Running head: OBSESSIVE COMPULSIVE DISORDER 1

Obsessive Compulsive Disorder

Name

Institution
OBSESSIVE COMPULSIVE DISORDER 2

Obsessive Compulsive Disorder

Introduction

Personality disorders may have a profoundly adverse effect on the person’s life and

become a severe problem for family, friends, and colleagues. In some cases, people with the

disorder are dangerous for random people around them. Therefore, understanding of personality

disorders nature leading to the production of sufficient treatments is critical. Today there is no

unified point of view or clear preference of some risk factors over others; different authors pay

more attention to theories oriented to biological, social, and psychological factors. The other

point of view finds all elements essential and concentrate on the interaction between them.

The obsessive-compulsive disorder symptoms usually include preoccupation with danger,

disease, and doubt account, grooming, washing, and checking rituals. In general, OCD leads to

compulsions (repetitive unwanted behaviours, mental or physical rituals) and obsessions

(intrusive thoughts) (Pauls, Abramovitch, Rauch, and Geller, 2014; Burguiere, et al., 2015). This

range of symptoms is the same for children and adults. In 25% cases, the subjects with the

disease have a first-degree relative with the disorder (Swedo, 1989). From following twin

studies, it becomes clear that OCD is a multifactorial familial condition involving both

environmental and polygenic risk factors (Pauls, Abramovitch, Rauch, and Geller, 2014). This

type of studies supports as well association between OCD and BDD symptoms and genetic

influences (Monzani, Rijsdijk, Harris, and Mataix-Cols, 2014).

Currently in the professional classification for treatment purposes, OCD is a part of a

broader group of obsessive-compulsive related disorders such as body dysmorphic disorder

(BDD), hoarding disorder (HD), trichotillomania (TTM), and excoriation disorder (SPD)

(Monzani, Rijsdijk, Harris, and Mataix-Cols, 2014). The next review has an aim to discuss in

more details factors from various groups and compare the quality of unidimensional models and

integrative approach to check the assumption about their interaction in the development of OCD.
OBSESSIVE COMPULSIVE DISORDER 3

Biological Factors

The function of genetic factors in obsessive-compulsive disorders were studied on twins

in many experimental works. For example, the paper by Monzani, Rijsdijk, Harris, and Mataix-

Cols (2014) checking the common for all groups of OCRD and specific for OCD in particular

genetic factors. They state that symptoms of OCRD have a moderate heritability ranging from

31.6% to 51.1%. (Monzani, Rijsdijk, Harris, and Mataix-Cols (2014) points that diseases relate

to two latent genetic factors, one of them is common for all groups of OCRD, and the other is

exclusive for TTM and SPD. So for OCD, in particular, is possible to talk about one genetic

vulnerability that is nonspecific for this disease, but conferring risk to all groups of OCRDs.

Such factors could explain the similarities in phenomenology and comorbidity patterns as well as

familiality (Monzani, Rijsdijk, Harris, and Mataix-Cols, 2014). This factor affects more the

group of cognitive OCRDs (OCD, BDD, HD), while body-focused repetitive behavioural

disorders have a lower loading of it. The study reports both about disorder-specific genes for

OCD. More details on this topic provided in the first genome-wide association study by Stewart,

Yu, Scharf et al. (2013). Some of the OCRDs genetic factors may be common for a broader

group of emotional disorders, however, this question requires the subsequent research.

Psychological Factors

The function of neuropsychological factors in obsessive-compulsive disorders getting

increasing evidence in the current studies. In particular, they discuss abnormalities in

corticostriatal circuits and their role in the pathophysiology of OCRDs. The study by Burguiere,

Monteiro, Mallet, Feng, and Graybiel, 2015 relates the typical loss of control of habitual,

compulsive behaviours to the striatal circuit dysfunction. This idea has a support in imaging and

functional studies in animal models. Also, genetic factors affect the disease probably through the

phenotype changes in circuits.

