Hormones, Brain Chemistry and OCD
Obsessive-Compulsive Disorder (OCD) is a neurobiological disorder with resultant cognitive, emotional and behavioral symptoms. Research shows that there are changes in brain function associated with OCD, and that biological and physiological changes can trigger OCD. There is also evidence that by changing OCD behaviors, we can change brain chemistry.
One of the ways in which I have seen biology impact OCD has been when hormonal changes in women have triggered or worsened symptoms. The precise way in which hormones impact OCD is unclear; however, there is much research on the effects of estrogen and other hormones on serotonin, the main neurotransmitter most often associated with OCD.
One type of hormonal OCD is post-partum OCD. Post-partum OCD is a rapid onset OCD, likely triggered by hormonal changes which accompany pregnancy and childbirth. In post-partum OCD there is a distinct set of symptoms: the obsessions involve horrific or violent thoughts or images relating to the baby being harmed (and resultant compulsions) and/or fear of contamination.
Though there are documented cases of new fathers experiencing post-partum OCD, it is likely not just the stress of having a new baby that may worsen OCD. Symptoms of OCD are worse when women are pre-menstrual, and having a miscarriage is associated with a higher risk of OCD as well. Hormones and their effect on brain chemistry seem to play some role.
Researchers at the Yale OCD Clinic found that 32% of the women patients who had ever been pregnant had their first OCD symptoms triggered by the pregnancy or childbirth. Interestingly, among women who had OCD prior to pregnancy, 33% reported that their symptoms worsened with pregnancy and 22% reported that symptoms in fact improved with pregnancy! A history of pre-menstrual worsening of OCD symptoms was highly predictive of OCD symptoms worsening as a result of pregnancy.
Exogenous hormones have an impact on OCD symptoms as well. In a large study of over 1200 women, researcher Elizabeth Young and her colleagues from the University of Michigan and Massachusetts General Hospital found that women who were on a combined hormone contraception were less likely to experience OCD than those taking no hormones or progestin only.
The role of serotonin in OCD has been identified via brain imaging studies which have been able to pinpoint both specific areas of the brain and specific neurotransmitters which are more or less active in those with OCD. Some of the research on the brain chemistry of OCD is being done by David Rosenberg at Wayne State University. His research focus is on children with OCD given that roughly 80% or more of all OCD has onset in childhood or adolescence.
Using brain imaging, Rosenberg has found that pediatric OCD is associated with low levels of serotonin and high levels of glutamate, a brain chemical which may regulate serotonin. These findings have led to new ideas about the use of different medications (not just serotonergic) to treat OCD.
Medication is not the only treatment for OCD. Research by Jeffrey Schwartz at UCLA has shown that the brain chemistry of those with OCD can be changed not only with medication, but also with a specific type of Cognitive Behavioral Therapy known as Exposure with Response Prevention (ERP).
John March at Duke University found that medication alone, ERP alone, and the combination of medication and ERP were all more effective than no treatment. Neither the combined treatment nor the ERP alone resulted in significantly different outcomes (both were better than medication alone).
Though there is strong evidence of brain changes associated with OCD (triggered by hormones or not), there is also strong evidence that behavior therapy can reverse those changes. Research provides valuable data which then leads to improved treatment.
One of the ways in which I have seen biology impact OCD has been when hormonal changes in women have triggered or worsened symptoms. The precise way in which hormones impact OCD is unclear; however, there is much research on the effects of estrogen and other hormones on serotonin, the main neurotransmitter most often associated with OCD.
One type of hormonal OCD is post-partum OCD. Post-partum OCD is a rapid onset OCD, likely triggered by hormonal changes which accompany pregnancy and childbirth. In post-partum OCD there is a distinct set of symptoms: the obsessions involve horrific or violent thoughts or images relating to the baby being harmed (and resultant compulsions) and/or fear of contamination.
Though there are documented cases of new fathers experiencing post-partum OCD, it is likely not just the stress of having a new baby that may worsen OCD. Symptoms of OCD are worse when women are pre-menstrual, and having a miscarriage is associated with a higher risk of OCD as well. Hormones and their effect on brain chemistry seem to play some role.
Researchers at the Yale OCD Clinic found that 32% of the women patients who had ever been pregnant had their first OCD symptoms triggered by the pregnancy or childbirth. Interestingly, among women who had OCD prior to pregnancy, 33% reported that their symptoms worsened with pregnancy and 22% reported that symptoms in fact improved with pregnancy! A history of pre-menstrual worsening of OCD symptoms was highly predictive of OCD symptoms worsening as a result of pregnancy.
Exogenous hormones have an impact on OCD symptoms as well. In a large study of over 1200 women, researcher Elizabeth Young and her colleagues from the University of Michigan and Massachusetts General Hospital found that women who were on a combined hormone contraception were less likely to experience OCD than those taking no hormones or progestin only.
The role of serotonin in OCD has been identified via brain imaging studies which have been able to pinpoint both specific areas of the brain and specific neurotransmitters which are more or less active in those with OCD. Some of the research on the brain chemistry of OCD is being done by David Rosenberg at Wayne State University. His research focus is on children with OCD given that roughly 80% or more of all OCD has onset in childhood or adolescence.
Using brain imaging, Rosenberg has found that pediatric OCD is associated with low levels of serotonin and high levels of glutamate, a brain chemical which may regulate serotonin. These findings have led to new ideas about the use of different medications (not just serotonergic) to treat OCD.
Medication is not the only treatment for OCD. Research by Jeffrey Schwartz at UCLA has shown that the brain chemistry of those with OCD can be changed not only with medication, but also with a specific type of Cognitive Behavioral Therapy known as Exposure with Response Prevention (ERP).
John March at Duke University found that medication alone, ERP alone, and the combination of medication and ERP were all more effective than no treatment. Neither the combined treatment nor the ERP alone resulted in significantly different outcomes (both were better than medication alone).
Though there is strong evidence of brain changes associated with OCD (triggered by hormones or not), there is also strong evidence that behavior therapy can reverse those changes. Research provides valuable data which then leads to improved treatment.
