What is Obsessive-Compulsive Disorder?

Jul 28

Obsessive-compulsive disorder, or OCD, is characterized by intrusive and excessive thoughts that trigger fear and cause the action of compulsive, or uncontrollable, actions that must be repeated over and over (10). Common obsessions are worries or fears over germs and common compulsions are rearranging things in specific order or over-washing of hands. These compulsions are uncontrollable to the person living with OCD and they often feel powerless to stop the behavior.

How Common is Obsessive-Compulsive Disorder?

OCD is estimated to impact 2-3% of the United States population. It is most common among women, though it is also present in men. Of the people reported to be living with OCD, 50% of those cases are considered to be serious and debilitating (1). In neurodevelopmental OCD, or OCD seen in children who did not develop specific regions of their brain, it is seen more commonly in males than females.

What are Symptoms of Obsessive-Compulsive Disorder?

Symptoms of OCD can come in many forms. It is normal for someone to experience occasional worrying thoughts or engage in habitual behaviors. However, when these become things that take up more than an hour of the day, are difficult to control, or are inhibiting your ability to live your life normally, you may be struggling with OCD.

OCD can manifest in the form of obsessive checking to see if doors are locked or that the stove was turned off. It can also present as an obsession of having a specific order to things, having to have a certain number of things, or the compulsion to clean. Each person may experience different symptoms, but all feel that these symptoms are more in control of them than they are. People experiencing OCD are often aware their compulsions do not make sense. They do not enjoy having to engage in their compulsions, but are helpless against the urge. OCD is often episodic, worsens with stress and they go into remission when the stress reduces (18).

Tic disorders, Tourette’s syndrome and OCD are all considered to be variations of the same neurological disorder (19).

What Causes Obsessive-Compulsive Disorder?

Obsessive-Compulsive Disorder develops secondary to dysfunctional brain responses to structured event complexes (SEC). An SEC is a representation that is made up of a series of goal-oriented sequences of events. It involves executing, planning and monitoring action. Everyone has SECs and these representations exist in our prefrontal cortices. In healthy people, initiation of an SEC leads to motivational anxiety. When a SEC is completed, our brain is rewarded. A reward signal leads to reduced motivational anxiety in a healthy person. In an individual with OCD, they receive an incomplete reward. This can be due to damage to specific regions involved with reward signal circuit or it may occur in children who have failed to develop specific related regions of their brain (17).

Imagine you are in a discussion with someone, and you come up with a important point that will settle the debate. Just as you are about to make your statement, the other person interrupts or cuts you off. This leaves you stuck in a motivational loop, as you know that you will be unable to move on from your point until you get the chance to speak your peace. This situation provokes stress, which is diffused when you finally get to make your point.

Motivational anxiety feels essentially the same as this for someone suffering from OCD. When they complete a motor program, their brain fails to release sufficient neurotransmitters into their reward circuitry, and they feel stuck in motivational loops. This can provoke severe anxiety.

Over time, people with OCD discover that by repeating some aspects of the structured event complex through repetitive and ritual behaviors, they can generate just enough of a termination signal to allow them to move on (17).

What is Happening to the Brain with Obsessive-Compulsive Disorder?

The pathway that mediates the reward signal is called the corticostriatal indirect pathway. This pathway involves the cortex of the brain, specifically the orbitofrontal cortex (OFC), anterior cingulate cortex (ACC) and the nucleus accumbens, and the basal ganglia. In a person with OCD, they do not receive the full reward signal and experience the reduction of anxiety upon SEC completion. They are then left feeling as though the task is incomplete, so they attempt to complete it with repetitive components of the SEC. Damage to any of the areas mentioned above (the OFC, ACC, or basal ganglia) can cause OCD. Depending on the area involved, this may express itself as an emotional disorder (Tourette’s syndrome) or a repetitive action disorder (OCD or tic disorder).

Neurotransmitters are chemical signals that relay messages between brain cells, called neurons. A neurotransmitter may either excite another neuron, causing it to fire, or inhibit another neuron, preventing firing. Serotonin is an inhibitory neurotransmitter, and it is typically decreased in OCD (3). Dopamine is another neurotransmitter and is excitatory. It is thought to be increased in OCD (4).

In children with neurodevelopmental OCD, we see early onset in childhood of repetitive thoughts or behavior patterns and it usually worsens as they grow up. Studies have shown that there are detectable differences in size of brain structures from left to right, whereas these differences are not seen in adults with OCD (9). Other mechanisms may include Pediatric Autoimmune Neurological Disorder Associated with Streptococcus (PANDAS), which is a sudden childhood onset of OCD following a bacterial Streptococcus infection (also known as Strep throat). The child develops an autoimmune response against their striatum and this results in high repetitive behaviors (5).

How is Obsessive-Compulsive Disorder Usually Treated?