Neuroimaging studies allow characterising the related to OCD circuits and their

functions. In particular, there is a special connection linking the orbitofrontal cortex (OFC),
OBSESSIVE COMPULSIVE DISORDER 4

anterior cingulate cortex (ACC), and the caudate nucleus. Other structures involved in

maintaining of decease are putamen and caudate nucleus where healthy and OCD people have a

significant morphological difference (Burguiere, Monteiro, Mallet, Feng, and Graybiel, 2015).

Functional magnetic resonance imaging (fMRI) studies show the alteration of activities in the

striatum and these two cortical regions during expression of symptoms and resting-state.

While the importance of caudate nucleus-anterior putamen and cortical regions

connected to them is clear from the studies on animals, neuroimaging, and other methods, the

core functions of those regions and the mechanic of OCD on the neuropsychological level stay

unclear. The habit hypothesis state OCRDs is a form of neural processes dysregulation in the

sphere of routinised, the habitual sequence of actions expression favouring in the case of

environmental stimuli triggering. In the other opinion, it reflects the dysfunction of the action's

termination (Burguiere, Monteiro, Mallet, Feng, and Graybiel, 2015).

Social Factors

Weingarden, Renshaw, Wilhelm, Tangney, and DiMauro (2016) in their paper discuss the

importance of anxiety and shame in maintaining of such symptoms of the obsessive-compulsive

disorder as depression, suicidality, days housebound, and functional impairment. The similarity

of these factors effect on body dysmorphic disorder allows to talk about the common

characteristics of two diagnoses and treat them similarly in the medical approaches. The shame

and anxiety are well recognised as risk factors for obsessive-compulsive disorder since 1994

when the experience of prominent negative emotions was reflected in the classification of

disorders, OCD used to be an anxiety disorder. Many studies support the relation between

anxiety and suicide risk, depression, and functional impairment, some of them put it in the

context of OCD.

The other negative emotion related to OCRDs symptoms maintaining is a shame. The

mechanic of shame effect on the disorder comes from its highly distressing moral quality, that

comes with the negative judge of self. A person feeling worthless or bad prefers to withdraw
OBSESSIVE COMPULSIVE DISORDER 5

yourself from others and focus on their shame worsening circumstances. The empirical study by

Weingarden and Renshaw (2014) points on the mediative effect of shame on depression

symptoms in OCD cognitions context.

The work by Weingarden, Renshaw, Wilhelm, Tangney, and DiMauro (2016) gives

empiric support to the concepts above. They state the higher level of anxiety in the group of

people with OCD than among ones with BDD or health ones. However, the relation between

anxiety and housebound rates, depression, and impairment is similar for both diagnoses of

OCRDs. The results support the cognitive-behavioural model of the disorder. The shame levels

are similarly high in both groups and may be a target factor in treatment development. This risk

factor relates mostly to such outcomes as functional impairment and suicide risk. It allows

working with OCRD category by more general methods with attention to emotional factors

beyond the anxiety. However, the shame is the risk factor for depression in the BDD case, but

not OCD. Thus, priority of anxiety and shame may vary within the OCRD spectrum.

Interaction

An article by Pauls, Abramovitch, Rauch, and Geller (2014) provides an integrative

perspective on the obsessive-compulsive disorder. The authors state that all directions of studies

have their positive input into an understanding of the disease. By neuroimaging studies becomes

clear the role of the cortico–striato–thalamocortical circuit in the pathophysiology of the

disorder, in particular in the impairments in executive functions in the case of OCD. Through

genetic studies understood the effect of genes on serotonergic, dopaminergic and glutamatergic

systems. The interaction between effects in these systems may significantly change the outcomes

of the circuit functionality. In addition to interactions between genes and neurocircuits,

environmental factors play their role in modification of risk genes expression and OCD

behaviours manifestation triggering. They can be psychological or neurological trauma, adverse

perinatal events.
OBSESSIVE COMPULSIVE DISORDER 6

The work by Mas, et al., 2016 supports the idea of integrative approach through the

conjunction of diffusion tensor imaging data (DTI), neuropsychological and genetic data, and

structural magnetic resonance imaging data (MRI) in the aim of OCD severity prediction.

