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Thought Control & OCD (Obsessive-Compulsive Disorder)

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OCD & Thought Control Can I learn to eliminate my OCD thoughts? I hear this question all the time from new patients who are searching for ways to suppress their unwanted thoughts. When I answer this question with a resounding “no”, there is often much surprise and grief. After all, this is why they’re coming to see me. Many people with Pure-O OCD imagine thought control to be the only way to improve the quality of their lives. Unfortunately, thought control conceptualized in this way is not an attainable goal in OCD treatment. Our brains just don’t work like that. I explain it like this, “A penguin obsessed with flying is an unhappy penguin.” Expecting thought control to work is a little bit like a penguin flapping its wings and expecting to fly. It may work for the other...

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Reassurance Seeking in OCD

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Although contamination OCD and washing rituals often go hand-in-hand, many rituals in this domain do not actually involve cleaning or disinfecting. These more subtle rituals are often based around reassurance seeking behaviors that become ingrained in everyday habit. In the context of exposure and response prevention (ERP), reassurance seeking OCD rituals are just as important to address as washing rituals. If you resist washing rituals but continue to engage in reassurance seeking rituals, your recovery will eventually stall (or perhaps never get started at all). Do you believe that knowledge is power? Do you aspire to optimum health? Do you believe that an ounce of prevention is worth a pound of cure? If so, you may be vulnerable to reassurance seeking rituals. Information-Seeking vs. Reassurance Seeking Reassurance seeking rituals involve mentally preparing for potential threats. These compulsions are often...

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OCD & Contamination: Reasons Why People Do Rituals/Compulsions

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In my last post, I identified several idiosyncratic feared outcomes in OCD that are associated with contamination/health-related obsessive-compulsive disorder (OCD). Obsessions are intrusive, recurrent, and distressing thoughts, impulses, or images related to these feared outcomes. Today, I’ll discuss the function of compulsions. Why do people with OCD do rituals? Compulsions, or rituals, are the other main feature of OCD. These physical and/or mental behaviors reduce the anxiety brought on by obsessions and reflect one’s attempt to avoid, reduce, or prevent certain feared outcomes from occurring. Ask someone with a fear of contamination, disease, illness, or germs why they ritualize; and they will likely tell you that rituals serve as a means to destroy, neutralize, or escape from potential pathogens. As a consequence, rituals common to health-related OCD often incorporate washing, cleaning, disinfecting, and sanitizing behaviors. Excessively long OCD-driven shower...

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Obsessive-Compulsive Disorder (OCD) – Decision Making Abnormalities

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Does OCD affect decision making processes? Now that we have reviewed the neurobiology of OCD and cognitive deficits associated with OCD, what relevance might this have for predicting abnormalities on tasks of decision making? Sachdev and Malhi (2005) recently have drawn attention to the substantial overlap between the circuitry implicated in OCD and the circuitry required for intact performance on simple decision tasks.  They suggest that due to the commonalities of these neural systems, individuals with OCD would be expected to exhibit deficits on tasks of decision making.  Furthermore, they indicate that OCD might even be conceptualized appropriately as a disorder of decision making, given that many of the hallmark features of the disorder seemingly arise from a primary deficit in decision making processes.  For example, OCD doubt and the inability to decide whether or not one’s hands have...

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Obsessive-Compulsive Disorder (OCD) – Cognitive Deficits

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What cognitive deficits are associated with OCD? Research has been successful in characterizing the underlying neurobiology of OCD, and cognitive abnormalities associated with the disorder have been documented within the domains of basic learning processes, attention, and executive functioning, each of which arguably is requisite for intact decision making.  We will begin by highlighting abnormalities in basic associative learning processes that have been observed in OCD and subsequently will extend our discussion to higher level cognitive processes. Basic Associative Learning in OCD The idea that pathological anxiety might develop initially via basic associative learning mechanisms was advanced largely by Mowrer (1939), who proposed a two factor theory about anxiety development.  Mowrer (1939) hypothesized that during an initial learning stage, anxiety develops via classical conditioning processes.  This occurs when a neutral cue becomes associated with fear due to a negative...

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Obsessive-Compulsive Disorder (OCD) – Neurobiology

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What causes OCD? Researchers have had much recent success in elucidating the neural circuitry involved in obsessive-compulsive disorder (OCD).  Advances in functional neuroimaging have identified robust alterations in neural activity within particular functional circuits in individuals with the disorder (Graybiel & Rauch, 2000).  Specifically, OCD is associated with pervasive disruptions in frontal subcortical circuitry (Luxenberg et al., 1988; Robinson et al., 1995).  Before we discuss abnormalities in this circuitry related to OCD, it is worth reviewing the generalities of this neural system. Frontal subcortical circuitry in OCD According to Tekin and Cummings (2002), frontal subcortical circuits share several commonalities.  They often “originate in prefrontal cortex, project to the striatum (caudate, putamen, ventral striatum), connect to the globus pallidus and substantia nigra and from there connect to the thalamus.  There is a final link back to the frontal cortex [such...

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