Understanding the Obsessive Compulsive Disorder: Conceptual Background and Brain Etiology

Patients suffering from obsessive–compulsive disorder (OCD) experience a combination of anxiety-producing obsessive thought patterns and related compulsive behaviors designed to reduce the distress associated with the obsessions.

Obsessions are recurrent thoughts, impulses, or images that are threatening because they are perceived as either unacceptable or leading to a dreaded outcome, and thus cause marked anxiety. Common obsessional ‘themes’ include contamination (thinking one has contacted dangerous germs or toxins), aggression (image or urge to drive into oncoming traffic or stab one’s spouse), accidental harm (fear that one has hit a pedestrian or doubting whether one turned off the stove), blasphemy (thinking one has offended God by doing a religious ritual incorrectly), and sexuality (intrusive images of having sex with a child or parent). Sometimes an obsession is vague, yet still evokes a looming sense of danger: a ‘bad feeling’ that occurs during an action, or the inexplicable sense that a behavior has not been done correctly. Multiple types of obsessions are found in most affected individuals and can change over time.



Compulsions include behaviors (e.g., hand washing, checking, ordering, or arranging things) and mental actions (e.g., praying, counting, repeating words silently) that are aimed at preventing or neutralizing the threat associated with the obsession, and thus temporarily reduce anxiety. This relief from the distress is highly reinforcing, resulting in the persistent use of compulsions. Compulsive behaviors are often repeated (checking the stove 15 times), or have to be performed according to rules that must be applied rigidly (a sterilization ritual for plates and silverware before meals).

Sometimes compulsions are ‘logically’ linked to the obsessions, as in the case of washing one’s hands in response to a contamination obsession, or driving back to a spot where one fears they may have hit someone. Done once, such behavior might seem reasonable; it is the repetitive, time-consuming, and rigid quality that distinguishes compulsions. Sometimes there is no ‘logical’ action to prevent the obsessional threat so, compulsions develop that are more akin to superstitious rituals. For example, going through doorways can often trigger an obsession (‘bad feeling’). Given no clear antidote to the vague threat, individuals may develop a ritualized compulsion aimed at neutralizing the obsession in some magical way. This might involve having to go through the door on the left side, touching both sides of the threshold 3 times, or passing through the doorway repeatedly until it is accomplished without any ‘bad thoughts.’



Individuals with OCD generally have some degree of insight that their symptoms are excessive or unreasonable. Nonetheless, the disorder is time-consuming, distressing, and severely impairing within the realms of both social and occupational functioning. It is also associated with increased risk of suicide. OCD has an estimated, lifetime prevalence in the general US population of 2–3%, and is equally common in both males and females. The age of onset follows a bimodal distribution: early onset (prepubescent, the majority of cases) and late onset (early 20s). Early-onset cases are more likely to be male, have a family history of OCD, greater symptom severity, and co-occurring tics, OCD spectrum (discussed in section Differential Diagnosis), and disruptive behavioral disorders (e.g., attention deficit hyperactivity disorder).

Differential Diagnosis
It is important to distinguish OCD from worry, intrusive thoughts, and compulsions seen in everyday life. OCD obsessions are experienced as unwanted and anxiety-producing, whereas worry functions more as a mental coping strategy that provides a sense of control and preparation for a perceived future threat. Intrusive thoughts (i.e., suddenly envisioning a family member falling off a cliff while hiking together) are common, but in OCD they occur at a higher frequency, and are experienced as having unusual importance, so are more distressing to the affected individual. Compulsive behaviors are also frequently seen in normal populations in the form of superstitious behavior and repetitive checking. The diagnosis of OCD is made only if they are time consuming or if they result in significant psychosocial impairment or distress.

There are a number of disorders that share the features of OCD, and are sometimes considered as ‘OCD spectrum disorders.’ Disorders such as body dysmorphic disorder, hypochondriasis, and hoarding and eating disorders include obsessive-like fears (that one has a serious illness or is fat), but the thoughts are not experienced themselves as highly intrusive and inappropriate. Derma-tillomania (skin picking) and trichotillomania (hair pulling) have repetitive behaviors that may bring some anxiety relief, but they are neither triggered by obsessions nor have the magical or ritualistic quality of OCD compulsions. Although impulse-control disorders such as kleptomania, pyromania, and pathological gambling also have recurrent thoughts and behaviors that are difficult to resist, the drive tends to be more pleasure-seeking than distress reducing.



