What is Obsessive-Compulsive Disorder?
Obsessive-Compulsive Disorder
Obsessive-compulsive disorder (OCD) involves unwanted, intrusive thoughts that cause fear or distress (obsessions), and repetitive behaviors or mental acts a person feels driven to perform (compulsions) (1). A common example is a fear of germs paired with repeated hand-washing, or a need to arrange things in a specific order. People with OCD often feel powerless to stop these behaviors, even when they know they don’t make sense.
If you are struggling with thoughts of harming yourself or are in crisis, call or text 988 to reach the 988 Suicide & Crisis Lifeline, or call 911.
How Common Is OCD?
OCD affects about 2% to 3% of Americans at some point in their lives. In adults, it is somewhat more common in women than in men. About half of people with OCD have serious impairment from it (2). When OCD begins in childhood, it is more common in boys than in girls.
What Are the Symptoms of OCD?
OCD can take many forms. It’s normal to have occasional worrying thoughts or habits. But when they take up more than an hour a day, are hard to control, or get in the way of daily life, they may be signs of OCD.
OCD can show up as repeatedly checking that doors are locked or the stove is off, needing things in a specific order or a certain number, or compulsive cleaning. Symptoms vary from person to person, but many people feel that their symptoms control them, rather than the other way around. People with OCD often know their compulsions don’t make sense, and they don’t enjoy them, but they feel unable to resist the urge. OCD symptoms often rise and fall over time and tend to get worse with stress (3).
OCD, tic disorders and Tourette syndrome are closely related and often occur together, and they appear to share some underlying brain circuits (4).
What Causes OCD?
The causes of OCD are complex and still being studied. One theory focuses on how the brain handles goal-directed sequences of actions, which researchers call structured event complexes. These are mental plans for carrying out a series of steps toward a goal, and they are managed largely by the prefrontal cortex. Normally, starting a task creates a mild drive or tension, and finishing it produces a sense of completion that relieves that tension. According to this theory, people with OCD may not get a full sense of completion, which can happen because of differences in the brain circuits involved in this “done” signal (5).
Imagine you’re in a conversation and about to make the point that settles the debate, and the other person cuts you off. You feel stuck, unable to let it go until you finally get to say it. In this theory, people with OCD often feel this kind of unresolved tension. When they finish an action, the brain doesn’t fully signal that it’s done, so they feel stuck in a loop, which can cause intense anxiety.
Over time, people with OCD may find that repeating parts of the action through rituals and repetitive behaviors gives them just enough of a sense of completion to move on (5).
What Happens in the Brain With OCD?
The brain circuits most often linked to OCD connect the cortex, especially the orbitofrontal cortex and anterior cingulate cortex, with the basal ganglia and nucleus accumbens. In OCD, these circuits may not fully deliver the sense of completion and relief that normally follows finishing a task. The person is left feeling that something is incomplete and tries to resolve it by repeating parts of the action.
Brain chemicals also play a role. Research has linked OCD to differences in serotonin (6) and dopamine (7), which is one reason medications that affect serotonin are often helpful.
When OCD begins in childhood, symptoms often start early and may change over time. Studies have found differences in the size of certain brain structures on the left and right sides of the brain in children with OCD that are not seen in adults (8). In some children, OCD comes on suddenly after a strep infection, a condition called PANDAS, in which the immune system is thought to target the basal ganglia (9).
How Is OCD Usually Treated?
OCD is diagnosed by a qualified healthcare provider, and it is most often treated with a specific type of therapy called exposure and response prevention (a form of cognitive behavioral therapy), medication, or both. These treatments aim to bring symptoms under control so they no longer run your daily life. Depending on severity, treatment may be short-term or long-term. Transcranial magnetic stimulation (TMS) has been cleared by the FDA for OCD (10), and deep brain stimulation is available for some people with severe OCD that doesn’t respond to other treatments (11).
How the NeuroRescue Program Can Help
OCD treatment is led by mental health professionals, and our care is designed to support that care, never replace it. At our clinic, TMS for OCD is provided by our psychiatric mental health nurse practitioner, who will evaluate whether it’s appropriate for you. Please continue any therapy and medications you’re receiving, and don’t make changes without talking with your prescriber.
Our chiropractic neurology care focuses on the neurological side of the picture. One of the brain’s most important jobs is figuring out where you are in the world. It uses your inner ear to sense where your head is in relation to gravity and how it’s moving, your muscles and joints to sense where your body is and what it’s doing, and your eyes to sense where you are in relation to everything around you. Your brain combines all of this into a picture of where you are, so you can respond to the world around you.
Some of the brain regions involved in OCD also help control eye movements, balance and how the brain processes sensory information. Some people with OCD also have difficulties in these areas, and our testing helps us find out whether that’s true for you.
Depending on your needs and test results, your program may include eye movement exercises aimed at the brain systems involved in holding back unwanted responses and regulating emotions (12); exercises designed to help the brain get used to uncomfortable sensory input (13); light therapy, which has been studied for anxiety (14); and exercises in a virtual reality environment (15).
How the NeuroRescue Program Works
Your NeuroRescue Program begins with your Discovery Day. We start with a detailed history of your condition and your life on a timeline. This helps us understand the factors that may have contributed to where you are now, and identify related conditions that may be making it harder to move forward.
We measure how your visual, vestibular and balance systems are working through computerized analysis of your eye movements, inner ear reflexes and balance under different conditions. Our testing includes videonystagmography and saccadometry to measure several types of eye movements, the video head impulse test to measure inner ear reflexes, and CAPS computerized posturography to assess your balance under different sensory conditions. We also use NeuroSensoryMotor Integration testing to evaluate hand-eye coordination and cognition, and Virtualis testing to assess dynamic eye tracking and your perception of vertical in a virtual reality environment.
We combine this with a thorough physical and neurological exam of your sensory, motor, autonomic and cognitive systems. We also review any relevant lab work, imaging and prior testing, and integrate it with our findings.
Together, this helps us understand which parts of your nervous system are working well, which are struggling, and how quickly they tire. We use that information to design your personal NeuroRescue Program, aimed at improving function in the systems that need support. Our testing also helps us decide when to push and when to let you rest.
Our goal is to support the neurological systems that work alongside your mental health care, so you can feel more steady, comfortable and in control in daily life.
Your Next Step
Living with OCD can be extremely challenging, but effective help is available. To find out if the NeuroRescue Program is right for you, contact one of our patient care coordinators to schedule your Discovery Day.
It’s never too late to take the next step.
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