A misconception corrected: obsessive-compulsive disorder

Have you ever heard a friend exclaim “I’m being so OCD right now!” when they can’t help but double check for their house keys before slamming the front door? It seems that this phrase has become a cultural colloquialism, it is used so often. Luckily, most people who say “I am so OCD!” do not, in fact, have a debilitating anxiety disorder marked by uncontrollable obsessive thoughts and behavioral compulsions, the hallmark features of obsessive-compulsive disorder.

Though the term obsessive-compulsive is often misattributed to those of us who are perhaps too meticulous, prone to anxiety, or a combination thereof, we as a society have familiarized ourselves with the term through our exposure to literature and media to the extent that it is now a part of our lexicon. For example, recalling the days of junior high school can bring back memories of Shakespeare’s Lady Macbeth and her compulsive hand washing:

Doctor: What is it she does now? Look, how she rubs her hands.

 Gentlewoman: It is an accustomed action with her, to seem thus washing her hands: I have known her continue in this a quarter of an hour.

Lady Macbeth: Yet here’s a spot…”

In OCD, which affects approximately 2.2 million Americans, obsessive thoughts are not protective or useful- they can be uncontrollable, frightening and disturbing. Obsessions are thoughts that recur and persist despite efforts to ignore or confront them. Obsessions may involve a preoccupation with sexual, violent or religious thoughts, relationship-related obsessions, or a concern over dirt and germs.

The compulsive behaviors which accompany obsessive thoughts are a compensatory mechanism meant to bring comfort and control back to the individual, however, these behaviors invariably cause more anxiety than they alleviate. Compulsions may include excessive washing or cleaning, hoarding, aversion to particular numbers, repeated checking and nervous rituals (e.g., opening and closing a door a certain number of times before entering or leaving a room). Clearly, if the symptoms of OCD are severe enough, they can hinder normal functioning by preventing a person from working or engaging in normal social interactions.

One notable example of extreme compulsive behaviors is in the case of the innovative Howard Hughes. It is known that in Hughes’ later years his OCD in part lead him to live as a recluse. Interestingly, because of his amassed wealth, he was able to live out his compulsions vicariously through his work staff. Hughes wrote memos delineating how his staff should perform certain tasks,exemplifying the extent to which OCD can control one’s behavior:

[On opening a can of food:]

The man in charge turns the valve in the bathtub on, using his bare hands to do so… He then takes one of the brushes, and, using one of two special bars of soap, creates a good lather and then scrubs the can from a point two inches below the top of the can. He should first soak and remove the label, and then brush the cylindrical part of the can over and over until all particles of dust, pieces of paper label, and, in general, all sources of contamination have been removed…”

Clearly, there is a true distinction between the general scrupulousness of double checking that the stove is off and the doors are locked, and the mental illness that is OCD. And so the next time you hear someone say “I’m being so OCD right now!” you can rebut: “You may not have a mental illness, but you are, in fact, quite meticulous!”


Conscientious consumption of pornography

It has been estimated that in the US 66% of men and 41% of women watch pornography at least on a monthly basis.

Even if you are not one of those who partake in this pastime, you are likely not protected from the ubiquity of erotic images on TV, in movies, and of course, on the internet. In fact, it is estimated that 50% of all internet traffic is dedicated to sex, making it a true phenomenon of our time.

If you’ve ever wondered about the neurological implications of chronic exposure to pornography, your answer may have arrived! 

A recent publication shed light on areas of the brain vulnerable to chronic use of pornography- and surprise!- they’re the same areas implicated in drug addiction.

The article published last month in JAMA psychiatry implicates changes in two main regions of the brain- the striatum and the prefrontal cortex (PFC) – in chronic pornography exposure. The striatum (caudate/putamen/nucleus accumbens) is a brain region responsible for motivation, reward seeking and movement, whereas the PFC is necessary for planning and decision making. Together, these areas work to initiate reward-seeking behavior and assess reward cues from the environment.

dopamine pathways

The main results of the article show an overall loss of neural volume in the striatum in accordance with the amount of porn watched per week. Moreover, they observed a significant decrease in activity of the striatum in response to sexual cues-hinting at a desensitization of the reward system. Additionally, they noted a decrease in functional connection between the striatum and the PFC.

Overall, it seems that the more pornography you watch, the more stimulus you need to feel sexually aroused.

So if you ever wondered if pornography influences natural desires, the answer is quite possibly. It seems that chronic exposure to pornography can highjack the natural reward pathway of our brains in a similar fashion to drugs of abuse, like cocaine. And like drug abuse, with time and overuse, pornography alters our neural pathways to compensate for the overwhelming stimulus.