Schizophrenia is often characterized by strongly held beliefs that are clearly false (delusions) as well as by stereotyped behaviors. Individuals with OCD, however, generally show considerable insight into their symptoms. In major depression, the depressed individual may have distressing, repetitive thoughts, but these are rarely resisted, and are often focused on a past incident rather than on a current or future threat. Although it has a similar name, obsessive–compulsive personality disorder is actually quite different from OCD. Obsessive–compulsive personality disorder does not involve obsessions or compulsions; rather, it is characterized by a pervasive pattern of maladaptive orderliness, perfectionism, and control.

Other disorders may mimic OCD. Tics and stereotyped movements are similar to compulsions in their appearance but not in their function. Generally, the cognitive elements involved in OCD compulsions are much more complex, whereas in tics and stereotypic movements, the individual does not report any specific reason for the behavior, but only a nonspecific tension that builds until the behavior is performed. Of note, Tourette’s syndrome and OCD are frequently co-occurring disorders, and individuals with Tourette’s should be routinely asked about the presence of obsessions and compulsions.



Etiology
There is converging evidence that OCD involves dysfunction of the corticostriatal-thalamic circuits, which help integrate cognitive and sensorimotor functions, and in particular initiate automatic, procedural behaviors. The high co-occurrence of OCD with Tourette’s – a disorder involving cortical and striatal pathways – is suggestive of a similar etiology. There are also data supporting an association between an autoimmune response to Group A β-hemolytic Streptococcus, affecting the striatal regions, and the acute emergence of OCD, often with tic symptoms (including Tourette’s). The term pediatric autoimmune neuropsychiatric disorder associated with Streptococcus refers to a group of children with this presumed immunological etiology. The role of serotonin in the corticostriatal-thalamic circuits is thought to be important, and several studies suggest that serotonin reuptake inhibitors may normalize activity in these pathways. Medications that boost serotonin activity reliably reduce OCD symptoms. Research also suggests that abnormalities in the glutamate and dopamine systems are involved in OCD as well.

The evidence for a genetic contribution is supported by the monozygotic twin studies showing a concordance rate from 63% to 87%, and first-degree relatives showing rates of OCD in the range of 10–22.5%. No candidate gene has been identified that can reliably account for the broad phenotype of OCD. Animal models of OCD, such as those found naturally in dogs or induced in laboratory mice identify the potential genes for further study.



From the standpoint of neuroimaging, OCD is one of the most investigated illnesses in the anxiety cluster. As of yet, it remains impossible to attribute causality to particular brain structures in the cognitions and clinical features of OCD. In animal models, abnormalities in the orbitofronto-striatal circuits are associated with an impaired ability to modify behavior in response to new information, for example: impaired inhibition of previously important, but now inappropriate response to stimuli. Humans with injuries to the striatum, or areas to which it projects, often develop obsessive –compulsive behaviors. Nevertheless, no consistent structural abnormality has been identified in patients meeting the criteria for OCD. This may suggest that the causative abnormalities are present at the level of a system or network, not at the level of isolated neuroanatomical structures, or because of a marked heterogeneity within the diagnosis. Illnesses with components of compulsive and impulsive behaviors, such as Tourette’s syndrome and trichotillomania, tend to occur in comorbidity with OCD, or cluster with OCD within families. Further research into these disorders of overlapping end phenotype may serve to illuminate the rest of the OCD picture as it relates to the brain structure.
Source: Vimen L. Beckner, University of California San Francisco, and San Francisco Group for Evidence-Based Psychotherapy, San Francisco, CA, USA.

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Is the Lose of Religious Liberties Inevitable in a Modern Society?

By: Alexandria Addesso

Religion has long been the scapegoat of many of the world’s problems; poverty, ignorance, immorality, backwardness, and war. It is believed and frequently perpetuated that most wars were started and carried out because of religion, such instances were usually deemed “holy wars”. But do these notions suggest that there must be a war fought against religion itself?

