Lecture on Obsessive-Compulsive Disorder (OCD)

Introduction

• Host: Andrew Huberman, Professor of Neurobiology and Ophthalmology, Stanford School of Medicine.
• Topic: Obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD).
• Distinction between OCD and OCPD.

Obsessive-Compulsive Disorder (OCD)

Definition

• Involves intrusive obsessions and compulsions linked by anxiety.
• Ranked 7th among the most debilitating illnesses.
• Treatments include behavioral therapies, drug therapies, brain stimulation, and holistic therapies.

OCD vs. OCPD

• OCD: Characterized by intrusive, recurrent obsessions and compulsions.
• OCPD: Involves delayed gratification and orderliness without intrusive thoughts.

Types of OCD

• Checking: Repeatedly checking things like locks or stoves.
• Repetition: Counting or repeating actions multiple times.
• Order: Need for symmetry, order, cleanliness, or completeness.
• Disgust: Fear of contamination.

Neural Circuitry

• Involves cortico-striatal-thalamic loop.
• Studies using neuroimaging show this circuit is active in OCD.

Treatments for OCD

Cognitive Behavioral Therapy (CBT)

• Focuses on increasing anxiety tolerance and preventing compulsive behaviors.
• Includes exposure therapy, homework, and sometimes home visits.
• Proven to be highly effective in many cases.

Drug Treatments

• SSRIs (Selective Serotonin Reuptake Inhibitors): Commonly prescribed but not effective for everyone.
• Neuroleptics: Often combined with SSRIs.
• Psilocybin, ketamine, cannabis, TMS (Transcranial Magnetic Stimulation): Being explored but with mixed results.

Hormonal Factors

• Imbalances in cortisol, DHEA, and testosterone observed in individuals with OCD.
• GABA system involvement suggested.

Holistic and Alternative Treatments

• Mindfulness meditation: Useful indirectly through enhancing focus on CBT.
• Nutraceuticals: Inositol shows some promise.

Obsessive-Compulsive Personality Disorder (OCPD)

• Not characterized by intrusive thoughts.
• Often involves deferred gratification and can be advantageous in some contexts.

Superstitions and OCD

• Superstitions can develop into compulsive behaviors but typically lack the intrusive thought component of OCD.

Conclusion

• OCD is a common and debilitating condition with various treatment options.
• Understanding the distinct mechanisms of OCD and OCPD is crucial for effective treatment.