This paper surveys research on the treatment of Obsessive-Compulsive Disorder (OCD), drawing on an annotated bibliography and literature review to evaluate psychological, pharmacological, and neurological approaches. It examines studies on exposure and response prevention (ERP), cognitive behavioral therapy, thought stopping, serotonergic medications, and deep brain stimulation (DBS). Brain imaging research linking OCD symptoms to specific metabolic patterns in the orbital frontal cortex and cingulate gyrus is also discussed. The paper concludes that while current treatments help most patients, the limited volume of rigorous research means that clinicians must often tailor approaches individually, and that ongoing neurological research holds promise for future breakthroughs.
"About OCD." Obsessive Compulsive Foundation, 2006.
Although this site was not used specifically for information in the final report, it was helpful in providing an overview of what is currently taking place in the OCD field. A yearly conference focusing on OCD is among the first resources visible upon entering the site. It also offers intensive treatment programs and hoarding information for both adolescents and young adults with OCD, descriptions of medications used in treatment, and information on research participation with a focus on special interest groups. By examining what OCD really is, the website helps its audience recognize the difference between obsessions and compulsions, and by offering external links it allows those seeking more information or treatment to find it easily. This site is useful for anyone seeking general knowledge, ways to find treatment, or support for dealing with the disorder. It proved helpful in developing a thesis, given the information shared by both medical professionals and sufferers.
Abramowitz, Jonathan S. "Effectiveness of psychological and pharmacological treatments for obsessive-compulsive disorder: A quantitative review." Journal of Consulting and Clinical Psychology 65.1 (1997): 44–52.
Although relatively dated — a great deal can occur in mental health research over a decade — this quantitative review by Abramowitz was very helpful. It provided a thorough overview of studies conducted on the two main therapeutic approaches to OCD as well as the pharmaceutical results available at the time. It also showed that there is a crossover between cognitive approaches and exposure procedures, and that both were equally effective in treatment. Serotonergic medication, especially clomipramine, also significantly reduced OCD symptoms. Most importantly, however, this quantitative review highlighted how few studies have been conducted in this area and the need for more research to determine the best approaches for OCD treatment. Abramowitz, in addition to his professorship, served as the director of the OCD/anxiety program at Mayo Clinic in Minnesota. His work is therefore not only informative but highly credible.
Hackman, A., and C. McLean. "A comparison of flooding and thought stopping in the treatment of obsessional neurosis." Behavior Research and Therapy 13 (1975): 263–269.
This study is of interest from a historical standpoint, as it was an early investigation comparing flooding in vivo and thought stopping in patients with OCD. Although the authors hypothesized that the two techniques would produce different effects on symptoms, they found no significant differences between them. One limitation of this study is that it included only 11 participants, as it was a pilot study. Efforts to find biographical information on Hackman and McLean were unsuccessful; because APA style uses only first initials, there was insufficient information to locate profiles on these individuals. However, their 1975 study has been cited in numerous subsequent research reports as a primary source.
Glannon, Walter. "Altering the brain and mind." American Journal of Psychiatry 161.6 (2004): 1038–1048.
Glannon's article was thought-provoking because it examined how certain therapies can be helpful while also carrying a sizeable risk of side effects, requiring patients to carefully weigh the benefits against potential negative impacts. In this case, Glannon focused on electrical deep-brain stimulation (DBS), which had previously been used for Parkinson's disease. A particularly striking finding: two patients receiving DBS for severe OCD stated that had this treatment not been available, they would have committed suicide, so debilitating was their illness. After DBS, they were able to live their lives with enjoyment as before. However, rare side effects were also documented — for example, one Parkinson's patient became manic as a result of the treatment.
Lambert, Mara. "APA releases guidelines on treating obsessive-compulsive disorder." American Family Physician 78.1 (2008): 131.
This report is particularly valuable as the most recent source consulted. As an overview of the 2007 American Psychiatric Association published treatment recommendations for OCD, it is comprehensive and covers all areas of mental care for patients with the disorder. For readers without extensive knowledge of the different types of therapy and pharmaceuticals available for OCD — and the advantages and disadvantages of each — this is an excellent source. Because it draws on a conservative institutional source, however, alternative approaches are not included, and that information must be obtained from other research. One noteworthy finding is that OCD patients have symptoms that "wax and wane" over time, meaning treatment must be adapted to these changing symptom patterns.
Saxena, Sanjaya, Arthur L. Brody, Karron M. Maidment, Erlyn C. Smith, Narineh Zohrabi, Elyse Katz, Stephanie K. Baker, and Lewis R. Baxter Jr. "Cerebral glucose metabolism in obsessive-compulsive hoarding." Archives of General Psychiatry 59.12 (2002): 1162–1172.
Lewis Baxter, one of the authors of this study, conducted several earlier studies on more general aspects of OCD while continuing to examine neurological changes in the brain during periods of obsessive behavior. The more that is understood about the brain, the better treatment for OCD is likely to become. Therapy and pharmaceuticals have proven very helpful, but they represent secondary treatments. When researchers can narrow down the primary neurological sources of OCD, they will eventually be positioned to address the disorder at its root. This study represents an important step in that direction, and continued research holds promise for treatments that are more definitively curative.
Obsessive-Compulsive Disorder (OCD) is a potentially disabling syndrome that can persist throughout an individual's lifetime. Those suffering from OCD become enmeshed in a pattern of repetitive thoughts and behaviors that are senseless and distressing, yet extremely difficult to overcome. Disagreement exists about the true number of people afflicted with OCD. Until recently, mental health professionals considered it a rare disease, because only a small minority of their patients had the condition — largely because many people with the illness did not seek treatment. However, a survey conducted in the early 1980s by the National Institute of Mental Health (NIMH) showed that OCD affects more than 2% of the population, making it more common than such severe mental illnesses as schizophrenia, bipolar disorder, or panic disorder. The social and economic costs of OCD were estimated at $8.4 billion in 1990.
