The Biological Perspective To Explaining OCD
Ever heard people misuse the term “OCD” to depict the qualities of being neat and organized? They often confuse this severe psychological disorder with their obsessive personality traits. OCD is not a positive thing, rather gets in the way of an individual’s functioning. With certain people considering OCD as a quirk, it encourages family and friends to overlook those who actually suffer.
Obsessive-compulsive disorder (OCD) is a mental illness in which an individual feels the necessity to execute “obsessions” and “compulsions”. Obsessions are repetitive thoughts while compulsions rely on ritualistic behavior. These urges are often difficult to control for more than a short period of time. Psychological disorders have multiple approaches for in-depth studies, but in this post I will be covering the biological perspective of understanding OCD.
The biological perspective interprets the disorder by studying genetic factors, chemical imbalances and brain abnormalities. It gives importance to nature in the “nature vs nurture” debate. It provides empirical and scientific evidence but disregards other possible influences.
Clinical Features & Diagnosis
The symptoms for OCD involve both obsessions and compulsions while some individuals experience just any one. It is a part of the obsessive-compulsive spectrum that usually occurs during adolescence or young adulthood.
1. Obsession symptoms:
· Fear of contamination and triggers
· Excessive concerns about morality, harm and order
· Disturbing sexual and religious images, aggressive thoughts and ideas causing severe distress
· Repetitive doubts
2. Compulsion symptoms
· Repetitive routine activities and abnormal movement
· Checking compulsion to avoid harmful thoughts
· Washing/cleaning compulsion due to fear of contamination
· Rigid positioning of objects and hoarding
· Seeks constant reassurance
· Mentally repeating words/numbers
OCD is difficult to diagnose as it has similar symptoms like depression, anxiety disorder and schizophrenia. It cannot be assessed through the biological approach using X-ray, blood sample or other medical tests but rather through psychotherapy. But the biological approach assessments can prove whether the obsessions and compulsions are side effects of substance abuse or other medical conditions.
A physical examination based on medical experience and judgement will help understand the severity of these obsessions and compulsions. Individuals with severe OCD are aware of their illness and the distress caused tends to interfere with social functioning. Another method of diagnosis could be neuroimaging as it can detect abnormal activity in the brain circuit which plays a major role in the causation of OCD.
Causes
Years of research has still not found a certain cause for OCD. Out of all the perspectives, the biological perspective has gained the most acceptance.
1. Hereditary Factors:
According to research, 25% of people with OCD have a close family member with the same condition. In a twin study, the identical twins were more susceptible to OCD than non-identical twins if one twin had the condition. In the study, genetics comprises 45-65% of OCD risk in children. These individuals recognize their intrusive behavior and senseless impulses and struggles to resist them.
2. Abnormal Brain Circuit Activity:
The orbitofrontal cortex is in charge for complex behaviors like regulation of emotions, decision making based on rewards, fixed goals for evaluation and behavior. Abnormal impulse activation from the circuit relay system, that is placed between the orbitofrontal cortex and thalamus, causes OCD. The orbitofrontal cortex circuits also includes the caudate nucleus of the basal ganglia, that helps in the cognitive and voluntary motor movement functioning.
Normal activation of the circuit brings the impulses to your attention and makes you perform the particular behavior appropriately. Once it diminishes, you stop the behavior. But OCD patients have trouble in dismissing these impulses leading to uncontrollable and repetitive behavior and thoughts- compulsions and obsessions. For example: Cleaning compulsion due to fear of contamination obsession.
In support to this understanding, obsessions and compulsions based on aggression, sexuality and contamination,often related to OCD, are also controlled by the same circuits.
3. Over activity in Limbic System:
The limbic system, basal ganglia and cingulate gyrus sets the temperamental mood of an individual. The basal ganglia sets the body’s standard arousal and subdues motor movement regulation while the cingulate gyrus is linked with cognitive flexibility. Over activity leads to physical sensations of anxiety, tics and rigid thinking and behavioral patterns.
4. Chemical Imbalance:
The neurotransmitter serotonin sends messages between brain cells and helps regulate anxiety, memory and sleep. Serotonin reuptake inhibitors (SRI) and selective serotonin reuptake inhibitors (SSRI) medication proved serotonin hypothesis. It was concluded an important neurotransmitter to keep OCD symptoms in check.
