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Biology 202, Spring 2005
Third Web Papers
On Serendip

Understanding Obsessive Compulsive Disorder


Jasmine Shafagh


Obsessive Compulsive Disorder, also known as OCD, is a very complex and fascinating disease, for its symptoms force doctors and scientific researchers to question the existence of free-will in the brain. Because OCD sufferers experience unsettling thoughts (obsessions) and carry out actions to alleviate their distress and anxiety (compulsions), even though they know both are irrational, it makes me believe that OCD is caused by irregularities in the brain, and as a result, the brain must equal behavior. Furthermore, I believe that there must be an unknown part of the brain controlling free-will, for OCD patients can minimize the symptoms of the disorder through behavioral therapy, (i.e. they can control their symptoms through recognition of the disorder and through their own free-will,) which is known to be equally as effective as medications in alleviating OCD symptoms and behaviors. Thus, from my research, I believe that the brain ultimately equals behavior, for OCD symptoms and behaviors are controlled by irregularities in the brain, and that free-will is also a component of the brain, for OCD patients use their free will to control the obsessive and compulsive behaviors just as medicine does.

OCD is the fourth most common psychiatric disorder in the United States and affects one in every fifty people, (1) . It is a disease of obsessions, fears, unsettling thoughts that occur over and over again, compulsions, and repetitive behaviors and rituals that sufferers perform to alleviate their intense anxiety, (1) . Avoiding the fearful thoughts and performing the rituals fortifies the fear and maintains the OCD cycle, (3) . OCD is fairly easy to diagnose because of its signature symptoms. The most common sign of OCD is when a person spends an inordinate amount of time washing, cleaning, checking things, repeating certain actions, or making sure that all the objects in his/her home are orderly and symmetrical. OCD sufferers may also have hoarding rituals, undoing rituals (such as repeating certain phrases or counting backward from one thousand to ward of disaster), superstitions, pure obsessions, and obsessional slowness, (1) . In a sense, they may be parting from the spectrum of normal behavior. The variety and intensity of OCD symptoms change over years and symptoms vary from person to person. Generally, OCD obsessions and compulsions worsen during stressful times, and at times, people may not even notice that they have it, (1) .

So what causes OCD? Unfortunately, the definitive cause of OCD still remains a mystery to doctors and psychotherapists today. The root cause is believed to be hereditary, (1) . However, the biological explanation is more complex and requires more time and attention to comprehend. To describe what is going wrong in the OCD patient's brain, we must first understand how "normal" brains work. In healthy and normal functioning brains, information is transmitted through the nervous system via a network of electrical and chemical signals that travel from one neuron to the next. Serotonin and other neurotransmitters travel from nerve cell to nerve cell across the fluid-filled gaps called synapses, passing along messages about moods and emotions by attaching themselves to receptors on neighboring nerve cells (neurons). Special receptor chemicals on the next neuron in the chain of communication are prepared to receive this message from a neurotransmitter, and that neuron will pass it to the next one, and so no, (1) .

One theory on the cause of OCD is problems with certain neurotransmitters in the brain; experts believe OCD is caused by a chemical imbalance of the neurotransmitter serotonin, which can throw off the sequence of communication in the brain, (1) . This communication failure occurs when serotonin is reabsorbed or sucked back into nerve cells instead of crossing the synapse. As vital chemical messages are lost, (because of the serotonin re-uptake) OCD symptoms develop. Therefore, treatment for OCD, according to this theory, is from drugs such as SSRI's, or selective serotonin-reuptake inhibitors, (drugs such as Prozac, Anafranil, Zoloft, Luvox and Paxil), which work by selectively locking the absorption of serotonin in the area of the neurotransmitter's receptors, (1) . Both the treatment for the faulty serotonin neurotransmitter and this specific theory behind the cause of OCD strengthen my belief that the brain equals behavior.

