Biology 202
2002 Second Paper
On Serendip

Obsessive Compulsive Disorder (OCD) is an anxiety disorder that is the fourth most common mental illness in the U.S. (8). OCD affects five million Americans, or one in five people (3). This is a serious mental disorder that causes people to think and act certain things repetitively in order to calm the anxiety produced by a certain fear. Unlike compulsive drinking or gambling, OCD compulsions do not give the person pleasure; rather, the rituals are performed to obtain relief from the discomfort caused by obsessions (2). OCD is more common than schizophrenia, bipolar disorder, or panic disorder, according to the National Institute of Mental Health (6). This disorder can be therapeutically treated, but not cured. The causes of OCD are not completely understood, and warrant further exploration of self-control and autonomy.

There are many branches or types of OCD. Within all branches, ninety percent of people suffer from both obsessions and compulsions, rather than solely one or the other (1). One category of OCD sufferers tend to check and recheck items from 10-100 times - such as a locked door. The overwhelming impulse to recheck remains until the person experiences a reduction in tension despite the realization that the item is secure (1). OCD sufferers also tend to habitually wash due to fear of contamination. Another form of OCD is hoarding, which is excessive saving of typically worthless items such as shoes or computer disks due to an overwhelming fear that one day these items might be of use. People who suffer from the ordering branch of OCD, feels compelled to place items in a designated spot or order to alleviate worries of disorder and mayhem. Pure-O sufferers are those people who grapple with unwanted and unethical thoughts. They tend to be superstitious and compulsively do problem solving in order to control their thoughts. OCD sufferers can also be subject to hyperscrupulosity, which involves extreme worry and anxiety for the safety of others. Another form of OCD is body dysmorphia. This is a condition where people become excessively focused on some body part which they perceive to be grossly malformed (1). Hypochondriacs -people who have an extreme fear of sickness - fall into this category of OCD. General behaviors that may indicate OCD are: excessive washing, repeating, checking, touching, counting, ordering/arranging, hoarding, or praying (2). OCD patients live in a vicious cycle. They have obsessions about certain things and cause anxiety. To relieve this anxiety, compulsions are performed, and then attention can be paid again to the obsessions that have not truly been alleviated. The difference between OCD sufferers and other people, is the OCD sufferers use up at least an hour of their day thinking or doing these incessant tasks and they interfere with the person's work, social life, and relationships (2).

If OCD is found in conjunction with another disorder, it is usually found with a ticking disorder or depression. Ticking is involuntary motor behavior that results from a feeling of discomfort (much like the compulsions of OCD), and depression usually is exemplified from the person's disappointment or shame for having the OCD. Sixty to ninety percent of people with OCD have suffered from at least on major episode of depression at some point in their lives (3). However, OCD is usually easy to distinguish from schizophrenia, delusional disorders, and other psychotic conditions because unlike psychotic individuals, people with OCD continue to have a clear idea of what is real and what is not (4). Eighty percent of people with OCD are painfully aware that their behaviors are unreasonable and irrational (1). A person with OCD, in eighty percent of cases, is conscious that their actions are not normal, and cannot stop them. The person seems to be suffering from a separation between self and behavioral instincts. Their self is no longer in control of their actions or thoughts, is this separation possible? What is the purpose of the 'self,' the person, in patients with OCD if they have lost control over their mind and body?

In order to better understand the changes that have overcome a person with OCD, it is helpful to analyze what is going on in their brains, even though there is no single cause for OCD. OCD involves problems in communication between the orbital cortex, the front part of the brain, and the basal ganglia, deeper structures. These parts of the brain are used in motor control, and have been found in OCD patients to have impaired inhibitory mechanisms. The inhibition is shown by lower levels of synchronization of the prefrontal area and basal ganglia after simple self-paced movement, and may extend the concept of reduced inhibition in OCD patients to refrain from performing impelling actions (9). These parts of the brain use the messenger seratonin, and when there are low levels of seratonin, the symptoms of OCD increase. When there are high concentrations of seratonin, the communication between these two areas of the brain involved in processes that in some way mediate OCD behaviors is increased, and the symptoms of OCD decrease (2). Drug therapy is one answer to OCD. Medicines that function as seratonin reuptake inhibitors are most affective at relieving the compulsions of OCD patients. The purpose is to increase the availability of seratonin in the synapses of the brain so that the orbital cortex and basal ganglia can communicate more efficiently. If OCD is treated by a drug that acts as a selective seratonin reuptake inhibitor (SSRI) the symptoms of OCD typically decrease from forty to ninety-five percent (3).