5. Infections:
According to a study, children developed symptoms of OCD after getting strep throat due to the reaction between the antigens and the basal ganglia tissue. But a 2004 study revealed that the infections could only trigger symptoms in children who were already susceptible to the disorder.
Treatment
1. Medications:
According to neuroimaging, abnormal activity of the brain circuit can be treated with psychotropic medications like antidepressants- selective serotonin reuptake inhibitors (SSRIs) and dopamine. These increased the neurotransmitter amounts and improved the ability to develop and enjoy relationships and activities. Antibiotic medications could be used only if an autoimmune infection coincides with the onset of the OCD symptoms. If the symptoms still occur, anti-psychotic drugs like Risperdal and Abilify are prescribed.
2. Neuro Surgery & Modulation:
Surgeries are used as a last resort of treatment. A surgical lesion in the cingulate cortex and electric device placement methods like deep-brain stimulation, transcranial magnetic stimulation and vagus nerve stimulation send impulses to certain areas of the brain. The placement methods avoid destruction of brain tissues.
3. Increases Treatment Response
According to research, medication enhanced Exposure Response Prevention (ERP) therapy. The therapy neutralizes compulsions by letting the patients face their obsessions. The patients that took the medication, d-cycloserine, before the therapy improved at a faster rate in the first week.
Prevention
Obsessive-compulsive disorder cannot be prevented rather the severity and amount of time can be reduced by early diagnosis and treatment. Medical therapy is not as successful as psychological treatments as discontinuation of pharmacotherapy may worsen the symptoms. The relapse prevention using continuous Selective serotonin reuptake inhibitors (SSRI) therapy is a reasonable method if it is used for at least a year or two.
According to Morphometric studies, the thickness and volume of brain regions changes the outcome of possible prevention therapy. Also, Neurobiological framework by Gillan & Robbin predicts that studying the neutral mechanisms can lead to clinical improvement as abstaining from compulsions during ERP can stop the ritualistic behavior (obsessions).
Recent Research & Findings
1. Common neurobiological processes contribute to OCD Persistence (2nd March, 2020)
OCD is associated with changes in brain structure and the orbitofrontal circuit. Current research further associates OCD to other regions that have low cortical thickness. This contributes to disinhibition, loss of control of habitual response patterns of the basal ganglia and reduced cognitive functioning. The research increases the vulnerability of OCD by identifying asymptomatic OCD patients.
2. Antibodies could provide new treatment for OCD (21st April, 2020)
Drugs that aim at the immune system discovered as a new method of treatment. OCD patients have a high level of Immuno-moodulin (Imood) protein in their lymphocytes, a type of immune cell that exhibits anxious behavior. An antibody that neutralized Imood was tested on a mouse leading to low anxiety levels. Currently they have filed for the antibody’s patent.
References
OCD is a part of the obsessive-compulsive phenomenon that is most likely to happen in puberty or early adulthood. OCD is difficult to assess because it includes signs close to insomnia, panic disorders, and schizophrenia. Bio-approach evaluations may determine that obsessions and compulsions are side effects of drug abuse or other medical complications.
ReplyDeleteIt was very informative ... Easy to read and understand. The recent research findings make the information more relevant and reliable.
ReplyDeleteThe biological Cause of OCD was very Informative. I never knew that infection could lead to OCD. However I must say that OCD treatment is often a combination of medication and psycho-behavioral therapy. I do agree that medication can reduce frequency of the illness but a joint treatment of psychotherapy has better treatment outcomes.
ReplyDeleteThe article is well written and researched. People usually do not understand the fact that biological factors can also be a reason for OCDs, it is always or rather was assumed that it was due to social and environmental factors. This article is an eye opener for those who would like to change their opinion about the biological aspect of OCD.
ReplyDeleteThe biological approach is based on actual evidence and facts, which support that OCD does have a genetic basis. This approach is more reliable as significant research has been done to assess that biological factors lead to the manifestation of OCD. However, this approach undermines other influences such as free will, childhood experiences, other stress inducing conditions. Nonetheless, the writer has done immense justice to the biological approach of OCD. The recent research and findings are quite insightful and informative.
ReplyDeleteWhen talking about mental illnesses, people often think of psychological reasons, which narrow down to environmental and behavioural factors for a common man of non psychological background. I don't think many people would know that mental disorders can have its causes in biological reasons. And this post tells us that biological causes of OCD not just lies in genetics and mutations, but even infections! These are interesting facts which are important not just for researchers but also for other people as part of general awareness about mental illness.
ReplyDelete