New Developments in Obsessive-Compulsive Disorder - Research Paper Example

? New Developments in OCD Research Due For many years, obsessive-compulsive disorder (OCD) was known to be an uncommon psychiatric condition resulting to one’s obsessive behavior. However, today our understanding of OCD has provided an insight about its prevalence and disabling effects on the mind of its sufferers. For instance, obsessive compulsive disorder is known to involve two components – obsession and compulsion. As to what comes first, whether obsession or compulsion is still unclear among researchers. According to the National Institute of Mental Health (2010), obsessions in the form of upsetting thoughts cause a person with OCD to feel an “overwhelming urge to repeat certain rituals or behavior called compulsions”. However, recent research conducted by the University of Cambridge in 2011 suggests that the OCD pattern happens the other way around – that compulsions in fact lead to obsessions. This paper will focus on the recent developments in OCD research and other scientific breakthroughs that have helped researchers understand this brain condition. Specifically, it will discuss the research studies on the following 1.) Compulsion as a critical factor in initiating OCD behavior (Gillan et al, 2011); 2.) Development of cognitive behavior therapy designed specifically for OCD patients who are checkers (Radomsky et al, 2004); and 3.) The capability of a brain scan to detect OCD through the examination of underactive brain regions (Chamberlain et al, 2008). By presenting new developments in OCD research, this paper will give researchers another insight and perspective in finally understanding OCD and its adverse effect to one’s psychological health. Introduction Based on the 2005 National Comorbidity Survey - Replication study, the National Institute for Mental Health declared that around 2.2 million adult Americans suffer from a neurobiological disorder known as obsessive-compulsive disorder (OCD). In the UK, the Royal College of Psychiatrists (2009) claimed that one in every 50 people in the country, at some point in their lives, has suffered from OCD. Adding to this, the World Health Organization listed OCD as one of the 20 most disabling mental health problems in the world, based on its National Burden of Disease Studies (2001). This statistical data about OCD reveal that the condition is affecting more people worldwide than previously thought. Because of its prevalence and severity, it is important to focus more about research developments on OCD to gain better understanding about this brain condition. Recent developments in OCD research include extensive study about the nature of compulsion and obsession. Also, it includes examining studies on the genetic factors that may affect the development of OCD, as opposed to the popular notion that environmental factors cause it. What is OCD? As the name suggests, obsessive compulsive disorder is a mental disorder which involves two components – obsession and compulsion. As to what comes first, whether obsession or compulsions still remains unclear among researchers. According to the National Institute of Mental Health (2010), obsessions in the form of upsetting thoughts cause a person with OCD to feel an “overwhelming urge to repeat certain rituals or behavior called compulsions”. This means that people with OCD tend to experience repetitive and unwanted obsession over thoughts, images or impulses and because of this, they may develop compulsions to do things repetitively such as hand washing, door checking, or putting things into order. These routines are done excessively to bring down anxiety. The cognitive behavioral model of OCD is also present in other studies which suggest that OCD begins with an event that triggers obsessive thoughts and images that leads to repetitive behavior (Rachman & de Silva, 1978; Maerts, 2009). In fact, this relationship between obsession and compulsion is presented in a cyclical manner – that is, obsession causes distress and distress needs to be reduced by compulsion (Veale, 2007; Goodman, 2010; OCD-UK, 2011). New Study: Compulsion Leads to Obsession Despite the popular conception that repetitive behaviors are done in response to disturbing fears, recent research conducted by the University of Cambridge in 2011 suggests that OCD pattern happens the other way around – that in fact, compulsion leads to obsession. This means that a person’s compulsive behavior such as hand washing or door checking is a precursor to obsessive thoughts justifying the behavior. The study, which was carried out by University of Cambridge in collaboration with the University of Amsterdam, revealed that the behaviors of OCD patients were habitual – that they perform repetitive tasks regardless of related obsessive thoughts or images. There were 40 participants in the study, with half of them suffering from OCD and the other half being control subjects. In the research experiment, the groups were tested in performing tasks that enables researchers to see whether habit-like behavior are likely to arise. Each participant is encouraged to win some points upon completing the simple tasks of association between stimuli, behavior, and outcomes. The result for the study revealed that the group suffering from OCD tends to react to stimuli even if the behavior did not produce desirable outcomes. As such, the researchers, led by Claire Gillian and Trevor Robbins from University of Cambridge, believed that the behavior of OCD patients was borne out of habit. Since it was observed that compulsive behavior can exist without related obsessions, researchers now believe that compulsion is a vital characteristic of OCD. Research Significance & ERP The results of this recent OCD research by the University of Cambridge were important because they support the cognitive behavioral theory, which involves exposure and response prevention, as an effective treatment for OCD. Exposure and response prevention (ERP) is a therapy that exposes OCD patients to the things or circumstances that trigger their rituals or compulsive behavior. Since research shows that compulsions, not obsessions,were a critical factor in initiating OCD behavior, ERP allows patients to face head-on their compulsive behavior and the underlying fear behind it. For instance, a person with OCD might repeatedly scrub the floor for fear of germs or microbes. As such, during ERP treatment, the patient will likely be asked to touch the floor repeatedly and not be allowed to wash his hands for a few hours. In this way, he will be able to confront the compulsion and resist the rituals with increased anxiety until the brain gets accustomed to it. In other words, the exposure part of the program is exposing the patient to the substances or things he is anxious