An overly sensitive amygdala, the small portion of the brain stem that responds to emergency circumstances, is also thought to play a large role in OCD patients. Brain mapping studies tests were used on OCD patients. The brain activity of the amygdala increased dramatically when an OCD patient was presented with a 'stressor' or a fear that would provoke a habitual compulsive response to mediate and relieve that fear (8). Because OCD patients have a heightened response to emergency situations, the innate response to seek a soothing and relieving action or thought is made. The OCD patients find relief from their overly active emergency response by habitual and calming compulsions. Because the amygdala is not involved in cognitive and rational abilities, not responding to obsessive thoughts can only be learned by contradictory, repetitive acts (8). This is one form of cognitive behavioral therapy (CBT); it is called exposure and response prevention (E/RP) (7). The person suffering from OCD is presented with his/her fear and is forced to inhibit their usual, calming response. The OCD patient could be made to rub their hands on the floor before eating a sandwich to prove to them that their fear of germs is irrational and does not really cause sickness or death. The person clearly can understand that his/her fears are superfluous and uncalled for, but they cannot control their response or fears. The I-function, therefore, cannot be involved in the human's response to fear, fright, or anxiety, except through learned responses. Can the I-function and the self 'teach' more primal parts of the brain to act differently?

Another form of treatment given to OCD patients is cognitive therapy (CT), which is usually paired with E/RP. CT helps to reduce the catastrophic thinking and exaggerated sense of responsibility often seen in OCD sufferers by challenging the inaccuracy of faulty assumptions in the person's obsessions (5). The first thing that OCD patients are taught in CT, is to understand that they are not crazy even though they are troubled by so many thoughts and actions that they know are inappropriate (8). The patients with OCD are taught to say, "It's not me, it's my OCD," or "It's not me, it's how the natural brain works." Usually when a person does not, and thus cannot, control a behavior then they are unaware of the processes underlying that behavior. We are not conscious of the blind spot when our brain 'fills in' the empty area created by the blind spot, and thus have no control over our blind spot. However, OCD patients are aware of their brain's autonomous control over their behavior that causes obscure actions and thoughts that are typical of OCD patients. The I-function is not involved in the blind spot, but is it or is it not involved in OCD behaviors? How can the OCD patient be aware of what is going on, but not be able to control himself? Surveys show that eighty percent of the American population experiences violent and upsetting thoughts, which are speculated to occur due to automatic associations produced by the brain (8). Can we control any of our thoughts? Are we all as helpless as OCD patients, but we just are upset by this fact to a lesser degree than OCD patients seem to be? The OCD sufferers are shown that everyone has abnormal, strange thoughts, but that OCD sufferers accompany these thoughts with incredible anxiety. CT attempts to make the person understand that giving into an obsessive response increases the brain's sensitivity to the threat that caused the obsessive response, thus creating a negative affect on the persons ability to create a determination in avoidance of relief seeking, obsessive behaviors (8).

OCD is present in many people, 5 million in the US, all to differing degrees - to what degree is relevant? When does OCD behavior become a factor in one's life and personality? Although OCD is not completely understood, and the treatments are not one hundred percent accurate, there has been a majority of decreased suffering after treatment. In one form of treatment, OCD patients are taught to "discover the ability to make their own choices" by understanding that they can successfully ignore obsessions (8). Doesn't the I-function involve "choices," which would implicate that OCD patients are not able to have full use of their I-function? If the I-function seems to be aware of OCD behavior, but has no control, what implications does this have on our understanding of the I-function and autonomy? How much control DO we really have?

References

1)What is O.C.D.?
2) Obsessive Compulsive Foundation-What is OCD?
3) Most Frequently asked questions about OCD
4) Obsessive Compulsive Foundation, related Disorders
5) Obsessive Compulsive Foundation-How is OCD treated?
6) OCD and Tic Disorders
7) A Cognitive Therapeutic Differentiation Between Conceptualizing and Managing OCD
8) Obsessive Compulsive Disorder: OCD
9)Letizia et al. 2001. Abnormal Pattern of Cortical Activation Associated with Voluntary Movement in Obsessive Compulsive Disorder: an EEG Study. American journal of Psychiatry. 158: 140-142.


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