OCD… is it a problem with uncertainty?
Sunday, October 15, 2023. This is another one for my friend Meg... Meg, I promise not to exploit your OCD to counter my sloppiness…
Humans with Obsessive Compulsive Disorder (OCD), prefer cleanliness, and sense of order, and propriety. Folks with OCD can experience this preference quite passionately, but the reason is not because they are fussy or particular.
New research from neuroscience suggests that humans with OCD have a difficulty in processing uncertainty.
In my last post, I discussed the importance of knowing how to make a good decision. People with OCD find it a helluva lot more difficult to make decisions when the correct course of action is not readily apparent.
Since so much of life is unclear, this contributes to many of the abiding symptoms of OCD.
How the study was conducted
This research project recruited over 80 humans (ok, 83 to be exact). Some of the study subjects had OCD, some had healthy controls. It also included an important cohort that suffered from OCD to such a debilitating extent that they had a form of brain surgery called capsulotomy. This is sometimes used as a last-ditch effort to treat extreme and debilitating OCD.
Dr. Valerie Voon, the study co-author, explained the procedure:
“We used a simple card gambling task like that commonly used in drinking games.
Participants faced with an open card simply bet whether they thought the next card would be higher or lower than the open card.
At the extremes, with high or low open cards, certainty is high, but uncertainty was much higher with cards near the middle of the deck.”
Their brains were scanned for activity in areas of the brain critical to decision making, including the dorsal anterior cingulate cortex and the anterior insula.
Dr. Voon described the findings:
“Critically, patients with OCD showed slower decision making, but only when the outcomes were more certain.
Because these impairments appeared in both the OCD patients and those who had improved after capsulotomy surgery, that suggests this cognitive mechanism might be a core feature underlying why OCD develops, irrespective of how severe the symptoms might be.”
The brain scans revealed that problems dealing with uncertainty underlie OCD, said Dr Voon:
“The imaging data may provide a representation of how OCD patients might struggle with their symptoms.
Whereas healthy individuals might be able to say, ‘this is clean’ and stop cleaning, people with OCD might struggle with that sense of certainty, and perhaps spend more time wondering ‘is this still a bit dirty, or is this clean enough,’ and clean further.”
Some personal thoughts on this study…
What I’d like to learn more about is how humans with OCD might be suffering as a result of childhood trauma. The fact is, although we can describe and define OCD, we really don’t have a full grasp on how the condition emerges.
It’s been my experience that the reality of having OCD, like bi-polar, may not necessarily perceived as a negative. Some folks I’ve met with an OCD diagnosis report experiencing a sense of satisfaction when they regulate their nervous systems through an act of robust cleaning.
Can OCD sometimes manifest as a ritualistic metaphor for mental house cleaning? And if so, it might explain the inability to cease cleaning.
At this point, we don’t believe that there is one direct cause of OCD, although researchers seem to honing in on childhood trauma as being somehow correlated.
But trauma and stress, especially in childhood, can play a powerful role in triggering not only the onset of OCD, trauma can also render your symptoms more severe.
Anyway, Meg, I appreciate your willingness to clean. but when necessary… I’ll suggest when your efforts are “good enough.” LOL.
Be well, stay kind, and Godspeed.
RESEARCH:
Evidence Accumulation and Neural Correlates of Uncertainty in Obsessive-Compulsive Disorder
Author links open overlay panelYi-Jie Zhao a b c d, Yingying Zhang a b c, Qianfeng Wang a b c, Luis Manssuer e, Hailun Cui e, Qiong Ding e, Bomin Sun f, Wenjuan Liu d 1, Valerie Voon a b c d e 1
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