Neuropsychological Deficits
in Obsessive-Compulsive
Disorder
By Eliana Sidlow, B.A.
Nova Southeastern University
In Fulfillment of the Research Dissemination
OCD
• Brief Background
• Relevant Terms & Definitions
• Intrusive thoughts
• Etiology, model of OCD, cycle of OCD
• Differential diagnoses
• Treatment
A COMMON THREAD
• Clients with Diagnoses such as _____ can present with Executive Functioning difficulties
in domains of Working Memory, Processing Speed, Inhibition, Planning, Decision-Making, Selective Attention,
Set Shifting
• Obsessive Compulsive Disorder (OCD) (Purcell et al., 1998) (Olley et al., 2007) (Jk, 2006) (Wang et al., 2023)
• Anxiety (Majeed et al., 2023)
• Attention Deficit Hyperactivity Disorder (ADHD) (Jk, 2006) (Kramer et al., 2020)
• Depression (Nuño et al., 2021)
• Specific Learning Disorder (SLD) (Moll et al., 2014) (Kramer et al., 2020)
• Etc… (Pain Disorders…)
OBSESSIVE-COMPULSIVE DISORDER
(DSM-5 DIAGNOSTIC CRITERIA)
A. Presence of obsessions, compulsions, or both:
Obsessions are defined by (1) and (2):
1.
Recurrent and persistent thoughts, urges, or images that are
experienced, at some time during the disturbance, as intrusive and
unwanted, and that in most individuals cause marked anxiety or distress.
2.
The individual attempts to ignore or suppress such thoughts, urges, or
images, or to neutralize them with some other thought/action (performing a
compulsion).
OBSESSIVE-COMPULSIVE DISORDER
(DSM-5 DIAGNOSTIC CRITERIA)
Compulsions are defined by (1) and (2):
1.
Repetitive behaviors (hand washing, ordering, checking) or mental acts (praying,
counting, repeating words silently) that the individual feels driven to perform in
response to an obsession or according to rules that must be applied rigidly.
2.
The behaviors or mental acts are aimed at preventing or reducing anxiety or
distress, or preventing some dreaded event or situation; however, these behaviors
or mental acts are not connected in a realistic way with what they are designed to
neutralize or prevent, or are clearly excessive. (Note: Young children may not be
able to articulate aims of behaviors or mental acts.)
OBSESSIVE-COMPULSIVE DISORDER
(DSM-5 DIAGNOSTIC CRITERIA)
• The obsessions/ compulsions are time-consuming (take >1 hour per day) or
cause clinically significant distress or impairment in social, occupational, or
other important areas of functioning.
Get source
THE WHAT - EXECUTIVE FUNCTIONS ARE A SET OF COGNITIVE PROCESSES THAT ALLOW
INDIVIDUALS TO REGULATE AND CONTROL THEIR THOUGHTS, ACTIONS, AND EMOTIONS TO ACHIEVE
GOALS. THESE FUNCTIONS WORK TOGETHER TO FACILITATE HIGHER-ORDER COGNITIVE ABILITIES.
HERE ARE SOME COMMON EXECUTIVE FUNCTIONS AND THEIR CONSTITUENT PURPOSES: THESE EXECUTIVE
FUNCTIONS WORK TOGETHER DYNAMICALLY, INTERACTING AND INFLUENCING EACH OTHER TO SUPPORT ADAPTIVE BEHAVIOR AND COGNITIVE FUNCTIONING IN VARIOUS CONTEXTS AND
SITUATIONS.
•
1. Inhibition:
•
•
•
•
•
•
•
Purpose: To allocate time effectively, prioritize tasks based on urgency and importance, and monitor progress to meet
deadlines or goals.
Purpose: To establish clear objectives, define criteria for success, and develop plans to work towards achieving desired
outcomes.
11. Attentional Control:
•
•
Purpose: To evaluate ongoing performance, detect errors or discrepancies, and adjust behavior or strategies
accordingly to maintain optimal task performance.
10. Goal Setting:
•
•
Purpose: To control impulses, resist temptations, and refrain from engaging in behaviors that may be inappropriate,
harmful, or counterproductive.
9. Task Monitoring:
•
Purpose: To begin tasks or activities independently, overcome procrastination, and take action without external
prompting.
6. Time Management:
•
•
Purpose: To manage and modulate emotions in response to internal and external stimuli, maintain emotional stability,
and make decisions calmly and rationally.
