The neurological disorder called obsessive-compulsive disorder (OCD) is characterized by compulsive, repetitive behaviors such as cleaning and checking, even when there is clear objective evidence that the environment is clean, orderly, and adequate.
Although this disease is sometimes misdiagnosed as a “fixation” disorder, the disease is actually caused by processing uncertainty issues. However, the brain basis for this abnormal processing is still unknown.
Now, a recent study published in Elsevier, “Biological Psychiatry: Cognitive Neuroscience and Neuroimaging,” uses brain imaging to take a closer look at the mechanisms underlying uncertainty processing in OCD.
Also read: Can you overcome OCD with willpower? Experts bust the myths
Researchers led by Dr Valerie Voon from the University of Cambridge studied three groups: people with OCD, people with OCD who underwent capsulotomy therapy, which is thought to reduce OCD-related brain activity, and healthy controls. . The researchers wanted to examine processing in OCD, but also how capsulorhexis affected processing.
Dr. Voon explained: “We used a simple card gambling task, such as that commonly used in drinking games. Participants, faced with an open card, simply asked whether they thought the next card was higher or lower than the open card. At the extreme, you have more certainty if the open card is high or low, but you have much more uncertainty with cards near the center of the deck.”
In a functional magnetic resonance imaging (fMRI) experiment, the researchers focused on brain regions involved in decision-making: the dorsal anterior cingulate cortex (dACC) and the anterior insular cortex (AI). Participants with OCD showed abnormal activity in this circuit compared to healthy controls when making certainty judgments.
Dr. Voon said, “Importantly, OCD patients are slower in decision making, but only when the outcome is more certain. These deficits were present in both OCD patients and those who improved after capsulorhexis. , suggesting that this cognitive mechanism may be a core feature underlying why OCD develops, regardless of symptom severity.”
Dr. Voon added, “Image data may represent how people with OCD are suffering from their symptoms. Healthy people may be able to say, ‘This is clean,’ and stop cleaning.” However, a person with OCD may struggle with that belief and perhaps spend a lot of time thinking, “Is this still a little dirty or is it clean enough?” And clean some more. ”
The findings reveal that OCD is not a disorder of excessive cleanliness, but one of a disorder of the brain’s processing of certainty.
Cameron Carter, MD, editor of Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, said of the study: The disorder, as well as the neural systems underlying these processes, such as dACC and AI, may offer new hope for those suffering from this difficult-to-treat and disabling disorder. ”
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