Neurobiology of Obsessive-Compulsive Disorder

Individuals with OCD present various symptoms, such as washing rituals for contamination fear,

checking rituals for harm avoidance, or hoarding rituals. This paper will follow the model of recent

research that proposes a multi-dimensional model involving a brain network model with discrete

mechanisms for the checking rituals type OCD and the contamination fear type OCD. There is evidence

of functional brain differences among OCD subtypes using fMRI methods (Nakao, Okada, & Kanba,

2014). In keeping with the type of OCD that the fictional character Monk presents with, this paper will

focus on checking type OCD and give only a brief reference to the contamination fear type OCD.

In recent years, brain imaging approaches have identified abnormal patterns of activity in a

particular circuit called the Cortico-striatal-thalamo-cortical circuit (CSTC circuit) (Ting & Feng, 2011).

This circuit may be implicated in ritual checking type OCD. Furthermore, it is speculated that

abnormalities in several bilateral cortico-cerebellar regions contribute to symptoms correlated with

contamination fear types of OCD.

These regions and their roles will be briefly outlined to understand these abnormalities'

significance. The CSTC circuit forms the basic information-processing structure of the brain (Tekin &

Cummings, 2002). The processing sequence is sub-cortically by the basal ganglia and thalamus. The basal

ganglia are anatomically below the cortex and are engaged primarily in motor control and various roles,

such as motor learning, executive functions, behavior, and emotions. The thalamus is located in the

diencephalon. It receives input from the basal ganglia and sends information to the cerebral cortex. The

thalamus also receives reciprocal information from the cerebral cortex so that the cortex can modify

thalamic function. Basal ganglia and thalamus return to the prefrontal cortex (Vergne, 2017).

To fully understand the operation of the CTSC circuit and its dysfunction in OCD, further detail is

required regarding the flow of information from the basal ganglia to the thalamus. The neuronal circuits
passing through the basal ganglia, specifically the striatum, take either a direct or indirect pathway

through the striatum with a final projection through to the thalamus. These direct and indirect pathways

have opposing actions on the thalamus and, ultimately, on the feedback to the frontal cortex. The direct

pathway disinhibits thalamic activity (meaning it causes an increase in thalamic activity). In contrast, the

indirect pathway has inhibitory connections resulting in a down-regulation of thalamic and frontal cortex

activity. When this circuit functions normally, these opposing neural circuits are in balance.

With that basic description of the CTSC circuit, it is now possible to describe the neurobiological

abnormalities apparent in individuals with OCD. The pathways connecting these areas in the CTSC circuit

are involved in the initiation and termination of behavior. An imbalance within these pathways may

cause individuals with OCD to get stuck in repetitive loops of thought and behavior. To elaborate, for a

person suffering from OCD, an imbalance between direct and indirect pathways in the striatum causes

changes in thalamic activity. Therefore, excitatory impulses originating in the thalamus reach the frontal

cortex producing a barrier that prevents individuals from removing some (usually irrelevant) worries

from their focus of attention" (Mercadante, 2004, p. 39). it appears to be the neurological basis of

checking and ritual-type OCD.

In contrast, it seems that washing rituals were more affected by a frontal-limbic system related

to emotional discomfort (Nakao, 2014). Neural components of the limbic system are likely to process

emotional dimensions, such as disgust for uncleanness, driving the contamination feat type OCD. A

possible loop for OCD may be the following dorsolateral prefrontal cortex; ventrolateral prefrontal

cortex. This type of OCD will not be explored further in this paper as there is a dearth of research on this

subtype, and in our case study, Monk did not suffer from this type of OCD.

I have found this course begins to provide a new lens to understand several different mental

disorders and the neurobiological complexity behind all mental disorders and other problems in the
living being. Of particular relevance are the discussion of Post-traumatic stress disorder and the

operations of the sympathetic nervous system and the parasympathetic nervous system.

This project, in particular, has helped advance my understanding of OCD and the new proposal

that there are specific subtypes of OCD and that these subtypes reflect unique neurobiological

mechanisms.