8. Response Inhibition:
•
Purpose: To create structured sequences of actions, set goals, allocate resources efficiently, and anticipate potential
outcomes to achieve desired results.
5. Initiation:
•
•
Purpose: To adapt to changing circumstances, switch between tasks or mental sets, and generate alternative strategies
when faced with obstacles or new information.
4. Planning and Organization:
7. Emotional Regulation:
•
Purpose: To temporarily store and manipulate information needed to complete tasks, make decisions, and solve
problems in real-time.
3. Cognitive Flexibility:
•
•
Purpose: To suppress irrelevant or distracting stimuli, thoughts, or actions, allowing individuals to stay focused on tasks
and goals.
2. Working Memory:
•
•
Purpose: To regulate the focus and direction of attention, sustain attention on relevant stimuli or tasks, and ignore
distractions to maintain task engagement.
12. Problem Solving:
•
Purpose: To identify, analyze, and generate solutions to overcome obstacles, address challenges, and achieve goals
effectively.
RELEVANT TERMS
• Inhibition / Filtering – Ability to maintain attention, ability to prioritize relevant
information, and decreased susceptibility to distractions
• Think of it as mental that "brake" allows for control their impulses, thoughts, and attention.
SO Too…
• OCD
OCD DEFICITS - MOST CONSISTENT FINDINGS
• Difficulties with Visuospatial,Visuoconstructional, and Visuospatial Working Memory in
adults (Jk, 2006; Wang et al., 2023) as well as children and adolescents (Bernardes et al.,
2020)
• Motor and processing speed (Bernardes et al., 2020)
OCD – VWM Capacity
(WANG ET AL., 2023)
• Anxiety levels in subjects with OCD
significantly predicted checking
compulsion symptom severity with
the most significant effect in subjects
with poorest WWM capacity
•
Individuals with OCD with highest anxiety
level with the highest severity of
compulsion checking symptoms
demonstrated the poorest WWM capacity
•
Individuals with OCD with lowest anxiety level
with the lowest severity of compulsion checking
symptoms demonstrated the strongest WWM
capacity
Interaction Effect
THE WHY
(Suhas & Rao, 2019)
STRENGTHS & WEAKNESSES OF LIT
• Assessments
TREATMENT
• Diagnostic Interview (SCID; ADIS)
• Yale-Brown Obsessive-Compulsive Scale (YBOCS)
• Other Self report Measures (MOCI; Obsessive-Compulsive
Inventory-Revised, Leyton Obsessional Inventory, Lynfield
Obsessional/Compulsive Questionnaire)
• Initial Interview
• Identify patient’s specific/idiosyncratic threat cues (internal &
external)
• Avoidance behaviors and rituals (*explicit and subtle)
• Feared consequences
• Strength of beliefs/insight
• History of main complaint, treatment history, social
functioning, etc.
• Introduction of SUDS
• Get your patient’s personalized anchor points
• It’s important that you know what this looks like
• Exposure and Ritual Prevention (EX/RP or ERP)
• Exposure: Gradual, prolonged in vivo (real-life setting) PLUS
ritual/compulsion prevention
TREATMENT
• Patient cannot “un-do” the exposure with their rituals
• Exposure activates the emotional response (distress/anxiety), we
allow time for habituation (riding out the storm), without
compulsions
• Note about avoidance (short-term vs. long-term)
• Imaginal exposures can also be helpful
• Must sit with uncertainty and doubt (both you and the patient!)
• Cognitive Behavior Therapy
• ERP holds some components of CBT, but meta-analyses indicate
that exposure may be necessary to maximize outcomes
• Cognitive processing happens during exposures by modifying
appraisals and beliefs, overestimations, and likelihoods of feared
outcome(s).
• Most research supports a combination of CT and ERP
• Serotonergic Antidepressant Medications (SSRIs)
(Hezel & Simpson, 2019)
(Foa, 2010)
(Kellner, 2010)
• Can be helpful in severe cases, comorbid cases, and cases in
which patient is unwilling to do ERP without medications
• Filter Efficiency Training (Group A Filtering
NEW
TREATMENT
efficiency, Group B Consolidation, Group C control)
• Filter Efficiency experimental group demonstrated
improved Visual Working Memory by gradual
increase in number of distractors.