The integration of various factors initially comes from the family studies where effects of

environmental risk factors and genetic risk factors are hard to divide clearly. While studies

overcome this problem with the twin studies, it stays important to pay attention to both genetic

and environmental factors (for example, trauma-related loss or appearance-related teasing) and

understand causation or triggering of the social events for disorders prerequisite in the genome

(Monzani, Rijsdijk, Harris, and Mataix-Cols, 2014). Brander, Pérez-Vigil, Larsson, and Mataix-

Cols (2016), on the other hand, in their systematic review of environmental risk factors deny any

statistically proved causation between potential factors such as postnatal complications,

reproductive cycle, and stressful life events and OCD as an outcome. Parental age, the season of

birth, socioeconomic status, parental rearing practices, infections, traumatic brain injury,

substance use or vitamin deficiency also discussed in existing literature has even less relation to

the disease realisation (Brander, Pérez-Vigil, Larsson, and Mataix-Cols, 2016).

Conclusion

An approach that focuses on shame and anxiety as a key factor of OCD symptoms

maintaining including depression and housebound lead to treatments requiring cognitive

restructuring of shame-prone cognitions and shame-driven behaviours through behavioural

activation. It points to the importance of mindfulness and acceptance in the therapy in shame

treatment.

By the study of neuropsychological factors comes suggestion that frontostriatal circuits,

and their connections with basal ganglia, thalamus, and brainstem, are propitious candidates for

therapeutic intervention in OCD (Burguiere, et al., 2015).

OBSESSIVE COMPULSIVE DISORDER 7

The understanding of the interaction between various factors leads to the application of

multi-modal therapy that reduces a possible effect of all groups of factors helping to deal with

bottlenecks and get better progress in the treatment.

OBSESSIVE COMPULSIVE DISORDER 8

References

Burguiere, E., Monteiro, P., Mallet, L., Feng, G., & Graybiel, A. M. (2015). Striatal circuits,

habits, and implications for obsessive-compulsive disorder. Current opinion in

neurobiology, 30, 59-65.

Brander, G., Pérez-Vigil, A., Larsson, H., & Mataix-Cols, D. (2016). A systematic review of

environmental risk factors for Obsessive-Compulsive Disorder: a proposed roadmap from

association to causation. Neuroscience & Biobehavioral Reviews, 65, 36-62.

Mas, S., Gassó, P., Morer, A., Calvo, A., Bargalló, N., Lafuente, A., & Lázaro, L. (2016).

Integrating genetic, neuropsychological and neuroimaging data to model early-onset

obsessive compulsive disorder severity. PloS one, 11(4), e0153846.

Monzani, B., Rijsdijk, F., Harris, J., & Mataix-Cols, D. (2014). The structure of genetic and

environmental risk factors for dimensional representations of DSM-5 obsessive-

compulsive spectrum disorders. JAMA psychiatry, 71(2), 182-189.

Pauls, D. L., Abramovitch, A., Rauch, S. L., & Geller, D. A. (2014). Obsessive-compulsive

disorder: an integrative genetic and neurobiological perspective. Nature Reviews

Neuroscience, 15(6), 410-424.

Stewart SE, Yu D, Scharf JM, et al. Genome-wide association study of obsessive-compulsive

disorder. Mol Psychiatry. 2013;18(7):788-798.

Swedo, S. E., Leckman, J. F., & Rose, N. R. (2014). Obsessive Compulsive Disorder.

https://jamanetwork.com/journals/jamapsychiatry/article-abstract/494524?redirect=true

Weingarden, H., Renshaw, K. D., Wilhelm, S., Tangney, J. P., & DiMauro, J. (2016). Anxiety

and shame as risk factors for depression, suicidality, and functional impairment in body

dysmorphic disorder and obsessive-compulsive disorder. The Journal of nervous and

mental disease, 204(11), 832.

Weingarden H, Renshaw KD (2014) Associations of obsessive compulsive symptoms and

beliefs with depression: Testing mediation by shame and guilt. Int J Cogn Ther. 7:1–15.
OBSESSIVE COMPULSIVE DISORDER 9

Appendix