The Brain, Behavior and Obsessive Compulsive Disorder (OCD)
The Brain, Behavior and Obsessive Compulsive Disorder (OCD)
Approximately 3.3 million Americans suffer from Obsessive Compulsive
Disorder (OCD) and this disease affects 2.3% of United States citizens
between ages 18-54 (1) . This disorder is equally common in males and females and occurs at similar rates throughout the world (2) . In class and in the forum, we have discussed the notion that brain equals behavior as proposed by Emily Dickinson (3)
. This paper investigates the differences in brain structure and
behavior between individuals with OCD and those without the disorder in
hopes of determining the validity of Emily's statement. Furthermore,
two different types of treatment for this disease will be discussed.
One form of therapy targets structures in the brain in order to modify
behavior, while the other form aims to modify the behavior in hopes of
altering the way in which the brain functions. Therefore, this paper
aims to shed light on the question that was set forth in the first week
of class, using OCD as a means to determine if brain equals behavior.
An obsession is defined to be an inappropriate and unwanted thought or image that stems from fear of danger or contamination, as well as the persistent need for order. Individuals with OCD also may be plagued with sexually explicit thoughts. A compulsion is defined as repetitive behavior, such as excessive checking, counting, and silent repetition of words, hand washing, cleaning, arranging or hoarding. Symptoms of OCD usually begin during childhood for males, while for females, the age of onset can occur during childhood or around the time of pregnancy or birth, perhaps due to the interactions between the hormones within the brain (2) . The actual cause of OCD has yet to be determined, but several theories as to why individuals are afflicted with this disorder have been proposed. One theory postulates that a stressful event in an individual's life can spark the onset of the disorder (4), while other scientists and doctors argue that the disorder is genetically inherited, because OCD seems run in families (2) .
During most of the 20th century, doctors and scientists speculated that OCD could be understood in terms of psychoanalytic and behavioral theory, meaning that individuals afflicted with OCD were stricken because they struggled with internal and external unresolved conflicts. At this time, it was also believed that an individual may contract OCD as a result of an internal struggle for control over their own lives (5) .
However, as science and technology advanced, it seemed there was more involved in this disorder than unresolved feelings and the need for control. Moreover, it was found that analyses of the structure of the brain might hold the answers. Lewis R. Baxter Jr. and his colleagues at the University of California at Los Angeles and the University of Alabama in Birmingham were the first group to use positron-emission tomography (PET) in order to study the brain's link to OCD. PET scans are able to produce color-coded images of the brain in order to provide information as to where metabolic activities are occurring. In this study, it was found that elevated activity occurred in the frontal lobes, in particular, the orbital cortex and the basal ganglia in individuals with OCD. The basal ganglia functions to integrate and process information that is being sent from all parts of the brain. Dr. Judith L. Rapport of the National Institute of Mental Health reported similar results. She found that the basal ganglia and connecting regions in the brain were turned on inappropriately in individuals with OCD. Furthermore, she believed the obsessions and compulsions were preprogrammed in the basal ganglia (5) .
Magnetic resonance imaging (MRI) has also been done on patients with
OCD and it was found that there was less white matter in the brain of
these subjects (6)
. White matter refers to the portions of the brain and spinal cord that
are able to facilitate and direct communication between regions of gray
matter, as well as communication between the gray matter regions and
other parts of the body (7) . Therefore, communication between the brain and the body is compromised in individuals with OCD.
Jeffrey Schwartz and his colleagues at the University of California at Los Angeles College of Medicine used similar techniques to investigate OCD and changes in the brain. This group used PET scans of the brain as well, on 18 patients between 25-51 years of age. Radioactively labeled glucose was injected into the patients in order to determine where in the brain the glucose was traveling, which would tell the researchers which areas of the brain were metabolically active in the subjects with OCD. Four main areas of the brain were under study: orbital cortex, caudate nucleus, cingulate gyrus, and the thalamus. It was found that the orbital cortex was hyperactive in the individuals with OCD. Studies performed on monkeys found that damage to the orbital cortex leads to repetitive behaviors. Therefore, the researchers believed that the orbital cortex sends out repetitive false alarms in those with OCD. Usually these false alarms can be turned off, however, with OCD, the alarms continue to be sent and eventually reach the caudate nucleus, which controls the movement of limbs. The signal then travels to the cingulate gyrus which causes the heart to pound and the stomach to churn, while the thalamus controls and integrates the information from the aforementioned three parts of the brain as well as other areas. Schwartz and his colleagues thus found that all four regions took up the glucose at high and similar rates, suggesting a linkage between these components of the brain. Confronted with these results, the researchers have speculated that this linkage and close relationship between these four parts of the brain is the cause of OCD (8) .
There is also a link between OCD and serotonin, a neurotransmitter that facilitates cell communication (9) . Most neuronal cells are separated by a fluid-filled space called a synapse. A neurotransmitter is released into this space, which then interacts with the receptor on this cell causing an electrical signal to be generated that is then directed to other areas in the brain in order to bring about a particular response or behavior. Released serotonin is usually taken back up by the cell from which it was released, enabling serotonin to be recycled for further use. This process also prevents excess levels of this neurotransmitter from clogging up synapses (10) .
Once these studies were performed, researchers then turned their attention to methods of treatment. Two major methods exist to treat OCD; one involves drug therapy while the other focuses on modifying a patient's behavior in hopes of alleviating the obsessive and compulsive behavior.
