This document discusses obsessive compulsive disorder (OCD) in adults. It provides an overview of OCD, including its neurological and biological underpinnings such as involvement of cortico-striatal pathways and neurotransmitters like serotonin. Treatment options for OCD discussed include selective serotonin reuptake inhibitors (SSRIs), cognitive behavioral therapy (CBT), and emerging interventions like deep brain stimulation. The document concludes by discussing future directions for research on OCD including use of neuroimaging to predict treatment response and identify biological markers.

1. Running Head: Obsessive Compulsive Disorder in Adults 1
Obsessive Compulsive Disorder in Adults
Catherine Schulze
PSY350: Physiological Psychology
Instructor: Danielle Carr
May 26, 2014

2. Obsessive Compulsive Disorder in Adults 2
Obsessive Compulsive Disorder in Adults
The neurological disorder that will be discussed in this assignment will be that of
Obsessive Compulsive Disorder but in greater depth regarding everything that was listed for the
research of its characteristics and who is targeted and why to have such a debilitating disorder.
The research that was done for this assignment is based on the DSM-5 model and other useful
and resourceful sources according to APA guidelines. After choosing the disorder of OCD, I
realized that the issues I have regarding this disorder are nothing comparable to much more
serious cases, and that the research that I collected for Obsessive Compulsive Disorder includes
all of the following factors required to relate to OCD and my close observation of someone that I
know that suffers from this disorder.
The following description of the pathological features & clinical criteria for the
diagnosis of OCD is currently being studied and examined by clinicians and “The current study
examined clinical correlates and treatment response as they relate to auxiliary clinical
characteristics (i.e., insight; avoidance; indecisiveness; sense of responsibility; pervasive
slowness; pathological doubt; duration of obsession-free and compulsion-free intervals) in 172
adults with OCD…” (Reid, Storch, & Murphy, 2011).
The biopsychological theories of the pathology are the following research studies I was
able to collect on the subject. “Anxiety is an important component of the psychopathology of the
obsessive-compulsive disorder (OCD). However, neurobiological studies of OCD came to
conclusions that are not always compatible with those previously associated with other anxiety
disorders. Clues about the neurocircuits involved in the manifestation of anxiety disorders have
been obtained through the study of animal anxiety models, structural and functional
neuroimaging in humans. These investigations suggest that in OCD, in addition to dysfunction in

3. Obsessive Compulsive Disorder in Adults 3
cortico-striatal pathways, the functioning of an alternative neurocircuitry, which involves
amygdala-cortical interactions and participates in fear conditioning and extinction processes,
may be impaired…” (Diniz, Miguel, de Oliveira, Reimer, Brandão, de Mathis, & Hoexter, 2012).
The Nervous system structure(s), neurotransmitter(s), receptor(s), & pathways
implicated in the disorder navigate through the brain and the CNS. “Anxiety disorders are
frequently under-diagnosed conditions in primary care, although they can be managed effectively
by general practitioners. First-line pharmacological treatments for these disorders are selective
serotonin reuptake inhibitors (for all disorders), serotonin-norepinephrine reuptake inhibitors
(for some) and pregabalin (for generalized anxiety disorder only). A combination of medication
and cognitive behavior/exposure therapy was shown to be a clinically desired treatment
strategy…” (Bandelow, Sher, Bunevicius, Hollander, Kasper, Zohar, & Möller, 2012).
“The present review and critique of extant etiological theories centers on a single finding:
“Obsessive-compulsive disorder (OCD) is a common, disabling, psychiatric disease combining
intrusive thoughts (obsessions) and repetitive behaviours (compulsions). Although most patients
respond well to conventional pharmacological and/or psychological therapy, 25-30%, often with
extremely severe symptoms, fails to improve after treatment. High-frequency stimulation of deep
brain structures (basal ganglia included), a surgical technique developed for movement
disorders and otherwise known as deep brain stimulation (DBS), has been proposed as an
alternative to ablative surgery for these intractable cases... " (Haynes, & Mallet, 2010). ODC is
heritable (0.78) and not significantly influenced but shared-in-families environmental factors…”
(Hertler, 2014).

4. Obsessive Compulsive Disorder in Adults 4
Epidemiology of the disorder (demographics of those affected) “In half of Obsessive
Compulsive Disorder (OCD) patients the disorder runs a chronic course despite treatment. The
factors determining this unfavorable outcome remain unknown. The Netherlands Obsessive
Compulsive Disorder Association (NOCDA) study is a Multicentre naturalistic cohort study of
the biological, psychological and social determinants of chronicity in a clinical sample. The
baseline measurements also include DNA and blood sampling and data on demographic and
personality variables…”( Schuurmans, Balkom, Megen, Smit, Eikelenboom, Cath, & Oppen,
2012).
Clinical presentation and natural history of the condition “Obsessive-compulsive
disorder (OCD) is a chronic anxiety disorder with an estimated lifetime prevalence in adults of
2-3 %. Our aim is to provide an overview of the development of effective psychological
treatments for OCD, together with a systematic literature review of the latest research in the
field: obsessive--compulsive disorder, cognitive-behavioural therapy, exposure, response
prevention, cognitive therapy. Nevertheless, more studies are still needed, mainly focusing on
long-term follow-up, group-treatment and the combined use of CBT with SSRIs…” (Podea,
Suciu, Suciu, & Ardelean, 2009).
The current treatment options both pharmacologic & non-pharmacologic, are
Neurocognitive assessments and deep brain stimulation. “Neurocognitive assessments are useful
to determine the locus of insult as well as functional capacities of patients on treatment. In
psychiatry, neurocognitive assessment is useful in the identification of brain lesions, evaluation
of cognitive deterioration over time, and advancement of theories regarding the neuroanatomical
localization of symptoms. Such as OCD, by incorporating findings from neurocognitive,