Most first-world Western Nations are highly secularized. Where religions were once used to dictate moral standards and laws, now modern “norms” seem to be the guiding light. Such nations that lean toward secularism seem to hold atheism as the highest intellectual belief structure (or rather lack thereof). So what does that mean for those who still practice religions or formal faith structures?

Religious liberty and freedoms are hot-button topics in current events. The newly elected United States president, just days after being inaugurated, signed an executive order that banned people from entering the country if their visas were from 7 particular countries and if they were also Muslim. And while some may not disagree with these measures and brand the United States as a “Christian” nation, the state department completely disregarded the
Christian genocide that was ongoing in the Middle East and Africa for several years.



What is the cost we pay for progressiveness? Technological and scientific advances seem to push the need for the protection of religious liberties and freedoms further and further away. Would a religion-free society be better than a religious one? There is no doubt that many people would fight to establish the former, and there are currently people working for just that.

But with a look back on history to nations that tried to eliminate religions and make all such practices illegal does not paint a perfect picture, but rather just the gruesome opposite. The Cristero Rebellions in the 1920s where the Mexican government tried to suppress Catholicism and kill off clergy is one such example of such wickedness. The religionless Soviet Union is another. Yet in most of these cases the faith of such adherents only seemed to grow stronger, even unto death. So should these religious liberties be protected like any other human right or should they be part of the “final test”? Stay vigilant.

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The Neuropsychology of Religion (Part 2)

Neurological states associated with religious experiences strongly suggest that there are specific regions of the brain that produce them

A New Mind Journal Original
Jaime F. Adriazola
American Graduate University, Washington DC

Hamer and his colleagues used a measure (psychological test) of spiritual development and self-transcendence developed by Robert Cloninger, a psychiatrist at the University of Washington, School of Medicine in St. Louis. Cloninger's "Temperament and Character Inventory" added measures that correlated with the following three traits: self-forgetfulness, transpersonal identification, and mysticism. He administered his temperament test and character inventory on ordinary people, and then analyzed the results using statistical techniques that could find correlations in their responses. It was found that all three traits are highly correlated with each other, and were not as highly correlated with any other aspect of temperament and personality.

Hamer and his colleagues then began to determine whether self-transcendence is a hereditary trait. They did this by administering the ‘Cloninger Temperament and Character Inventory’ on pairs of identical twins and fraternal twins.

They found that identical twins were twice as likely to have very similar scores on the Inventory of Temperament and Characters rather than if they were fraternal twins. This result is consistent with the idea that the personality traits of the Temperament and Character Inventory measures are inherited genetically, since identical twins are twice as genetically related as fraternal twins.



Hamer and his colleagues then compared the results of self-transcendence with measures of environmental influence. They found that similarities and differences in the environment could only explain a small fraction of the differences in the Temperament and Character Inventory scores between identical twins versus fraternal twins.

Finally, Hamer and his colleagues began to determine whether the self-transcendence scores were related to specific genes. To make the long story short, Hamer and his colleagues found that specific mutations of a specific gene were highly correlated with differences in self-transcendence as determined by Cloninger's Temperament and Character Inventory.

The specific gene they found and that correlates with self-transcendence is called “VMAT2”, and is known to encode a protein that wraps and regulates levels of neurochemicals called mono amines that are in the brain. These mono amines regulate our moods and emotions; large amounts of them make us feel energized and euphoric, while an insufficiency of them could result in depression. Further analysis of the correlations between the different forms of the VMAT2 gene and measures of personality showed that differences in the VMAT2 gene were not correlated with other personality differences. Conversely, only self-transcendence correlated with changes in the VMAT2 gene.



Hamer also related the function of the VMAT2 gene to the same type of brain function investigated by Persinger, Ramachandran, Saber, Rabin, D'Aquili, and Newberg. Differences in temporal lobe and limbic system function correlate with differences in monoamine levels in those regions of the brain. Additionally, the differences in brain activity, measured by d'Aquili and Newberg, are also correlated with mono amines that are regulated by the protein encoded by the VMAT2 gene.

In other words, not only is the ability of religious experiences measured by specific regions of the brain and neurochemicals, but a specific gene is responsible for the regulation of those neurochemicals in those regions of the brain.

Again, the specific traits produced as expressions of specific genes are evolutionary adaptations. They exist and do what they do because in the past, individuals who had such traits survived and reproduced more often than those who did not.

