Dr. Phil Kronk: Is obsessive-compulsive disorder a biological brain-based disorder?

For decades, Obsessive-Compulsive Disorder (OCD) was viewed in terms of underlying anxiety. In many ways, it was seen as more of a “mental” problem than a biological disorder. That has changed.

In the latest 5th edition of the psychiatry’s diagnostic manual, OCD has been moved from the anxiety section to one called, “Obsessive-Compulsive and Related Disorders.” What are these related disorders?

They include: Hording Disorder, Trichotillomania (Hair-Pulling Disorder,) Excoriation (Skin-Picking) Disorder and Body Dysmorphic Disorder, which involves a preoccupation with perceived defects or flaws in one’s physical appearance.)

OCD can be found alongside of these other disorders, as well as being closely related to anxiety disorders (which is why it follows the anxiety diagnoses in the diagnostic manual.)

OCD also has a prominent cognitive aspect. First, the amount of insight a patient has about his OCD should be assessed. Secondly, along with medication, OCD is treated by cognitive behavioral therapy, though some choose to use only behavioral treatments.

Why do so, if OCD is a brain-based biological disorder?

Because ongoing research and clinical findings have found that your brain, and its complicated neural circuits, can be changed by either therapy or medication.

But which neural brain circuits are thought to make one develop OCD?

First, I must share that these nerve circuits are considered to cause OCD due to impaired misfiring.

These misfiring’s fail to control responses. The obsessive, impulsive aspects of OCD make one unable to stop initiating actions. The compulsive aspects make one unable to terminate ongoing actions once they are started.

No matter how much feedback the compulsive individual receives, he or she cannot adapt (and change) their behaviors, even after negative feedback. One begins to understand how much mental suffering and despair the patient with OCD can experience.

The nationally known psychopharmacologist, Stephan Stahl, M.D. (and author of over 500 articles and chapters) writes that the balance between the ventral striatum and the dorsal striatum areas of one’s brain may be impaired. In addition to this impaired neural circuit loop, other important inputs from the brain’s hippocampus, amygdala and prefrontal cortex are contributory.

Dr. Stahl writes that drug addiction is also related to the impaired interaction of the ventral and dorsal areas of the striatum.

Others have called the neural circuit from the prefrontal cortex to the caudate nucleus (of the basal ganglia area of the brain) the “worry circuit.”

The neural circuits of someone with OCD have been characterized as being in “brain lock.”

The latest thinking about OCD is that it is not goal-directed behavior to reduce anxiety, but that it consists of “habits provoked mindlessly from a stimulus in the environment.”

Cognitive behavioral therapy uses “exposure and response prevention” treatment. This involves gradual exposure to anxiety provoking situations.

Medication treatment for OCD usually involves one of the SSRI’s, such as Prozac, often at a high dosage, and augmented with an atypical antipsychotic, when needed. Deep-brain stimulation is an experimental treatment.

[This is the third column in a series on OCD this month. Future columns will look at how one ‘experiences’ OCD, as well as detailed explanations of helpful medication and cognitive therapy treatments.]

Phil Kronk, M.S., Ph.D. is a semi-retired child and adult clinical psychologist and neuropsychologist. He has a doctorate in clinical psychology and a postdoctoral degree in clinical psychopharmacology. Dr. Kronk writes a weekly online column on mental health for the Knoxville News Sentinel’s website, knoxnews.com. He can be reached at (865) 330-3633.