about. The response prevention, on the other hand, is stopping him from doing the ritual until the brain habituates to it. Cognitive Behavioral Therapy for Checkers Even though Cognitive Behavioral Therapy, which involves ERP, is known to be one of the most effective treatments for OCD, this form of cognitive behavioral therapy is also known to have a high refusal rate among OCD treatments (Veale, 1999; Frost &Steketee, 2002; Seligman &Reichenberg, 2012). Because of this, a new way to specifically develop treatment for compulsive checking was recently developed.Checkers are OCD sufferers who repeatedly feel the need to check stoves, door locks, or faucets. They constantly make sure everything is safe and in order. For psychologist Adam Romsky of Concordia University, ERP treatments were too broad to treat checking behavior of OCD patients. As such, he and his colleagues at the University of British Columbia and the University of Reading collaborated on a plan to develop and improve a form of ERP treatment that will specifically work for compulsive checkers. The group found out that OCD patients develop checking behavior because they have intense sense of perceived responsibility. For instance, a compulsive checker would always justify to himself that if he doesn’t turn the stove off, the entire house will be destroyed by fire. This thought, according to Dr. Radomsky, can rapidly turn into a lack of confidence in one’s own memory. In his previous research, he found that diffident memory plays a crucial role acquiring OCD when he tested patients who are cleaners and those who are not (Radomsky, 1994). The participants were shown 25 contaminated objects and 25 uncontaminated objects which they rated according to the level of anxiety they get when touching the object. It was found that the OCD group had better memory in the contaminated objects than the other group. Through this observation, it was resolved that senseless checking is constantly performed to reduce one’s anxiety and to gain confidence in one’s self (Radomsky et al, 2006).Also, from the study, it was found that the feeling of immense responsibility for OCD patients is making them anxious for their own or other people’s safety. Because of this, a specific treatment on how to pacify one’s sense of responsibility is being developed by the researchers as funded by Canadian Institutes for Health Research (CIHR). The study consists of encouraging patients to gain a confident memory and reduce their perception of dangerous predictions of misfortunes. Through this, the researchers aim to stress the importance of their thoughts rather than actions. As such, the treatment hopes to change a patient’s perception of himself and the world around him. Development in OCD Diagnosis Aside from the treatment, scientists have also worked on developing a better way to diagnose OCD as a brain condition. Currently, the diagnosis usually used to determine if a person has OCD is through a clinical interview. In psychology, a clinical interview is a structured and standardized consultation between a patient and psychologist. However, as a means of diagnosing OCD, a clinical interview is done after compulsive behavior has progressed and worsened. Because of this, scientists from the University of Cambridge (2008) suggested through their research that evaluating activity in a certain section of the brain enables psychologist to determine if people are at risk in developing OCD. In this way, OCD behavior can be detected and eventually treated earlier. The research, funded by Medical Research Council and Wellcome Trust (2007), showed that under-activation in the region of the brain responsible for stopping habitual behavior is present in OCD patients and their close family members. More specifically, the researchers examined the activity in the lateral orbitofrontal cortex of the brain which affects the decision making and behavior. The method for the research involved using functional magnetic resonance imaging (fMRI) in order to assess the mind activity in the lateral orbitofrontal cortex – the area in the brain responsible for making decisions. Through series of picture tests, 14 OCD patients, 12 of their immediate relatives, and 14 control subjects (non-OCD) were asked to look at layered images of a house and face on the screen. Through trial and error, they were asked to press a button if they believed the house or the face was the correct or incorrect target. This test was repeated six times and after a while, the test will be changed again so that the subjects had to re-learn the test process again. Throughout the experiment, the fMRI monitored the change in mind activity of the subjects. As revealed in the study’s result, subjects with OCD and their relatives showed under-activated brain activity in lateral orbital cortex and other regions of the brain. In contrast to this, the controlled subjects showed lesser activity in these areas of the brain. According to Dr. Chamberlin, head of the research from the University of Cambridge, “impaired function in brain areas controlling flexible behavior probably predisposes people to developing the compulsive rigid symptoms that are characteristic of OCD”. This means that the changes in the brain are present within families but a lot of research is needed to specifically identify the contributing gene of the brain activity for people with OCD. Conclusion OCD is affecting more people worldwide as previously thought. As such, many scientists have now provided attention to better understand the brain condition. From the recent developments in OCD research, it can be inferred that scientists have come a long way in studying OCD. However, there are still many areas that need to be explored when it comes to understanding the condition. The research about compulsion being a critical factor in initiating OCD behavior in a way mirrors the “chicken-egg” situation and because of this, more researches are needed to verify and conclude whether compulsion is indeed a precursor to obsession in OCD. On the other hand, it is yet to be seen whether the cognitive behavior therapy for checkers will eliminate the devastating effects of compulsive behavior. As such, there is need for researchers to further refine the treatment procedure in order to solve OCD problems. Moreover, the use of fMRI in scanning brain activity for OCD is a major breakthrough in the early detection and diagnosis for the condition. However, there is still much work that needs to be done in order to improve the therapeutic and pharmacologic treatment of OCD.Surely, in the future, the role of these new researches will serve as a basis to completely understand and finally treat the detrimental effects of OCD. References Agwani, S., Knox, M. & Adams, P. (2008). 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