OCD: The Brain Cannot Determine Whether Something Is Safe


People with obsessive compulsive disorder (OCD) frequently feel shame or guilt about being locked in a pattern of anxious thought and ritualistic behavior. However, it seems people with OCD have brains that do not easily distinguish between safe and risky situations.

Difficult to Treat

Responding to relentless anxiety-provoking thoughts, individuals with OCD compulsively perform behaviors, such as checking, counting, or hand washing to relieve overwhelming anxiety. The most effective treatment to date is Exposure Response Prevention Therapy (ERP) where people experience their anxiety, but do not perform their anxiety-relieving behaviors.

ERP is extremely difficult for most OCD patients. Progress tends to be slow, and though a few people can let go of their compulsive behaviors, many are helped partially, or not at all. This difficulty may be at least partly explained by some research done in the UK.

A Bit of the Brain’s Not Working

The UK investigators caused study participants, half of them with OCD, to fear a picture of an angry face by associating it with an electric shock on the wrist. Then, the researchers attempted to have the subjects stop associating the picture with fear by viewing it repeatedly without receiving shocks. The subjects’ fear level was determined by measuring their sweat response to the picture.

The participant’s without OCD quickly learned to stop reacting to the picture with fear, but those with OCD remained frightened. The researchers found:

  • The subjects with OCD had less activity in the ventromedial prefrontal cortex, a part of the brain that signals safety, and predicts rewards.
  • Initially, those with OCD were not more fearful of the picture than those without OCD—the sweat response of the two groups was the same. However, those with OCD were more fearful (increased sweat) when being trained not to fear the picture.

These results help explain why ERP is frightening, and takes a long time. “The bit of their brain that should be telling them it’s safe isn’t working,” says researcher Naomi Fineberg. “Now we can say to them this is why therapy takes so long long, and we should stick with it.”

Gift of Insight

Though we would prefer a cure, or immediate symptom relief, insight into the physical mechanisms behind OCD and other mental health disorders is one of the gifts of research. Knowing the physical reasons behind the symptoms can help with self-acceptance, and may encourage people to tolerate long and difficult treatment regimens.

Source: New Scientist
Photo credit: tamckile

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