How does the OCD brain work?

 

This was one of my first questions when I found out about my condition. I was very interested to learn more so I could better understand myself. In addition, it was very important to me to be able to explain to others what is “wrong” with me. I have to admit, I still struggle with some people’s perception about mental illnesses, however, I believe knowledge is power and I am willing to help others like me to feel safe and good about themselves.

It is important to point out that I could not find information of what exactly causes OCD. It is claimed that people with OCD have differences in the brain function and structure. When I have asked doctors about it the usual reply was “There is no clear answer yet for what causes OCD, however, it is believed that your brain cannot absorb serotonin well”.

Serotonin is also knows as a happy hormone. It acts as both a neurotransmitter (a substance that nerves use to send messages to one another) and a vasoconstrictor (a substance that causes blood vessels to narrow). It plays an important role in regulating aggression, body temperature, mood, sleep, vomiting, blood clotting, sexuality, and appetite. It is also involved in aging, learning, and memory.

I have found information that not only serotonin as a neurotransmitter could be the reason for OCD, but also glutamate (an excitatory neurotransmitter, which means it causes neurons to fire off a message to the next cell - people with OCD tend to have higher glutamate levels than other people) and gamma-aminobutyric acid (it can have a calming effect on the brain, as it blocks certain alert signals. Low GABA levels are associated with OCD).

Difference in the brain structure

There are certain brain areas that are associated with OCD symptoms. Neuroimaging studies have revealed structural and functional differences in the brains of individuals with OCD compared to those without the condition.

Thalamus - A structure in the diencephalon that is responsible for processing and further forwarding sensory signals to the cerebral cortex. The thalamus shows more activation in patients with OCD compared to healthy comparison subjects. This is likely related to the role of the thalamus as a relay and integrative site for other brain areas activated in OCD, such as the basal ganglia and the orbitofrontal cortex.

Orbitofrontal cortex - is the area of the prefrontal cortex that sits just above the orbits. It has extensive connections with sensory areas as well as limbic system structures involved in emotion and memory. The orbitofrontal cortex can be considered as the apex of the neural networks of the social brain and is critical to the adaptation of behavior in response to predicted changes in reinforcement (Rushworth, Behrens, Rudebeck, & Walton, 2007). The cortex is often hyperactive in people with OCD, which may contribute to the intrusive, anxiety-provoking thoughts characteristic of the disorder (obsessions).

Anterior cingulate cortex - is recognized as an important cortical center of integrations of pain with emotional and situational cues. Many studies attribute specific functions such as error detection, anticipation of tasks, attention, motivation, and modulation of emotional responses. Overactivity in this area may contribute to the heightened anxiety and the need for perfectionism common in some forms of OCD.

As far as I know it is not needed to scan your brain to find out what is “wrong” when having an OCD. Doctors, such as psychiatrists and clinical psychologists, could diagnose it. The idea of this post is to give you a brief understanding of the OCD brain, it is far more complicated and I am not a professional so it is just a start if you want to know more. There is plenty of research on the Internet. I find some of them quite interesting, especially those that observe the “beginning” of the OCD in kids.

I ended up crying while writing this. It is the middle of the night but I could not get to sleep because I was thinking about this post. Over the years, I have heard so many things, such as “Having OCD does not make you special.”, “Everything is in your brain just stop thinking about it.”, “This is nonsense you are just drawing attention.”, “Throw away your pills, you do not need them.” and so on. I have heard them so many times and it hurts a lot because usually they come from close friends and family. I really hope that with time people will become more open about mental illnesses and better understand that it is not a modern way to draw attention. I will do my best to help the process.