Everyone suffers anxieties, doubts, and fears about uncertainty. They are a natural and necessary part of the very successful survival mechanism “softwired” into the human brain by evolution. But people who ruminate or obsess endlessly are suffering from a biological, brain-based disorder. Excessive worrying, rumination, and OCD were once thought to have been caused by “bad parenting,” perhaps as a “neurosis” due to improper upbringing or conditioning. Not anymore.
With the advent of neuropsychology and brain imaging, a new understanding of the way the brain areas have evolved and how they function, has offered a primarily biological and anatomical explanation for unreasonable, excessive rumination – or “brain lock,” the term coined by OCD expert Jeffrey M. Schwartz, M.D.
Here’s the basic theory -- OCD involves three regions of the brain’s “circuitry,” and the primary causal factor is located in the area known as the caudate nucleus. Any damage to this area, either by “bad genes,” head injury, or autoimmune attack, can result in OCD. Damage to the other two areas implicated, the cingulate gyrus and the orbital cortex, will not lead to OCD as such.
Brain area #1. The caudate nucleus, metaphorically speaking, is the “automatic transmission” of the brain’s thought process. It is the area of the brain that allows thought to flow smoothly, easily, “naturally.” The person suffering from OCD loses the capacity to automatically filter the flow of thought or “gate” the worries.
In the neurotypical person, the brain moves on after a worrying thought is dealt with, but in OCD the doubts never cease, and the “gating” function of the caudate cannot suppress them. The malfunctioning caudate results in thought “leakage” or a hyperactivity of thought and compulsion.
Brain area #2. The orbital cortex, part of the cerebral cortex, houses the brain’s “error detection circuit.” The caudate nucleus normally modulates the orbital cortex, but a damaged caudate cannot turn off the terrible feeling “that something is wrong,” and so the feelings don’t go away. The feelings are never satisfied. These repeated “error message” feelings remain as fresh, new, and jarring as the very first time they appeared – there is no “leveling off.”
Brain area #3. The final implicated area, the cingulate gyrus, is a part of the emotional system of the brain known as the limbic system. This is the area responsible for the terrible psychic pain of OCD. The disorder is profoundly painful, so painful that sufferers often speak of “being tortured by their own thoughts.” OCD brings with its unsettling, recurring doubts, pain in the form of terror, thanks to the involvement of the cingulate gyrus. Each “error message” from the orbital cortex shoots down to the cingulate gyrus, which cranks up an extreme state of fear, panic, and alarm. For what should be a neutral or mildly worrisome stimulus, the over-amped OCD sufferer feels the overwhelming fear that a neurotypical would experience only from a catastrophic threat. OCD, in its classic form, torments sufferers who are driven against their better judgment, reason, and will to “check” over and over again, even though they absolutely do not want to continue this checking. They have an “objective bystander” part of their mind that knows these actions/reactions are illogical, but due to bad brain biology. they simply cannot stop themselves. They are gripped by terror, and must act now.
The Good News: After years of research, progress in treating the condition has improved greatly. The treatment for the disorder is to break through the “brain lock” with a combination of medication, exposure and response prevention, and by harnessing the healing power of neuroplasticity (or “rewiring the brain”). Parents are no longer blamed or need feel guilt over the way they raised their kids. Unfortunately, OCD is a chronic condition that must be treated long-term. More on all of that in my future posts.
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