It seems clear that the capacity for religious experience is an evolutionary adaptation. However, the capacity for language along with the capacity for religious experience does not cause us to learn a particular religion. Instead, it predisposes us to experience particular sensations in particular circumstances. When we perform a particular religious ritual or see (or hear, or smell, or taste, or touch) a particular religious symbol, and if it is performed or is perceived under the right conditions, we experience a strong surge of emotions which we interpret in the context of our cultural traditions learned.

This explains why religious rituals and symbols provoke powerful emotions in people educated in a tradition that venerates such rituals and symbols. On the other hand, these rituals and symbols virtually have no effect on people who are not educated in those traditions. This also explains why blasphemy is such a heinous sin against religious belief: it undermines the emotional meaning of the ritual or religious symbol, making it as insignificant as it would be for someone who was not educated to experience its effects. This is the difference between the sacred and the profane: sacred actions and their elements produce powerful emotions as profane things do not.



Latest discoveries:
Investigators of the New York State Psychiatric Institute and Columbia University found that the importance of religion or spirituality in individuals may also be related to the thickness of its vertices in the brain. They related the importance of religion or spirituality, but not the frequency of attendance at the 'house of worship', with thicker crusts in the left and right parietal and occipital regions, the right mesial frontal lobe of the right hemisphere, and the cuneus and pre-cuneus in the left hemisphere. The study was published this month in the journalJAMA Psychology. Significantly, this relationship between spiritual importance and cortex thickness was found to be stronger among those who suffered from severe depression. They mentioned that those who expressed a stronger spiritual inclination also showed thicker crusts over the left and right hemispheres. "A thicker cortex associated with a high importance of religion or spirituality can confer resilience to the development of depressive illness in individuals with high familial risk of major depression, possibly expanding a cortical reserve that counteracts to a certain extent the vulnerability, which the cortical thinning raises, to develop depressive family illness."

Significantly, the researchers stated that their findings are simply correlational; as the importance of religion does not necessarily cause greater thickness, or vice versa.



Psychology professor Brick Johnstone also said that, "Finding a neuropsychological basis for spirituality, but is not isolated to a specific area of the brain”. For the study published in the International Journal for the Psychology of Religion, Johnstone and his colleagues studied 20 people with traumatic brain injuries affecting the right parietal lobe, a brain area located a few inches above the right ear. The team interviewed the participants about their spiritual beliefs, wondering how close they felt to a Power, and if they considered their lives to be part of a divine plan.

They found that those participants with more significant lesions in their right parietal lobe expressed a feeling of greater closeness to a higher power. "Neuropsychology researchers have consistently shown that impairment in the right side of the brain diminishes one's focus on the self."



Professor Johnstone also measured the frequency of participants' religious practices, such as attending church or listening to religious programs. Johnstone compared these measures to activity rates in the frontal lobe and found a connection between increased activity in this part of the brain and increased participation in religious practices. "This finding indicates that spiritual experiences are likely to be associated with different parts of the brain." "Certain parts of the brain play more predominant roles, but they all work together to facilitate the spiritual experiences of individuals," Johnstone finally said.

References:
Allen D. MacNeill: Evolutionary Psychology.
D'Aquili: Because God? Brain Science and the Biology of Belief will not leave.
D'Aquili, Eugene G., and Andrew B. Newberg: Mystical Mind: Probing the Biology of
Religious Experience. Minneapolis, MN: Fortress Press.
Dawkins, Richard; The Desilution of God: New York: Mariner Books, 2007. Dennett.
Daniel C .; Breaking the Spell: Religion as a Natural Phenomenon, New York.
Penguin, Hamer, Dean H.: The Gene of God: How Faith is Wired in our Genes.
New York: Doubleday.
Harris, Sam: The End of Faith: Religion, Terror, and the Future of Reason, New York.
Ramachandran, Vilayanur S., and Sandra Blakeslee: Phantoms in the Brain: Probing the
Mysteries of the Human Mind. New York.
Miller L, Vansal R, Wickramaratne P, et al. Neuroanatomical correlates of religiosity and spirituality, one study in adults with high and low familial risk for depression. JAMA Psychiatry.
Johnstone B, Bodling A, Cohen D, et al: The "lack of interest" related to the right parietal lobeas the neuropsychological basis of spiritual transcendence.
International Journal of Psychology of Religion.