5. Obsessive Compulsive Disorder in Adults 5
neuroimaging, and other biological studies” (Rao, 2012). “Deep brain stimulation (DBS) is a
technique that consists of a surgically implanted lead that provides focal electrical neural-
network modulation within a brain circuit or circuits of interest. Initially, modern deep brain
stimulation (DBS) is an emerging interventional therapy for well-screened patients with specific
treatment-resistant neuropsychiatric diseases. Some neuropsychiatric conditions, such as
Parkinson disease, have available and reasonable guideline and efficacy data, while other
conditions, such as major depressive disorder and Tourette syndrome, have more limited, but
promising results…” (Williams, & Okun, 2013).
The future direction for our research and clinical management are neuroimaging and
Neurotherapeutics. “Neuroimaging has contributed profoundly to our understanding of the
pathophysiology of psychiatric disorders but has had little impact on treatment. An important
goal in neuroscience research is identifying biological markers that predict subsequent response
to given treatments. Here, we review neuroimaging findings pertaining to treatment-refractory
major depression and obsessive-compulsive disorder, and imaging markers that predict
response to Neurotherapeutics interventions; these promising findings should motivate additional
work establishing the reliability and cost-effectiveness of neuroimaging to predict treatment
response across psychiatric diagnoses and interventions” (Borairi, & Dougherty, 2011).
In conclusion, Obsessive Compulsive Disorder is a debilitating disorder to some because
others just cope with the issue. The DSM-5 model refers to the disorder as a neurological issue
and in regards to this disorder and my personal experience handling such an issue, well, all of the
following factors required relating to OCD I wish I knew what gene or chromosome makes an
individual act in such behavioral manner. I just hope that one day there is a cure.

6. Obsessive Compulsive Disorder in Adults 6
References
Reid, J., Storch, E., & Murphy, T. (2011). Clinical Correlates and Treatment Response of the
Yale-Brown Obsessive Compulsive Scale Auxiliary Items. Cognitive Therapy & Research,
35(5), 404-413. doi:10.1007/s10608-009-9275-5
Diniz, J., Miguel, E., de Oliveira, A., Reimer, A., Brandão, M., de Mathis, M., & ... Hoexter, M.
(2012). Outlining new frontiers for the comprehension of obsessive-compulsive disorder: a
review of its relationship with fear and anxiety. Revista Brasileira De Psiquiatria, 34(S1), S81-
S91.
Hertler, S. (2014). A Review and Critique of Obsessive-Compulsive Personality Disorder
Etiologies. Europe's Journal Of Psychology, 10(1), 168-184. doi:10.5964/ejop.v10i1.679
Podea, D., Suciu, R., Suciu, C., & Ardelean, M. (2009). AN UPDATE ON THE COGNITIVE
BEHAVIOR THERAPY OF OBSESSIVE COMPULSIVE DISORDER IN ADULTS. Journal
Of Cognitive & Behavioral Psychotherapies, 9(2), 221-233.
Haynes, W. A., & Mallet, L. (2010). High-frequency stimulation of deep brain structures in
obsessive-compulsive disorder: the search for a valid circuit. European Journal Of
Neuroscience, 32(7), 1118-1127. doi:10.1111/j.1460-9568.2010.07418.x
Schuurmans, J., Balkom, A. M., Megen, H. M., Smit, J. H., Eikelenboom, M., Cath, D. C., & ...
Oppen, P. (2012). The Netherlands Obsessive Compulsive Disorder Association (NOCDA)
study: design and rationale of a longitudinal naturalistic study of the course of OCD and clinical
characteristics of the sample at baseline. International Journal Of Methods In Psychiatric
Research, 21(4), 273-285. doi:10.1002/mpr.1372

7. Obsessive Compulsive Disorder in Adults 7
Bandelow, B., Sher, L., Bunevicius, R., Hollander, E., Kasper, S., Zohar, J., & Möller, H. (2012).
Guidelines for the pharmacological treatment of anxiety disorders, obsessive-compulsive
disorder and posttraumatic stress disorder in primary care. International Journal Of Psychiatry
In Clinical Practice, 16(2), 77-84. doi:10.3109/13651501.2012.667114
Rao, N. P. (2012). Pathogenetic and therapeutic perspectives on neurocognitive models in
psychiatry: A synthesis of behavioral, brain imaging, and biological studies. Indian Journal Of
Psychiatry, 54(3), 217-222. doi:10.4103/0019-5545.102410
Williams, N. R., & Okun, M. S. (2013). Deep brain stimulation (DBS) at the interface of
neurology and psychiatry. Journal Of Clinical Investigation, (11), 4546.
Borairi, S., & Dougherty, D. D. (2011). The Use of Neuroimaging to Predict Treatment
Response for Neurosurgical Interventions for Treatment-Refractory Major Depression and
Obsessive-Compulsive Disorder. Harvard Review Of Psychiatry (Taylor & Francis Ltd), 19(3),
155-161. doi:10.3109/10673229.2011.581888