Another theory for the cause of the disease is proposed by Dr. Jeffrey Schwartz, an expert on OCD and author of the book entitled: Brain Lock. He believes that the tight and hyperactive linkage among the orbital cortex, the caudate nucleus, the cingulate gyrus, and the thalamus causes a "brain lock" situation, leading to repetitive and intrusive thoughts, (1) . According to his theory, brain lock is when the orbital cortex alerts the brain to a potential problem by unnecessarily becoming hyperactive and sending out equivalents of false alarms. "When a false signal reaches other parts of the brain notably the caudate nucleus (which helps in switching gears from one thought to another), the cingulate gyrus (which makes your stomach churn and your heart beat faster), and the thalamus, (which processes signals from the cortex and other areas) anxiety results. All four brain areas (which are a part of the basal ganglia) lock into a hyperactive overdrive, frantically zinging inaccurate distress signals back and forth to one another," (1) . This brain lock results in the obsessions and compulsions of OCD. Dr. Schwartz also views OCD as a "shake in the mind," similar to the tremors seen in Parkinson's patients, because both disorders have irregularities in the basal ganglia, (1) . The basal ganglia serve to combine the converging information from different regions of the brain (which were mentioned above), (3) . According to Dr. Judith Rapoport of the National Institute of Mental Health (NIMH), the basal ganglia are incorrectly stimulated in OCD patients, which cause the unwanted or excessive obsessions and compulsions (3) . According to this brain lock theory, the notion of brain equals behavior is again strengthened, for abnormalities in the brains of OCD patients cause abnormal behaviors. Also, according to this theory, only behavioral therapy may be implemented to treat the disease.

Behavior Therapy, or BT, can identify and change negative patterns of behavior in OCD patients. The goals of the program are to suppress their urges, calm their anxiety coming from obsessions, and reduce or totally eliminate rituals, (3) . The two best methods for this approach are through exposure (openly confronting a situation or object that you fear), or response prevention (resisting urges to perform that certain ritual.) In Dr. Schwartz's research, as mentioned above, 12 out of 18 patients responded well to the behavioral therapy, (2) . Because the behavioral therapy (and one's free-will) is able to minimize the OCD symptoms and behaviors for defects in the basal ganglia (on an equal effect as drugs can provide, (1) .) I not only believe that brain equals behavior, but also am convinced that the component of free-will must be located in the brain.

Other theories explaining the cause and neurobiological basis for OCD are made from studying the spectrum disorders that are genetically related to OCD, such as: Tourette's syndrome, Trichotillomania, Body dysmorphic disorder, depression and Autism, (However, there is not yet enough data or information relating these to OCD). Another striking disease related to OCD is strep throat, a link discovered by a team of scientists led by Dr. Susan Swedo at the National Institute of Mental Health (NIMH). These doctors have found a link between group A beta-hemolytic streptococci and OCD. In susceptible children, a strep throat can trigger an autoimmune response affecting the basal ganglia and leading to the symptoms of OCD and tic disorders, (1) . In those children, strep infections, caused by group A streptococcus bacterium, cause antibodies to attack the basal ganglia in the brain, leading to fears of contamination and OCD behaviors. This theory supports the previous one, concerning the link between OCD and problems in the basal ganglia. Thus, again, I am convinced that brain equals behavior and that free-will must be located in a certain unknown region in the brain.

In conclusion, based on the evidence and research I have done on OCD, to me it does seem that the brain equals behavior; for its structure and function control the patients' behaviors, and because free-will (behavioral therapy) can also change the behavior just as well as medication does. Thus, I also now believe that free-will must be an aspect that is a structural component of the brain. However, this concept complicates my argument and creates even more unanswered questions; for, if this is the case, then does this learned behavior (behavioral therapy) actually change our brains, making "behavior equals brain?" In my view, this can just be seen as a play on words, and in most extreme neurobiological cases, the notion that brain equals behavior actually prevails.

Overall, this final web paper, among other papers and discussions in the course, has solidified my knowledge of the brain and nervous system. Through each topic that I now research, I am able to integrate the same techniques and questions to come to a more solid understanding behind the cause of the specific disease or problem. Because of this course, I now realize that every abnormality, wiring, pathway, or circuitry in the brain and nervous system affects our behavior in many different ways. And by studying certain diseases such as OCD, I am able to understand what went wrong in the brain, what should happen to keep the body and brain functioning in a "normal" manner, and to what extent medicine/doctors or the patients themselves can play a role in fixing the problem.

I also now comprehend that brains of different people are always going to be different, no matter what. There should be no ideal for attaining the "perfect" brain, and nobody should strive to be a certain way, for each individual needs to find peace and happiness within himself, and because each individual views life and his/her surroundings in a different way. Thus, the human race is a conglomerate of talent, uniqueness, individuality, and difference, and by learning from these differences or "flaws," we learn more about each other and ourselves. As Emily Dickinson truly says it, "The brain is wider than the sky, for put them side by side, the one the other will contain with ease and you beside."


References


1) Schackman, Dr. Lynn., and Shelagh Masline. Why Does Everything Have To Be Perfect?: Understanding Obsessive Compulsive Disorder. New York: Dell Publishing, 1999.

2) OCD Hope , article containing information about the chemistry of obsession.

3) Psych Central, article about the causes of OCD.


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