Cause of obsessive–compulsive disorder
Open-knowledge reference entry
The cause of obsessive–compulsive disorder is understood mainly through identifying biological risk factors that lead to obsessive–compulsive disorder (OCD) symptomology. The leading hypotheses propose the involvement of the orbitofrontal cortex, basal ganglia, and/or the limbic system, with discoveries being made in the fields of neuroanatomy, neurochemistry, neuroimmunology, neurogenetics, and neuroethology.
Drug-induced OCD
Many different types of medication can create/induce OCD in patients that have never had symptoms before. A new chapter about OCD in the DSM-5 (2013) now specifically includes drug-induced OCD.
Atypical antipsychotics (second generation antipsychotics), such as olanzapine (Zyprexa), have been proven to induce de-novo OCD in patients.
Neuroanatomy
Although there has been substantial debate regarding the assessment of OCD, current research has gravitated toward structural and functional neuroimaging. These technological innovations have provided a better understanding of the neuroanatomical risk factors of OCD. These studies can be divided into four basic categories: (1) resting studies that compare brain activity at rest in patients with OCD to controls, (2) symptom provocation studies that compare brain activity before and after incitement of symptoms, (3) treatment studies that compare brain activity before and after treatment with pharmacotherapy, and (4) cognitive activation studies that compare brain activity while performing a task in patients with OCD to controls.
Data obtained from this research suggests that three brain areas are involved with OCD: the orbitofrontal cortex (OFC), the anterior cingulate cortex (ACC), and the head of the caudate nucleus. Several studies have found that in patients with OCD, these areas: (1) are hyperactive at rest relative to healthy control; (2) become increasingly active with symptom provocation; and (3) no longer exhibit hyperactivity following successful treatment with SRI pharmacotherapy or cognitive-based therapy. This understanding is frequently cited as evidence that abnormality in these neuroanatomical regions may cause OCD.
The OFC and ACC are intricately connected to the basal ganglia via the cortico-basal ganglia-thalamo-cortical loop. Current theories suggest that OCD may be the result of an imbalance between the "direct" and "indirect" pathways through the basal ganglia.
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