Pathophysiology of obsessive-compulsive disorder: a necessary link between phenomenology, neuropsychology, imagery and physiology.

Bruno Aouizerate, Dominique Guehl, Emmanuel Cuny, Alain Rougier, Bernard Bioulac, Jean Tignol, Pierre Burbaud
Progress in Neurobiology. 2004-02-01; 72(3): 195-221
DOI: 10.1016/j.pneurobio.2004.02.004

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1. Prog Neurobiol. 2004 Feb;72(3):195-221. doi: 10.1016/j.pneurobio.2004.02.004.

Pathophysiology of obsessive-compulsive disorder: a necessary link between
phenomenology, neuropsychology, imagery and physiology.

Aouizerate B(1), Guehl D, Cuny E, Rougier A, Bioulac B, Tignol J, Burbaud P.

Author information:
(1)Service de Neurophysiologie Clinique, Centre Hospitalier Pellegrin,
Université Victor Segalen Bordeaux 2, CNRS UMR 5543, Place Amélie-Raba Léon,
33076 Bordeaux, France.

Obsessive-compulsive disorder (OCD) is characterized by repetitive intrusive
thoughts and compulsive time-consuming behaviors classified into three to five
distinct symptom dimensions including: (1) aggressive/somatic obsessions with
checking compulsions; (2) contamination concerns with washing compulsions; (3)
symmetry obsessions with counting/ordering compulsions; (4) hoarding obsessions
with collecting compulsions; and (5) sexual/religious concerns.
Phenomenologically, OCD could be thought of as the irruption of internal signals
centered on the erroneous perception that « something is wrong » in a specific
situation. This generates severe anxiety, leading to recurrent behaviors aimed
at reducing the emotional tension. In this paper, we examine how the
abnormalities in brain activity reported in OCD can be interpreted in the light
of physiology after consideration of various approaches (phenomenology,
neuropsychology, neuroimmunology and neuroimagery) that contribute to proposing
the central role of several cortical and subcortical regions, especially the
orbitofrontal cortex (OFC), the anterior cingulate cortex (ACC), the
dorsolateral prefrontal cortex (DLPC), the head of the caudate nucleus and the
thalamus. The OFC is involved in the significance attributed to the consequences
of action, thereby subserving decision-making, whereas the ACC is particularly
activated in situations in which there are conflicting options and a high
likelihood of making an error. The DLPC plays a critical part in the cognitive
processing of relevant information. This cortical information is then integrated
by the caudate nucleus, which controls behavioral programs. A dysfunction of
these networks at one or several stages will result in the emergence and
maintenance of repetitive thoughts and characteristic OCD behavior.