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The Neuropsychology of Religion (Part 1)

Neurological states associated with religious experiences strongly suggest that there are specific regions of the brain that produce them

A New Mind Journal Original
Jaime F. Adriazola
American Graduate University, Washington DC

It has been 145 years since Charles Darwin wrote his famous book "The Descent of Man" (1871), where he argued that humans do not have an innate instinct to believe in God. "Belief in God has often been not only the Great, but the most complete of all the distinctions between man and inferior animals. However, it is impossible. . . to hold that this belief is innate or instinctive in men."

This conclusion is based on the general observation that many human cultures do not include in their beliefs a deity that can be interpreted as being, in any way conceptually similar to the Judeo-Christian monotheistic God. However, Darwin went on to point out that ... "The belief in omnipresent spiritual entities seems to be universal; and it seems to have come from a considerable advance of man's reason, and from a greater advance in his faculties of imagination, curiosity, and questioning."



In other words, there seems to be no innate tendency to believe in the monotheistic God of the Judeo-Christian religion or to believe in some supernatural force or entity. Why could this be? Why is atheism not the universal result of the advancement of natural science?

The answer is inescapable. Our minds are adapted to think religiously, rather than rationally, and this is the result of our evolutionary history. The capacity for religious experience is found in all human societies. However, within each society there is considerable variation among individuals to the extent that they have such religious beliefs, and that such beliefs seem to modify their behavior.

Likewise, this ability, as well as human language capacity, has been empirically associated with specific neurological structures of the human nervous system. The capacity for human language and participation in war may be causally linked to specific ecological circumstances. The capacity for religious experience has consequences for those who have it: people who have the ability to believe in the supernatural (and especially to act in those beliefs) under certain circumstances, having high rates of survival and reproduction.



The most likely context for the capacity for religious experience to evolve is the same chronic, though episodic, small-scale warfare observed between our primate cousins ​​and our evolved ancestors. Moreover, not only has the capacity for religious experience been the result of war, but making war itself is more likely.

The capacities for religious experience and war are mutually reinforcing. They are a sort of evolutionary arms race which can be succinctly as a "law": religion facilitates the war, which in turn facilitates religion.

As Darwin said, the ubiquity of religious belief in our species is strong evidence that the capacity for such a belief is a specific evolutionary adaptation of the species. And, like all traits evolved, there is considerable variation within the human groups for this trait. In fact, precisely this variation is the prerequisite for evolution through natural selection.

In addition, the observation that most people, even in our technological culture, believe in the supernatural, essentially without empirical evidence, is strong evidence for the idea that the capacity for such a belief is "wired in our brains." And, like all evolutionary psychological mechanisms, one can ask the question, "What is the use?" Or, "What is the biological function of the capacity for religious belief?" As we shall see, it certainly seems that the evidence points to the conclusion that: "The ability of religious belief increases our ability to participate in war, which in turn improves our fitness."



Michael Persinger, a professor of psychology at Laurentian University in Canada, published “Neuropsychological Bases of Belief in God". In it, Persinger argued that a specific neurological condition known as 'temporal lobe epilepsy' produces psychological states that are similar to the religious experiences of people like Joan of Arc and St. Paul in 'The Road to Damascus'. 'Temporal lobe epilepsy' is different from other forms of temporal lobe epilepsy in which epileptic seizures do not involve seizures, immobility or loss of consciousness. In contrast, a person who has a 'temporal lobe epilepsy' attack observes a change in sensory perception, often involving changes in odors, sounds, tastes, and phantom sensations in the skin. Some people also experience cognitive changes such as 'Déjà Vu' or 'Jamais Vu' during a seizure in ‘temporal lobe epilepsy’, and a significant fraction of these people also experience a greater sense of 'religiosity', including the feeling of a presence Invisible and supernatural.

Researcher Persinger developed a machine, often called the "The God Helmet" (read the full article on 'NewmindJournal.com'), which generates a weak magnetic field in and around the right temporal lobe of a person's brain. Approximately 80 percent of people, in a test of the "Helmet of God", felt the presence of an invisible figure nearby, which is usually interpreted as a supernatural entity, as a figure of God or the spirit of a person absent or dead.



