The Neuropsychology of Psychopathology by Noggle Chad A.;Dean Raymond S.;

Author:Noggle, Chad A.;Dean, Raymond S.; [Chad A. Noggle and Raymond S. Dean]
Language: eng
Format: epub
ISBN: 978-0-8261-0701-5
Publisher: Springer Publishing Company, Incorporated

Obsessive-Compulsive Disorder

Robert M. Roth, Marc E. Lavoie, Emily A. Mason, &

Kieron P. O’Connor

INTRODUCTION

Obsessive-compulsive disorder (OCD) is characterized by intrusive, repetitive, and distressing thoughts, images, and impulses (obsessions), as well as repetitive behaviors or mental acts (compulsions) that the person feels compelled to perform, typically in response to obsessions and aimed at preventing an unwanted event or situation and/or reducing distress (American Psychiatric Association [APA], 2000). The symptoms are typically recognized as being excessive or unrealistic, although insight may be limited in some adults and especially in children with the disorder (De Berardis et al., 2005; Storch et al., 2008).

The symptom presentation of OCD is heterogeneous. Factor and cluster analytical studies of symptom measures, such as the Yale Brown Obsessive Compulsive Scale (YBOCS; Goodman et al., 1989), have identified a number of symptom dimensions that tend to be relatively stable over time within individuals (Fullana et al., 2009; Mataix-Cols et al., 2002b). These include repeatedly washing hands or other parts of the body to free oneself from imagined contamination, repeated checking behaviors to ensure that nothing has been forgotten or missed that may result in harm to oneself or others, excessive concern with order or symmetry, and hoarding (Bloch, Landeros-Weisenberger, Rosario, Pittenger, & Leckman, 2008; McKay et al., 2004). Obsessions pertaining to religious, sexual, or aggressive themes or health concerns are also reported. Obsessional doubt may manifest itself as slowness, indecisiveness, or rumination without any overt compulsion. It should be noted that although compulsive hoarding is currently listed as a symptom of OCD, there is evidence suggesting that it may represent a distinct subgroup or syndrome (Mataix-Cols et al., 2010; Pertusa et al., 2008; Samuels et al., 2007).

OCD is associated with significant disruption of psychosocial functioning (Moritz, 2008; Steketee, 1997), reduced quality of life in patients (Eisen et al., 2006; Huppert, Simpson, Nissenson, Liebowitz, & Foa, 2009; Moritz, 2008) and their relatives (Stengler-Wenzke, Kroll, Matschinger, & Angermeyer, 2006), as well as considerable economic cost to the individual and society (DuPont, Rice, Shiraki, & Rowland, 1995). This is particularly concerning given the typically lengthy period of time taken by people with OCD to seek treatment (Belloch, Del Valle, Morillo, Carrio, & Cabedo, 2009).

In this chapter, we first provide a brief overview of the epidemiology of OCD. We then review the neuropsychological correlates of the disorder, including variables that may contribute to the heterogeneity of findings. Treatments for OCD are briefly discussed along with evidence for their impact on neuropsychological functioning in the disorder. This is followed by a discussion of the neural substrates of OCD and its associated cognitive limitations, highlighting contributions from neuroimaging and neurophysiology.

EPIDEMIOLOGY

OCD is reported to be the fourth most prevalent mental illness after major depression, drug abuse, and panic disorder (Robins, Helzer, Weissman, & Orvaschel, 1984). Epidemiological studies of community samples have reported prevalence rates of approximately 1%–3% in adults (Fullana et al., 2009; Kolada, Bland, & Newman, 1994; Weissman et al., 1994) and 1%–4% in children and adolescents (Rapoport et al., 2000; Valleni-Basile et al., 1994; Zohar, 1999), rates being relatively consistent cross-nationally (Mohammadi et al.

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