• Helps Increase the ability to Prioritize relevant
information & inhibit irrelevant/distracting stimuli
• Adaptive Design Training (ADT) – “Participants were
continuously challenged as their performance improved, with the
level of task difficulty tailored to each participant.” Upping the
Ante
• Questions
• Do these training modules help individuals suffering from OCD
generalize these skills to everyday Inhibition of
Obsession/Compulsion symptoms
(Shin et al., 2015)
DIVERSITY CONSIDERATIONS
• Diagnosis of OCD vs. Culturally/Religiously consistent behavior
• Adult vs. Child/Adolescent clinical presentations
TAKEAWAYS
REFERENCES
•
Bernardes, E. T., Saraiva, L., De Marco E Souza, M., Hoexter, M. Q., Chacon, P., Requena, G., Miguel, E. C., Shavitt, R. G., Polanczyk, G. V., Cappi, C., & Batistuzzo, M. C. (2020). Cognitive performance in children and
adolescents at high-risk for obsessive-compulsive disorder. BMC Psychiatry (Online), 20(1). https://doi.org/10.1186/s12888-020-02751-5
•
Foa, E. B. (2010). Cognitive behavioral therapy of obsessive-compulsive disorder. Dialogues in Clinical Neuroscience, 12(2), 199–207. https://doi.org/10.31887/dcns.2010.12.2/efoa
•
Hezel, D. M., & Simpson, H. B. (2019). Exposure and response prevention for obsessive-compulsive disorder: A review and new directions. Indian Journal of Psychiatry, 61(7), 85.
https://doi.org/10.4103/psychiatry.indianjpsychiatry_516_18
•
Jk, T. (2006). Cognitive deficits in psychiatric disorders: Current status. Indian Journal of Psychiatry, 48(1), 10. https://doi.org/10.4103/0019-5545.31613
•
Kellner, M. (2010). Drug treatment of obsessive-compulsive disorder. Dialogues in Clinical Neuroscience, 12(2), 187–197. https://doi.org/10.31887/dcns.2010.12.2/mkellner
•
Kramer, E., Koo, B., Restrepo, A., Koyama, M., Neuhaus, R., Pugh, K. R., Andreotti, C., & Milham, M. P. (2020). Diagnostic associations of processing speed in a transdiagnostic, pediatric sample. Scientific Reports (Nature
Publishing Group), 10(1). https://doi.org/10.1038/s41598-020-66892-z
•
Majeed, N. M., Chua, Y. J., Kothari, M., Kaur, M., Quek, F. Y. X., Ng, M. H., Ng, W. Q., & Hartanto, A. (2023). Anxiety disorders and executive functions: A three-level meta-analysis of reaction time and accuracy.
Psychiatry Research Communications, 3(1), 100100. https://doi.org/10.1016/j.psycom.2022.100100
•
Moll, K., Göbel, S. M., Ng‐Knight, T., Landerl, K., & Snowling, M. J. (2014). Cognitive risk factors for specific learning disorder. Journal of Learning Disabilities, 49(3), 272–281. https://doi.org/10.1177/0022219414547221
•
Nuño, L., Gómez-Benito, J., Carmona, V. R., & Pino, Ó. (2021). A Systematic review of executive function and information processing speed in major Depression disorder. Brain Sciences, 11(2), 147.
https://doi.org/10.3390/brainsci11020147
•
Olley, A., Malhi, G. S., & Sachdev, P. S. (2007). Memory and executive functioning in obsessive–compulsive disorder: A selective review. Journal of Affective Disorders, 104(1–3), 15–23.
https://doi.org/10.1016/j.jad.2007.02.023
•
Purcell, R., Maruff, P., Kyrios, M., & Pantelis, C. (1998). Neuropsychological deficits in obsessive-compulsive disorder. Archives of General Psychiatry, 55(5), 415. https://doi.org/10.1001/archpsyc.55.5.415
•
Shin, E., Lee, H., Yoo, S., & Chong, S. C. (2015). Training improves the capacity of visual working memory when it is adaptive, individualized, and targeted. PloS One, 10(4), e0121702.
https://doi.org/10.1371/journal.pone.0121702
•
Suhas, S., & Rao, N. P. (2019). Neurocognitive deficits in obsessive–compulsive disorder: A selective review. Indian Journal of Psychiatry, 61(7), 30. https://doi.org/10.4103/psychiatry.indianjpsychiatry_517_18
•
Wang, P., Zhou, Y., Chen, T., Cao, W., Yang, X., Meng, F., Liu, Y., & Li, Z. (2023). Visuospatial working memory capacity moderates the relationship between anxiety and OCD related checking behaviors. Frontiers in
Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.1039849