Biology 202

2006 First Web Paper

On Serendip

Imagine leaving for your morning commute an hour earlier than necessary, in order to accommodate a series of ritualistic behaviors, which to an uninformed observer appear non-sensical, excessive, or bizarre. What if you had to wash your hands multiple times before leaving your home? What if you needed to check and re-check to make sure the front door was locked, and once you had checked the door sufficiently, you had to count out exactly 20 steps from your front door to car door? Imagine that if any portion of your morning ritual is done improperly, you must begin again, performing the rituals as many times as necessary in order to satisfy an unwavering and unsettling impulse or obsession. Roughly 2.2 million Americans over the age of 18 suffer these, or similar symptoms associated with Obsessive Compulsive Disorder (1).

Obsessive Compulsive Disorder (OCD) is a common anxiety disorder, characterized by "intense, recurrent, unwanted thoughts and rituals that are beyond the person's control" (2). Records of OCD and similar disorders are well documented for at least the last 300 years. As with many mental health conditions prior to advances in modern science, OCD was attributed to bad religious experiences, demonic possessions, or general loss of will on behalf of the afflicted (3). Modern science has continued the process of "getting it less wrong" by using new technology to uncover potential causes of OCD rooted in the brain, with the hope of working toward more effective treatment options; however, if OCD is a problem relating to brain function and/or neurochemistry as some hypothesize, how can options such as behavioral therapy be effective in OCD treatment? Can behavioral treatments change inherent differences in brain function?

Throughout the 20th century, a psychoanalytic approach to OCD was adopted; the medical community believed that OCD could be attributed to feelings of unresolved conflict from early stages of psychological development (3). Psychoanalysis, while effective in uncovering symbolic meanings for obsessions and compulsions, has no root in scientific evidence, specifically studies relating to the human brain and has become a less used theory to explain the onset of OCD.

The use of positron-emission tomography (PET) has allowed for researchers to view images of the brain in order to see where differences between individuals with OCD and individuals in the control group differ, with the hope of uncovering a structural disparity between the groups (6). Differences have been noted in metabolic activity within the frontal cortex and basal ganglia regions. Regulation of brain abnormality is more difficult to tackle, whereas if differences exist in the neurochemistry of a patient with OCD, the most sensible option would be to adminster a drug to adjust the brain chemistry of the affected patient in order to produce a normal pattern of function. Through clinical experiments, the chemical serotonin was found to be lacking in patients who exhibit OCD. Serotonin reuptake inhibitors (SRIs) such as Zoloft, Paxil, and Prozac were administered to patients. Administering SRIs to patients has had a markedly high success rate, near 75%, in the reduction of behaviors associated with OCD (3). The introduction of SRIs has shown in PET scans visible changes in the brain activity of OCD patients, bringing it more in line with the scans of persons in the control group. Though medication is effective, is it the only possible recourse available to afflicted persons?

Growing evidence shows that behavior therapy may have a similar effect on brain chemistry as medication (4). Behavioral or cognitive therapy is meant to help individuals conquer mental health problems including, but not limited to OCD and associated anxiety disorders, by exposing the person to their source of anxiety and forcing them to overcome the feelings and compulsions associated with it (5). Therefore alterations in behavior rather than brain/neurochemistry can bring about not only a visible change in the actions of OCD individuals, but an actual change in neurological scans such as PET and MRI (6).

While the causes of OCD largely remain unknown and the best course of treatment – drugs, therapy, or combination of the two – differ on a case by case basis, scientists continue to uncover new ways of approaching OCD and similar disorders. When I initially thought about brain equating to behavior, I thought the brain could only be altered internally – by way of chemicals and other treatments directly impacting the brain – and that behavior is in turn altered by changes in neurochemistry. My eyes are now opened to the possibility that behavior can equal the brain, and a change in behavior can lead to an actual change in neurological composition and function.

1)National Institute of Mental Health, This aspect of the site is devoted to statistical information regarding mental health in the United States.

2)Web MD, A basic defintion of Obsessive Compulsive Disorder.

3)Psych Central , A resource for psychological information produced by Dr. John Grohol.

4)OCD Online , A website devoted completely to OCD facts, developments in research, and frequently asked questions.

5)Bio-Behavioral Institute , Website of a private, New York based treatment and research facility offering medical, psychological, and nutritional services.

6)National Institute of Mental Health , Site provided by the National Institute of Mental Health devoted solely to OCD and related information.


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