A prison built of thoughts, impulses, or images
While most prisons are built of bricks and mortar, those with the symptoms of Obsessive-compulsive disorder (OCD) are locked in a prison created by his or her brain.
With obsessive thoughts, life is dominated by brain-created anxieties around preoccupation with contamination or dirt, making sure everything is orderly and symmetric, driven by impulses of aggressive or horrific feelings, or plagued by sexual images or thoughts. For those with compulsion actions, behaviors such as washing the hands may occupy much of the day, leaving little time for other activities. Classically, compulsions are stereotypical behaviors that must be repeated at frequent intervals: Washing and cleaning, counting, checking, demanding reassurances, performing the same act over and over again, or ritualized orderliness. In either case, the results are the same: Life's door has been slammed shut and locked.
Where is the jailer?
If the brain creates the prison, where or what is the jailer? That is, what causes these overwhelming thoughts or behaviors? This is likely to be due to an overactive neural loop locking in three brain areas: The caudate nucleus, orbital frontal cortex, and cingulate system.
- The caudate is located deep within the hemispheres of the brain. It is responsible for control of voluntary movement and automatic thinking. The caudate reminds us to wash when dirty, to check the doors before going to bed, and alerts us and focuses our attention on anything that is out of order.
- The orbital prefrontal cortex is the front of the brain just above the eyes. It is responsible for our ability to think, to assess what is going on in our environment, and to plan and strategize.
- The cingulate cortex, located deep in the frontal lobes, helps us focus our attention and tune into our own thoughts.
With OCD, the caudate triggers the urge to 'do something,' giving the orbital prefrontal cortex a feeling that 'something is wrong,' which then activates the cingulate cortex, which keeps attention focused on the feeling of unease. The cycle repeats when an uneasy feeling once again triggers the caudate to do something.
