Obsessive-compulsive disorder patients with washing symptoms show a specific brain network when confronted with aggressive, sexual, and disgusting stimuli

Neural correlates of symptom provocation in pediatric obsessive-compulsive disorder

“…De Putter and colleagues’ meta-analysis (2017) revealed only a small to medium sized effect for a Bad Thoughts subdimension (i.e., checking: g = 0.58), and the current study suggests none of the other subdimensions elicit strong behavioural group differences either. If true, this phenomenon might explain why only one neuroimaging study has reported on OCD provocation using sexual stimuli (Thiel et al., 2014). Other studies using Bad Thought stimuli may have produced null results and not been published (i.e., become part of the “file drawer problem”; Rosenthal, 1979).…”

“…Most SPT studies have not, however, studied the full range of OCD symptom dimensions (Brooks et al., 2018). For instance, only one adult study has examined the sexual obsession category of the Bad Thoughts symptom dimension (Thiel et al., 2014). An examination across dimensions is necessary, particularly in children, given the known associations between specific symptom dimensions and clinical outcomes in this population.…”

Disgust in Anxiety and Obsessive-Compulsive Disorders: Recent Findings and Future Directions

“…These studies suggest that insular activation is particularly relevant when OCD participants are placed in symptom-provoking conditions, where they are asked to confront unpleasant odors or inhibit disgusting images. In addition to the insular region, increased activation has also been observed in the parieto-sub-cortical circuit [47], caudate nucleus [44], and right frontal gyrus, right precentral gyrus, and left inferior parietal lobe [48]. Further, connectivity strength between the insula and ventral striatum was significantly correlated with contamination and washing OC symptoms, revealing functional connectivity in the limbic network [45].…”

Erroneously Disgusted: fMRI Study Supports Disgust-Related Neural Reuse in Obsessive-Compulsive Disorder (OCD)

“…For example, a clean toilet is often reported to provoke the patients’ urge to continue cleaning (in the disgusting pictures condition, in contrast, a dirty toilet would be shown that provokes emotions of disgust also in healthy participants). Numerous studies have reported the insula’s activation in such OCD-related conditions in patients but not in controls (e.g., Schienle et al, 2005; Schiepek et al, 2013; Thiel et al, 2014), especially also for the sample of this study (Viol et al, 2019). This suggests that the hypersensitivity to disgust in the pictures ratings of OCD patients corresponds to a hyperactivity of the insular cortex.…”

“…However, the difference in the activity of the insula between patients and controls in a pure disgust-based paradigm revealed heterogeneous results. While Schienle et al (2005) and Berlin et al (2015) found greater activation of the insula in response to disgust-inducing images in OCD patients compared to controls, no such group difference was found in Thiel et al (2014) and Weygandt et al (2012). Moreover, no correlation could be found between OCD symptom severity and insular activity (e.g., Berlin et al, 2017).…”