Trends in Cognitive Sciences
ReviewSpecial Issue: Cognition in Neuropsychiatric DisordersObsessive-compulsive disorder: beyond segregated cortico-striatal pathways
Section snippets
The current model of OCD
Intrusive thoughts, doubts, or concerns about safety, cleanliness, sex, violence, or symmetry, and urges to count or check ‘to be sure’ are common thoughts, feelings and behaviors that represent universal human experience to one degree or another. Healthy adaptive human function requires an ability to regulate and inhibit such intrusive thoughts, urges, feelings and behaviors. People with OCD are unable to control their thoughts and feelings and, consequently, experience obsessions accompanied
Why is the CSTC model insufficient?
Early characterizations of CSTC loops emphasized their parallel and segregated nature, emanating from various frontal subterritories and ramifying in specific striatal subterritories. For instance, one heuristic, dubbed ‘the striatal topography model of OCD and related disorders’, posited that comparable striatal pathology could explain the relationship between OCD and Tourette syndrome (TS); whereby OCD was the result of pathology within the caudate, disrupting OFC/ACC-caudate function,
The mOFC and lOFC
An extensive meta-analysis of OFC function associates the lOFC with processing negative valence and the mOFC with processing positive valence [24]. More specifically, the lOFC appears critical in responding to punishment and escape from danger, and may be involved in ritualized behavioral responses 25, 26, 27. The mOFC, by contrast, appears more involved in emotion regulation and reward processing. Extensive research conducted in rodents and healthy humans now implicates the ventromedial
The ACC: error processing and fear expression
The dACC is involved in numerous cognitive and affective functions, and is particularly relevant to OCD psychopathology. This brain region is involved in detecting the presence of cognitive conflict, and error monitoring and detection 44, 45. Common paradigms used to test the function of the dACC use an element of interference such that there are two conditions: congruent versus incongruent. Response to the congruent condition represents a prepotent or automatic response that is easy to
The amygdala and OCD
Although the amygdala responds to novelty, salience and a variety of emotional stimuli, its role in mediating fear and anxiety is the most commonly referenced [61]. In fact, the amygdala is often referred to as the hub of fear. A variety of experimental designs have been employed to test the role of the amygdala in fear and anxiety; these include the presentation of emotional faces, international affective picture system (IAPS) stimuli and classical fear conditioning. Such paradigms have
What is next in OCD research?
The past decade has witnessed expansive growth in neuroimaging and cognitive-behavioral neuroscience. Below, we highlight two prospective areas of research that may be ripe for additional advancements in knowledge regarding the neural basis of OCD and in the development of novel therapeutic approaches.
Concluding remarks
The cortico-striatal circuitry model of OCD pathophysiology emerged during the latter part of the 20th century and, for the past 25 years, has provided the principal platform for hypothesis-driven research in the field. Advances in neuroscience and progress in neuroimaging methods provided the means for extending and refining the original model. Specifically, (i) cortico-striatal loops are now understood to be interconnected rather than fully segregated, and OCD and related disorders may not
Disclosure Statement
S.L.R. has participated in research funded by Cyberonics and Medtronic. M.R.M. has received consulting fees from MircoTransponder Inc.
Acknowledgments
M.R.M. is supported by NIH grants R01-MH081975, DoD grant W81XWH-11-2-0079 and the Judah Foundation. We would like to thank Katelyn Trecartin and Daria Boratyn for their efforts in generating the figures and their assistance in conducting the meta-analysis.
Glossary
- Cognitive behavioral therapy (CBT)
- a type of psychotherapy commonly utilized for the treatment of anxiety and mood disorders. The general focus of this therapy is to aid patients in restructuring their thinking patterns, to reduce unhelpful and/or unrealistic thoughts using cognitive (i.e. reappraisal) approaches and to modify behavioral responses, such as through graded exposure to fear-provoking stimuli and situations.
- Deep brain stimulation (DBS)
- an intervention currently used for treatment of
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