Neuropsychology of obsessive-compulsive disorder: a review and treatment implications

doi:10.1016/S0272-7358(02)00232-5

Clinical Psychology Review

Volume 23, Issue 1, February 2003, Pages 95-117

https://doi.org/10.1016/S0272-7358(02)00232-5 Get rights and content

Abstract

The existing literature examining neuropsychological features of obsessive-compulsive disorder (OCD) is reviewed. The accumulated research points to a deficit in organizational strategies in general, suggesting problems in executive functioning. The available research is inconsistent in identifying memory deficits in OCD. However, memory problems are most evident when tests are used that require an implicit organizational strategy. While the majority of the research reviewed involves adult samples, there is emerging evidence that these deficits are present in children as well. It is suggested here that the interaction between organizational strategy deficits and the effort to recall unstructured information contributes to doubting, an important feature of OCD. Implications of this body of research for behavior therapy are considered.

Section snippets

Definition of OCD

OCD is defined by presence of either obsessions or compulsions, with recognition on the part of the sufferer that the beliefs or behaviors are excessive or unreasonable (Diagnostic and Statistical Manual-IV [DSM-IV]; APA, 1994). Obsessions are defined as recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress. The content of the cognitive intrusions in OCD can vary

Cognitive traits typical in OCD

Unfortunately, it would be rather difficult to successfully categorize patients with OCD by their symptom subtype. This is because patients often present with concerns from more than one domain. There are, however, some cognitive characteristics common to individuals with OCD. One of these characteristics is chronic doubting (Salkovskis & Forrester, 2002). Regardless of the nature of the fear, most individuals with OCD will describe a feeling of uncertainty regarding their own behavior, and

OCD in children

There is a similar prevalence of OCD in children as in adults (March & Mulle, 1998). Currently, there is some debate as to whether juvenile OCD is syndromally distinct from adult OCD. Some researchers point to the bimodal age of onset, noting that there are peaks in middle childhood and early adulthood (Jenike, Baer, & Minichiello, 1998). Other researchers have observed that many of the adult cases had their onset in childhood (Rasmussen & Eisen, 1990).

It is clear that children with the

The neuropsychology of OCD

Any review of neuropsychological differences can be divided along major areas of functioning. This review is organized into the following major domains of neuropsychological assessment: attention and executive functioning, memory assessment (including short and long term, emotional memory, and procedural memory), and physiology, with special attention given to the emerging neuropsychological literature on childhood OCD. While it is recognized that sensory and motor functioning are also an

Neuropsychology of children with OCD

There is little information available at this time on the neuropsychology of children with OCD. An initial study examined computerized axial tomography (CT) scans of the brains of 16 adolescents with OCD as well as neuropsychological functioning (Behar et al., 1984). It was found that the OCD patients had a mean ventricular/brain ratio (VBR) that was higher than the controls. On the tests, the OCD group showed spatial-perceptual deficits similar to patients with frontal lobe lesions. No

Neuropsychology links to physiology

It appears from the literature reviewed to this point that there are significant neuropsychological deficits evident in individuals with OCD. What has created the most noteworthy problem for future research is the identification of methods to distinguish neuropsychological functioning of individuals with OCD from that of other neuropsychiatric conditions that also manifest with similar impairments. The conundrum for researchers is that, upon presentations, individuals with OCD do not appear to

Model of neuropsychological functioning in OCD

From these data, it appears that a model of neuropsychological functioning in OCD must be articulated if progress is to be made in delineating specific deficit areas. Although it is still necessary to overcome limitations from the existing data, such as discriminating brain injury from acute OCD, it is possible to glean an overarching perspective on the basic neuropsychology of the disorder. The literature shows that deficits in executive functioning are apparent from commonly used

Etiological and treatment implications

To date, the weight of empirical evidence has supported use of cognitive-behavior therapy in reducing ritualized behavior and obsessional ideation among OCD sufferers. Summaries of the literature suggest large effects associated with exposure with response prevention (Abramowitz, 1997). Further, recent research has supported inclusion of specifically tailored cognitive therapy interventions, particularly efforts at targeting inflated responsibility Freeston et al., 1997, Salkovskis, 1985,

Acknowledgements

We would like to thank Leslie Burton and the two anonymous reviewers for their extremely helpful comments on an earlier draft of this manuscript.

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