From Thought to Action: How the Interplay Between Neuroscience and Phenomenology Changed Our Understanding of Obsessive-Compulsive Disorder

Abstract

The understanding of obsessive-compulsive disorder (OCD) has evolved with the knowledge of behavior, the brain, and their relationship. Modern views of OCD as a neuropsychiatric disorder originated from early lesion studies, with more recent models incorporating detailed neuropsychological findings, such as perseveration in set-shifting tasks, and findings of altered brain structure and function, namely of orbitofrontal corticostriatal circuits and their limbic connections. Interestingly, as neurobiological models of OCD evolved from cortical and cognitive to sub-cortical and behavioral, the focus of OCD phenomenology also moved from thought control and contents to new concepts rooted in animal models of action control. Most recently, the proposed analogy between habitual action control and compulsive behavior has led to the hypothesis that individuals suffering from OCD may be predisposed to rely excessively on habitual rather than on goal-directed behavioral strategies. Alternatively, compulsions have been proposed to result either from hyper-valuation of certain actions and/or their outcomes, or from excessive uncertainty in the monitoring of action performance, both leading to perseveration in prepotent actions such as washing or checking. In short, the last decades have witnessed a formidable renovation in the pathophysiology, phenomenology, and even semantics, of OCD. Nevertheless, such progress is challenged by several caveats, not least psychopathological oversimplification and overgeneralization of animal to human extrapolations. Here we present an historical overview of the understanding of OCD, highlighting converging studies and trends in neuroscience, psychiatry and neuropsychology, and how they influenced current perspectives on the nosology and phenomenology of this disorder.

Are nonclinical obsessive-compulsive symptoms associated with bias toward habits?

“…Tasks that more specifically tap habit formation independent of goal-directed control are needed to better address this issue. Also, future researchers may want to examine other hierarchical models of goal-directed dysfunctions and their relation with habit formation (Barahona-Corrêa et al, 2015), or explore the role of interfering emotional experiences (Dittrich and Johansen, 2013).…”

Neurodevelopmental heterogeneity and computational approaches for understanding autism

“…Children with high functioning ASD and Asperger’s often participated in typical classroom settings. Differences in defining Asperger’s syndrome continued even after it was added to the DSM in 1994 9 . Identification based on DSM definitions became more rigorous, valid, and reliable as diagnosticians captured detailed early developmental history from caregivers 10,11 and tested social engagement through direct observational tasks such as the Autism Diagnosis Observation Schedule (ADOS) developed in the 1990s.…”

Criterion Validity of the Yale-Brown Obsessive-Compulsive Scale Second Edition for Diagnosis of Obsessive-Compulsive Disorder in Adults

“…Obsessive-compulsive disorder (OCD) is a chronic and incapacitating neuropsychiatric condition, with a lifetime prevalence of 2.3% in the United States and an estimated prevalence of 5.3% in Portugal ( 1 – 3 ). It is characterized by the presence of obsessions (recurrent and persistent thoughts, experienced as intrusive or inappropriate and causing marked anxiety or distress) and/or compulsions (repetitive behaviors or mental acts that the person feels driven to perform, typically to reduce the anxiety caused by the obsessions) ( 4 – 7 ). Accurate assessment of OCD is critical due to its under-diagnosis, difficulty in establishing accurate diagnosis and need for careful and specific treatment planning and evaluation ( 8 ).…”