How Is an OCD Brain Different and Can It Be Treated?

TL;DR

OCD stems from a brain that puts excessive value on ordinary intrusive thoughts, treating them as dangerous and looping on them until a compulsion relieves the anxiety. Almost everyone has intrusive thoughts, but a mental filter usually lets them pass; in OCD that filter stays open. Recovery means the same thoughts stop sticking, not that they disappear.

Transcript

Hi, everyone! Today we have a special guest. It's  Nathan Peterson. He's a licensed clinician and OCD specialist and he is also the guy behind  the channel OCD and Anxiety on YouTube. So, I'm really excited to have him. Really excited to  hear what he has to say. I'm going to ask him 10 quickfire questions about OCD and its treatment  and I'm excit... Read More

Key Insights

• The OCD brain shows overactivity between the frontal lobe and basal ganglia, recycling a thought and getting stuck in a loop because there is often no real answer to what the person is seeking.
• A mental filter normally screens out unimportant thoughts, but in OCD that filter stays open, letting through information the brain does not need and does not know how to process.
• Genetics plays a big part in OCD, shown by twin studies suggesting people are almost predisposed to it, with onset varying from around age 5 to 18 depending on when the filter opens.
• OCD tends to attack a person's value system, so the thoughts cycle on what someone cares about most, and shifting life values such as becoming a parent can trigger new intrusive themes.
• Almost everyone has intrusive thoughts; the difference in OCD is the meaning and value the brain assigns, making a fleeting thought stick around for weeks, months, or even years.
• Stepping away from a feared situation teaches the brain that real danger existed, reinforcing the compulsion loop so the next similar thought triggers the same avoidance behavior.
• A useful test for whether a behavior is OCD is asking if you can step away and still feel okay; genuine distress, anxiety, and threatening thoughts when you stop signal OCD.
• Recovery does not mean being cured or thought-free, since most of the population has intrusive thoughts; it means the brain no longer sticks to them and they stop feeling like a big deal.

Questions & Answers

Q: How is the brain of someone with OCD different from a neurotypical brain?

In OCD the frontal lobe sends signals to the basal ganglia and brain scans show an overactivity that keeps recycling a thought, leaving the person stuck in a loop because there is often no real answer to what they seek. A mental filter that normally screens out unimportant information stays open, so the brain receives thoughts it does not need and tries to problem-solve them repeatedly to relieve anxiety even when there is no present danger.

Q: What role does genetics play in OCD?

Genetics plays a big part in OCD. Twin studies suggest a person can be almost predisposed to develop it, and whether it emerges depends on timing, appearing as early as age 5 or around 18. When the mental filter is open, far more unneeded information gets through and the brain does not know what to do with it, processing it however it wants and generating ideas to relieve anxiety when no real danger exists.

Q: Is everyone a little bit OCD?

No. Having preferences, liking organization, or wanting neatness is not the same as OCD. Someone without OCD can move on if they cannot organize, while a person with OCD keeps thinking about the problem until it is fixed, possibly becoming late for work or feeling intense anxiety relievable only by a compulsion. The clinician notes that if someone claims everyone has OCD, you already know they do not have it, because the actual experience is so different.

Q: What is the difference between an intrusive thought and a thought you just do not like?

Intrusive thoughts are unwanted thoughts that keep coming back, and almost everyone has them. The difference is the value the brain assigns. In OCD the brain gives the thought heavy meaning, so it returns day after day for weeks, months, or years. In another person the same thought is fleeting and fades because the brain has already worked through it. Peterson says your thought is not special even though you as a person are.

Q: Why do intrusive thoughts become sticky for some people?

Intrusive thoughts become sticky when the brain decides the thought means something about the person. For example, holding a knife while cutting vegetables and thinking about stabbing a spouse can lead someone with OCD to conclude they might hurt someone, so they avoid the kitchen and knives and engage in avoidance behaviors. Someone without OCD dislikes the thought but keeps cutting, because their brain has already recognized it is not meaningful and does not require action.

Q: Can you recover from OCD so it no longer impacts you?

Yes, though the clinician avoids the word cured. Over 14 to 15 years of practice he has seen people reach little to no symptoms for weeks, months, or years through treatment that retrains the brain to think differently. Recovery may not mean thought-free, since the vast majority of people have intrusive thoughts. Instead, you may still have the same thoughts, but your brain no longer sticks to them, so they stop feeling like a big deal.

Q: How can you tell if a behavior is OCD or just a strong preference?

A useful question is whether you can step away from the behavior and still feel somewhat okay. The clinician's example is wanting to vacuum 50 times but doing it only twice to see what happens. If stopping produces significant distress, anxiety, and threatening thoughts, something more than preference is happening and it may be OCD. The grandmother who vacuums one room 50 times over two hours illustrates a compulsion, unlike simply liking a room to be clean.

Q: Why do intrusive thoughts target the things we care about most?

Intrusive thoughts are ego-dystonic, meaning they are not truly part of us and usually go against our value system, which the host calls the weirdest thing about them. People do not get intrusive thoughts about having a wonderful day playing with butterflies; the thoughts focus on things we do not want to happen. Because OCD attacks our values, and values shift over life such as becoming a father, the disorder cycles on whatever a person cares about most at that time.

Summary & Key Takeaways

• Nathan Peterson, a licensed clinician and OCD specialist, explains that an OCD brain shows overactivity linking the frontal lobe and basal ganglia, recycling thoughts in a loop. A mental filter that normally screens out unimportant thoughts stays open, letting through information the brain cannot process and tries to resolve to relieve anxiety.

• Two people can have the identical intrusive thought, but the OCD brain assigns it heavy meaning and dives deeper, asking what-if questions. Genetics contributes strongly, evidenced by twin studies, and OCD attacks a person's value system, so cycling thoughts latch onto whatever a person cares about most as life values change.

• Not everyone is a little OCD; preferences like liking organization differ from being unable to move on until a compulsion is done. Intrusive thoughts are normal and ego-dystonic, but OCD makes them sticky. Recovery means the same thoughts stop sticking rather than disappearing, letting people live life the way they want.