Do you know anyone who consistently does something repeatedly, over and over again?. This is a rare psychological condition known as obsessive-compulsive disorder (OCD). People diagnosed with OCD tend to wash their hands, and re-wash; or check, and re-check, then check again, that the stove is off. The reasons for the behaviors are unclear, about half of patients don’t have effective treatment options. However, new research show promising signs why they keep on doing stuff on auto-repeat.
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Have You Done It? Lemme Check.
In a 2019 study by the University of Michigan published in the Journal of Biological Psychiatry, researchers gathered the largest-ever pool of task-based functional brain scans and other data from OCD studies around the world, and combined them for a new meta-analysis. The new study reveals the specific brain areas and processes that are linked to the repetitive behaviors common with OCD patients. In other words, patients get stuck in a loop of wrongness and can’t stop repeating their behaviors — even if they know they should.
For the study, the researchers focused on the cingulo-opercular network — a collection of neural networks deep in the center of the brain. This area monitors errors or the potential need to avoid an action, and triggers the decision-making areas of the frontal lobe when it senses that something is wrong. The researchers collected data of brain scans of people with and without OCD while they performed certain tasks while lying in a functional Magnetic Resonance Imaging (MRI) scanner. The data analysis includes 484 children and adults — both medicated and not.
“These results show that, in OCD, the brain responds too much to errors, and too little to stop signals, abnormalities that researchers had suspected to play a crucial role in OCD, but that had not been conclusively shown due to small numbers of participants in the individual studies,” says led author Luke Norman, a postdoctoral research fellow in the University of Michigan psychiatry department.
“By combining data from 10 studies, and nearly 500 patients and healthy volunteers, we could see how brain circuits long hypothesized to be crucial to OCD are indeed involved in the disorder,” he continues.
Why Can’t I Stop It
This study is the first of its kind to include a large-scale data analysis of OCD patients MRI brain scans, when they had to respond to error stimuli, and had to avoid themselves from constantly taken action. The results showed a correlation in the combined data analysis: people with OCD had more neural activity in specific brain areas responsible for error recognition, as compared with people without OCD, but they had less neural activity in the areas of the brain that could let them stop their actions.
The analysis “sets the stage for therapy targets in OCD, because it shows that error processing and inhibitory control are both important processes that are altered in people with the condition,” says Kate Fitzgerald, a faculty member in psychiatry. “We know that patients often have insight into their behaviors, and can detect that they’re doing something that doesn’t need to be done. But these results show that the error signal probably isn’t reaching the brain network that needs to be engaged in order for them to stop doing it.”
The researchers claim these differences aren’t the full story, and they can’t tell from the available data if the differences in activity are the cause, or the result, of having OCD. But the good news is, their findings suggest that OCD patients might be having an “inefficient” neural connection between their brain system that links their ability to recognize errors and the system that governs their ability to do something about those errors.
“It’s like their foot is on the brake telling them to stop, but the brake isn’t attached to the part of the wheel that can actually stop them,” Fitzgerald says. “In cognitive behavioral therapy sessions for OCD, we work to help patients identify, confront, and resist their compulsions, to increase communication between the ‘brake’ and the wheels, until the wheels actually stop. But it only works in about half of patients. Through findings like these, we hope we can make CBT more effective, or guide new treatments.”
Is OCD An Anxiety Disorder?
Patients are often anxious about their behavior — but OCD is not an anxiety disorder, the researchers say. In a new clinical trial, researchers plan to test techniques aimed at taming that drive, and preventing anxiety. In the meantime, the researchers hope that people who currently have OCD, and parents of children with signs of the condition, will take heart from the new findings.
“We know that OCD is a brain-based disorder, and we are gaining a better understanding of the potential brain mechanisms that underlie symptoms, and that cause patients to struggle to control their compulsive behaviors,” Norman says.
And as Fitzgerald concludes, “This is not some deep dark problem of behavior — OCD is a medical problem, and not anyone’s fault. With brain imaging we can study it just like heart specialists study EKGs of their patients — and we can use that information to improve care and the lives of people with OCD.”
Source: University of Michigan.
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Written by: Nana Kwadwo, Sat, Jul 06, 2019.
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