Because it is only within the past few decades that the true prevalence of OCD has been recognized, relatively few studies have been conducted on the disorder overall. This paper reviews a selection of the research that has been completed, summarizes the overall results and recommendations of these studies, and draws conclusions based on the evidence gathered. Three questions guide the review of these materials: (1) What therapy or pharmaceutical approach does each study focus on? (2) Was the approach found to be helpful in the treatment of OCD, and why or why not? (3) What recommendations does the author make based on his or her study results?
The central thesis of this paper is: "Although a number of studies have been conducted regarding OCD treatment and conclusions are being drawn based on these results, more research needs to be conducted to better refine the data and to consider alternative approaches that are either currently in process or may emerge in the future."
Obsessive-Compulsive Disorder (OCD) consists of invasive and unwanted thoughts or images — known as obsessions — which produce increased anxiety, along with repetitive deliberate rituals performed to neutralize that anxiety, known as compulsions. Not even a decade ago, this disorder was considered atypical. In recent years, however, the Epidemiological Catchment Area survey reported that the lifetime prevalence rate in the United States could reach 2.5%.
Further, while OCD was once believed to be uncontrollable, it is now understood to respond to specific psychological and pharmacological interventions. Debate continues, however, about which approaches best help patients gain control of the disorder, since a complete cure is not yet possible.
Psychological interventions for OCD include exposure-based procedures (ERP; Steketee), rational emotive behavior therapy (Ellis), cognitive behavioral treatment based on Beck's work with depression, and thought stopping (Hackman & McLean). Many researchers consider ERP to be the primary treatment of choice (Abramowitz), based on a number of studies. However, many of these have been single-case anecdotal reports and uncontrolled trials rather than comparisons between randomized patients and control groups. Such designs may not account for the fact that individuals with OCD experience periods that are better or worse than others and may seek therapeutic help only when their symptoms have worsened. Additionally, the overall number of studies in this area remains small (Abramowitz).
Most recent ERP treatments involve both daily purposeful exposure to the situations that trigger anxiety — until the compulsive response is extinguished — and total restraint from ritual performance. These studies underscore the importance of confronting feared stimuli in order to eliminate anxiety responses. At the same time, other research has found that cognitive methods produce results equivalent to those of ERP in OCD treatment. Hackman and McLean reported results with thought stopping comparable to those achieved with ERP. Once again, however, the number of studies on which these conclusions rest is very small (Abramowitz).
It is only within the past decade that advances have been made in another potential future treatment. In the early 1990s, Baxter began investigating changes in cerebral metabolic patterns that occur during obsessive-compulsive episodes, and was able to identify specific changes in cerebral patterns when OCD activity was present. These studies have continued and become increasingly refined. Most recently, Baxter collaborated on a study examining the effects of hoarding. Compulsive hoarding and saving are common in OCD, manifesting alongside symptoms such as inability to make decisions, perfectionism, disorganization, procrastination, and avoidance. Saxena and colleagues, including Baxter, used positron emission tomography (PET) to identify cerebral metabolic patterns specifically associated with compulsive hoarding. PET scans were taken from 45 adults meeting DSM-IV criteria for OCD, 12 of whom were compulsive hoarders. The authors compared regional cerebral glucose metabolism between groups and found that individuals with compulsive hoarding syndrome showed considerably reduced glucose metabolism in the posterior cingulate gyrus and cuneus compared to non-hoarding subjects.
By contrast, Saxena et al. found that non-hoarding OCD individuals had significantly higher glucose metabolism in the bilateral thalamus and caudate. Compared to non-hoarding OCD patients, compulsive hoarders showed much lower metabolism in the dorsal anterior cingulate gyrus. Across all OCD patients, high levels of hoarding were negatively correlated with glucose metabolism in the dorsal anterior cingulate gyrus. The authors concluded that patients with compulsive hoarding syndrome exhibit a different pattern of cerebral glucose metabolism than both non-hoarding OCD patients and comparison subjects. Obsessive-compulsive hoarding may therefore represent a neurobiologically distinct subgroup or variant of OCD, whose symptoms and poor response to anti-obsessional treatment are mediated by lower activity in the cingulate cortex. The positive implication of such studies is that researchers are getting closer to pinpointing the neurological underpinnings of OCD. In the future, these technologies may guide clinical diagnosis of psychiatric conditions and inform the selection of appropriate treatments.
Neurology is showing promise in addressing even the most difficult brain disorders. Electrical deep-brain stimulation (DBS) is now being used to treat OCD. Psychopharmacology can treat cognitive and affective disorders as well as greatly improve normal cognitive capacities. The other side of this development, however, is the question of whether treatments such as DBS should be applied routinely, given the possible risks and the patient's personal assessment of quality of life. Two patients who received DBS for severe OCD explained that, had this treatment not been available, they would have committed suicide, their symptoms were so debilitating (Glannon). After DBS, they were able to live their lives with enjoyment as they once had. They saw no ethical concern with the procedure, given that their symptoms were so severe they were willing to accept the risk of side effects. It is important to remain alert to minor changes in personality, which can be harder to detect than dramatic adverse events. Most people focus on the major risks, which are rare — such as the Parkinson's patient who became manic when the DBS stimulator was active.
"Brain scan studies and DBS as emerging OCD treatments"
"Interpretation of findings and recommendations for future research"
"Full list of cited academic sources"
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