Other researchers, such as Vilayanur S. Ramachandran, have also linked temporal lobe epilepsy and other neurological effects to religious experiences. Ramachandran based his work on the prior research of Norman Geschwind, a clinical psychiatrist. Geschwind described a clinical syndrome, called Geschwind syndrome, which is characterized by hypergraphia (the tendency to write lengthy detailed arguments and descriptions, often on religious subjects), hyper-religiosity, fainting, mutism (the inability to speak at certain events Social), and pedantism (the tendency to extensive discourse, on obscure topics, especially word definitions and the fine points of grammar).

Geschwind hypothesized that this syndrome is a manifestation of a form of mild temporal lobe epilepsy and suggested that it might explain the behavior of some historical hyper-religious figures.

Ramachandran tested the Geschwind hypothesis using a lie detector type device that measures the electrical conductivity of the skin as an indirect indication of emotional arousal. Ramachandran found that people with mild temporal lobe epilepsy reacted differently to religious words than people who did not have temporal lobe epilepsy.

Jeffrey Saver and John Rabin also studied the relationship between temporal lobe epilepsy and extended their recommendations to neurological states generated by the limbic system of the brain and neurochemical states generated by the ingestion of hallucinogenic drugs. They noted that a large amount of Americans have reported having religious experiences, characterized by feelings that included the belief that a specific event "should happen”, were aware of "the presence of God," that "God had responded to their Prayers”, which were being protected (or at least looked at) by an invisible presence (often characterized as the spirit of an absent or dead person), who felt the presence of a" sacred spirit in nature "or" presence Evil "or a deep sense of" oneness with the cosmos."



In particular, many people who had such experiences described a sense of depersonalization (they felt "outside themselves") and a sense of being united or part of their environment. They also noted descriptions of such feelings, often interpreted as religious experiences, by epileptics, such as the Russian writer Fyodor Dostoevsky.

They emphasized that such interpretations were just that: the interpretations were not the causes of such experiences, but rather the cognitive means by which people who had experienced such attacks explained their sensations to themselves. In other words, sensations came first, and subsequently, religious explanations.

Eugene d'Aquili and Andrew Newberg have recently presented an integrative model of the neurobiological underpinnings of religious experience. In his books, 'The Mind Mysticism: Probing the Biology of Religious Experience' and Why God will not go away: 'Brain Science and the Biology of Belief', the books report how their research in the states of Neurological factors associated with religious experiences strongly suggest that there are specific regions of the brain and states that produce such experiences.

This model is based on his research on neurological correlations between brain functions and regions, as well as the religious experiences of devoutly religious mystics and people. They studied these correlations using brain scans and other measures of brain activity using subjects trained in Eastern and Western meditative traditions i.e. (monks, nuns, and priests). They found that these subjects had consistent patterns of brain activity that were different from those not religiously trained, and that these patterns of brain activity were correlated with specific meditation and religious practices.



Researchers D'Aquili and Newberg have pointed out that the center of the greatest religious experience is a sense of wonder, combined with "sensations slightly pleasing to feelings of ecstasy”. They have shown that such sensations can be induced by rhythmic chanting and body movements, combined with loud music and colorful visual displays. Consequently, the factors that induce these sensations produce a condition of sensory overload and excitation of the sympathetic nervous system, together with simultaneous parasympathetic activation, due to the conscious "damping" of the excitation.

Such sensations are common in two contexts: military training and religious training. It is no coincidence that human beings preparing for war use exactly the same types of sensory stimuli described by d'Aquili and Newberg. They have tied such exhibitions to religious activities and demonstrated the deep similarities between religious and secular rituals: "Patriotic rituals ... emphasize the "holiness" of a nation, or a cause, or even a flag… meaningful idea in a visceral experience."

Researcher Dean Hamer found a correlation between a single human gene and a measure of human behavior that correlates strongly with the capacity for religious experiences. Using a combination of molecular genetic techniques, demographic analysis, and epidemiology, Hamer and his colleagues at the National Institutes of Health in Bethesda, Maryland, showed a strong correlation between a specific gene (called VMAT2), and "self-transcendence" which is correlated with religious experience.
………………….End of part 1

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