abnormalities are associated with every condition of brain dysfunction. With OCD, we see enhanced frontal activation at baseline, weakening with  provocation of symptoms. TREATING OCDAt the Arizona Center for Advanced Medicine we use a multi-faceted approach called BrainAdvantage™. We start by increasing the blood supply to the frontal lobes through a simple biofeedback mechanism initiated by focusing one's attention. Next, we teach the brain where we would like it to make new connections. Then we teach the brain how to repair the timing of information transfer through a series of exercises designed to improve coordination, balance, auditory processing and cognitive development. At the same time, during the treatment sessions patients are encouraged to alter their thought patterns, and are not allowed to perseverate while in clinic. This is called cognitive-behavioral therapy.We also look at diet and nutrition because blood sugar highs and lows can contribute to the dysfunction of OCD. As the OCD symptoms diminish, we find that patients can begin to decrease their pharmaceutical medication. Often, they are able to stop it entirely. The BrainAdvantage program usually encompasses 20 sessions, and there is "extra credit" you can do at home. If more is needed, more sessions are available at a reduced rate. You can call us to schedule a free 15-minute consultation.
[1] http://www.ocfoundation.org/what-is-ocd.html [2] Haddad J et al. Kids Battle Obsessive Compulsive Disorder. Downloaded from the ABD News website 08-07-09. [3] Shelton DL Obsessive-compulsive disorder: Nearly a lifetime without treatment. Downloaded from the Chicago-Tribune website 08-07-09. [4] Szeszko PR, Ardekani BA et al. White Matter Abnormalities in Obsessive-compulsive Disorder. Arch Gen Psychiatry. 2005;62:782-790. [5] Menzies L, Williams GB et al. White Matter Abnormalities in Patients With Obsessive-Compulsive Disorder and Their First-Degree Relatives. Am J Psychiatry 2008; 165:1308-1315. doi: 10.1176/appi.ajp.2008.07101677. [6] Kringelbach ML, Rolls ET. The functional neuroanatomy of the human orbitofrontal cortex: evidence from neuroimaging and neuropsychology . Progress in Neurobiology 72 (2004) 341-372. [7] Chamberlain AR, Menzies L et al. Orbitofrontal Dysfunction in Patients with Obsessive-Compulsive Disorder and Their Unaffected Relatives. Science (18 July 2008) 321:5887(421-422). |
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