OCD is most commonly treated with prescription medication, talk therapy, or the combination of the two. A doctor will perform and physical and psychological evaluation and see if you meet the diagnostic criteria for OCD.

Treatments generally work to bring symptoms under control so that they do not dictate your daily life. Depending on the severity of the disorder, treatment may be long or short term. Transcranial magnetic stimulation (TMS) (6) and surgical deep brain stimulation (7) have both been approved by the FDA to treat OCD.

How is the NeuroRescue Program Different?

One of the main things your brain does, and maybe even the primary thing, is help you determine where you are in the world. Your brain uses inputs from your inner ear to figure out where your head is in relation to gravity and how it is moving. It uses inputs from your muscles and joints to figure out where your body is in relation to your head and what your body is doing. It uses inputs from your eyes to figure out where your body is in relation to the visual environment.

Your brain needs to put all of that together to make sense of where the world is, and where you are in relation to the world. It needs to be able to localize you effectively in the environment, in order for you to be able to respond to the environment properly.

In patients with Obsessive Compulsive Disorder, we regularly see dysfunction in pathways that involve the eyes, the inner ear, and feedback from muscles and joints. This is because pathways involved in these functions utilize the same regions of your brain and brainstem that are affected by OCD. In most cases of OCD, at a foundational level a failure of regulatory systems has occurred, allowing for other circuits to get out of control.

This is why many patients fail to fully manage their OCD with medication, psychotherapy or alternative therapies, even if all of their therapies are performed at the same time. While all of these therapies can help with problems in the individual systems, none of them take the comprehensive NeuroRescue Program approach to address all of the systems involved in anxiety disorders and their ability to work together in harmony.

How Does the NeuroRescue Program Work?

We design your unique NeuroRescue Program to be among the most comprehensive diagnostic and therapeutic protocols available today. We create individual NeuroRescue Programs based on a comprehensive analysis of every relevant neurological system and pathway, using gold-standard, cutting edge neurodiagnostic technologies and examination procedures and state-of-the-art therapies.

We begin with your Discovery Day, wherein we perform a comprehensive history of not only your condition, but your life on a timeline. This allows us to dive deeply into your case and see all of the factors that led to where you are now. It helps us uncover hidden problems and associated conditions that may be making it difficult for you to move your recovery forward.

Our examination allows us to identify the areas and pathways of your brain that have been impacted by your OCD. We begin by precisely quantifying the function of your visual, vestibular, and proprioceptive systems through computerized analysis of your eye movements, your inner ear reflexes, and your balance in a host of different sensory conditions.

We employ technologies including Videooculography and Saccadometry to measure several classes of eye movements. We use Video Head Impulse Testing to measure the function of your inner ear, and Computerized Dynamic Posturography to assess your balance under varying circumstances.

We use NeuroSensoryMotor Integration testing to evaluate hand-eye coordination and cognition, and Virtualis testing to assess dynamic eye tracking and perception of vertical in a virtual reality environment.

We combine all of this with a comprehensive physical and neurological examination of your sensory, motor, autonomic, and cognitive systems. We review any relevant laboratory testing, radiological imaging, and prior neurodiagnostic testing, and integrate that information with our findings.

We use this information to identify which parts of your brain are working properly, which systems are struggling, and the precise point at which your systems fatigue.

We can then design a NeuroRescue Program that is unique and specific to your brain, and yours alone. Your NeuroRescue Program works to rejuvenate and reintegrate the damaged neurons and pathways in your brain. It works to improve energy, endurance, and functional capacity within your fragile systems. We can also employ supplement protocols to protect the neurons you have and support them to prevent further neurodegeneration and prevent future episodes.

Your therapy protocol may include specific forms of eye exercises to help rehabilitate structures involved in response inhibition and emotional regulation (11). It may involve exercises designed to increase sensory habituation and thus decrease OCD symptoms (12). It may involve transcranial electrical stimulation (13), or transcranial magnetic stimulation where appropriate (14). It may involve laser or LED photobiomodulation to reduce the anxiety associated with OCD (15). It may even include exercises performed in a virtual reality environment (16). Your unique NeuroRescue therapies will be decided based solely on your neurodiagnostic and examination findings.

We use our technologies and procedures to not only see what we need to address, but also when it is time to stop and let you rest. We address your impaired neurological function from multiple angles of therapy, and provide metabolic support to improve neurological recovery.

While we cannot bring back neurons that have been lost, your NeuroRescue Program allows us to take the pathways that remain and maximize their efficiency and endurance. And by focusing on the integration of systems, we can do more than just get pathways working better, we can get them working together again. This gives us our best opportunity to get your OCD under control, and return you to living a healthy, vibrant, and fulfilling life.

Your Next Best Step:

Living with obsessive-compulsive disorder can be extremely challenging, but there is hope for recovery and remission. To see if the NeuroRescue Program is right for you, contact one of our patient care coordinators to schedule your Discovery Day. And remember, it’s never too late to start getting better.