The drug therapy method attempts to alter the brain chemistry in hopes of modifying behavior. These drugs are mainly serotonin reuptake inhibitors (SRI's) or selective serotonin reuptake inhibitors (SSRI's). Both classes of drugs aim to increase serotonin levels. More specifically, they interfere with the recycling of serotonin, thereby allowing for the serotonin to linger in the synapse longer and affect the surrounding nerve cells for an extended period of time. Researchers have not yet determined how or why this helps to ameliorate the obsessions and compulsions (11) . Therefore, further research can be done in order to understand the chemistry of increasing serotonin levels in the brain and how this correlates to reducing the symptoms of OCD.
Anafranil (clomipramine) is the main SRI that is used in treatment of
OCD. However, this drug not only alters serotonin levels, but it also
can affect other neurotransmitter concentrations, therefore, this drug
is not selective. The main SSRI's used for treatment are: prozac
(fluoxatine), luvox (fluvoxamine), celexa (citalopram), zoloft
(sertaline) and paxil (paroxatine) (11)
. Studies have also been done in order to assess the effectiveness of
these drugs on the patients. One study found that roughly 75 percent of
patients were helped with these medications and more than half of the
patients reported relief of symptoms because the drugs diminished the
frequency and the intensity of their obsession and compulsions. During
these studies, it took the patients about three weeks or longer for
their symptoms to subside. If a particular SRI or SSRI is not working
for an individual, researchers have determined that one of the SRI's
can be used as the primary form of medication and then use another drug
as an augmenter. However, if an individual opts to stop using the
medication then a relapse will most likely follow and the symptoms of
the disorder will start to manifest themselves again. Therefore, even
if the symptoms subside, most people will need to continue to take the
medications, albeit at a lower dosage, in order to control their
obsessions and compulsions (12) .
The second method of treatment is called Cognitive-Behavioral Therapy (CBT), also referred to as exposure and response prevention, is supported by Dr. Jeffrey Schwartz author of Brain Lock. This form of treatment exposes the individual to his or her fear in hopes of having them confront their obsessions and compulsions (11) . After the exposure, their compulsive response is delayed. For example, if an individual has a fear of germs, the treatment would expose him or her to some form of contamination and then prevent the individual from compulsively washing their hands to rid themselves of the germs. The aim of this treatment is to ease the fear and stress in the individuals as well as make them less anxious by having them confront their anxieties. Schwartz believes this is the best form of therapy for individuals with OCD because they learn not to succumb to their obsession which is harmful behavior. Therefore, this form of therapy aims to dissuade individuals from engaging in their old destructive behavior. Schwartz also argues that the brain will respond to whatever form of behavior individuals engage in. Thus, if the individual continues to engage in healthy behavior, the brain will notice this and automatically begin to prevent the individual from reverting back to their potentially self-destructing behavior (11) .
In his book, Schwartz presents four steps that allow individuals with OCD to modify their behavior. The first step (relabel) involves naming the particular urges one feels as obsessions and compulsions. Individuals also must acknowledge that the urges they feel are false alarms and are not real problems. As this type of therapeutic behavior continues, the brain will recognize these as false alarms and these urges will, over time, subside. Step two (reattribute) involves acknowledging that the disorder causes these compulsions and obsessions in hopes of bolstering confidence and the willpower to ward off these feelings. The third step involves refocusing one's attention onto a more healthy activity when a false alarm occurs. Schwartz suggests finding a therapeutic hobby and putting one's energy towards this activity and learning to delay their response to the particular urges they may feel. The last step (revalue) involves placing less importance on the behaviors of OCD and he urges individuals to take charge and control of their behaviors rather than having them control you. Schwartz believes this is the best form of treatment for those with the disorder because it confronts the particular behaviors and urges that lead individuals to behave destructively (11) .
We began our class with the idea that brain and behavior are the same as proposed by Emily Dickinson. This paper looked at OCD in order to determine if this theory had any validity. Studies have been done on individuals with OCD and those without and it has been found that there are differences within their brains. These differences in the brain must then account for the differences in behavior, hinting at the fact that brain and behavior are the same. Two main types of treatment for this disorder were also discussed. Drug therapy involves altering the brain chemistry and neurotransmitters levels in hopes of modifying behavior by reducing the frequency and intensity of the obsessions and compulsions. The second form of therapy, CBT, involves altering one's behavior such that the brain chemistry will change as well. Therefore, these two therapies have diametrically opposed ways of healing. However, if the brain chemistry can be changed, causing behavior to change as well through the use of SRI's and SSRI's and one's behavior can be changed through CBT, which then causes the chemistry of the brain to change, then the brain must equal behavior. Based upon our discussions in class and in the forum, my thoughts as to whether brain equals behavior have been mixed, however, after investigating OCD, I have finally come to realize that the brain and behavior are synonymous. Using OCD as a lens with which to answer this elusive question has helped me come to a definite conclusion and a greater understanding of the points discussed in class and in the forum.
1)National Institute of Mental Health, National Institute of Mental Health site that offers information about OCD.
2)SA Mental Health, describes the genetics of OCD
3)Serendip Homepage, our class website and forum area
4)Help Guide for OCD , a site that provides an overview of OCD
5)Psych Central, a site that provides information about the probable causes of the disorder
6)Understanding Obsessive Compulsive Disorder, managed by the National Institute of Mental Health, this site also discusses possible causes of the disorder
7)Multiple Sclerosis Information, I used this site to find an informative definition of white matter
8)Chemistry of Obsession, a site that discusses the chemistry behind OCD
9)National Institute of Mental Health, I used this site maintained by the Nation's Voice on Mental Illness to search for information about OCD
10)Psych Central, this site discussed the various medications used to treat the disorder
11)Healthy Place OCD Community , this site also discussed treatments
12)OCD Support, this site discussed the various medications for the disorder
Comments made prior to 2007
I have been on 5 H T P for 3 days now and I feel a remarkable improvement in my O.C.D. Please pass on this info, I'm taking 100 mg. a day ... Donna, 13 February 2007