Psychonomic Bulletin & Review

, Volume 5, Issue 2, pp 161–172 | Cite as

Issues surrounding the cognitive neuroscience of obsessive-compulsive disorder

  • Kevin D. WilsonEmail author


Obsessive-compulsive disorder (OCD) has been studied extensively in recent years, with increased emphasis on understanding OCD’s biological substrates. There has been significant progress in documenting abnormal brain function in OCD patients, particularly in the orbitofrontal cortex, basal ganglia, and thalamus. Similar progress has broadened our understanding of the cognitive and behavioral manifestations of the disorder, including deficits in set shifting, hyperattention, and visuospatial construction abilities. Unfortunately, these results have not been replicated consistently. This report comprises a review of previous attempts to characterize the neurobiology and neuropsychology of OCD, and a discussion of several factors in OCD research that can help to explain previous inconsistencies.


Basal Ganglion Caudate Nucleus Orbitofrontal Cortex Symptom Provocation Sensorimotor Gating 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Abbruzzese, M., Bellodi, L., Ferri, S., &Scarone, S. (1995). Memory functioning in obsessive-compulsive disorder.Behavioral Neurology,6, 119–122.Google Scholar
  2. American Psychological Association (1994).Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.Google Scholar
  3. Aylward, E. H., Harris, G. J., Hoehn-Saric, R., Barta, P. E., Machlin, S. R., &Pearlson, G. D. (1996). Normal caudate nucleus in obsessive-compulsive disorder assessed by quantitative neuroimaging.Archives of General Psychiatry,53, 577–584.PubMedGoogle Scholar
  4. Baer, L. (1994). Factor analysis of symptom subtypes of obsessive compulsive disorder and their relation to personality and tic disorders.Journal of Clinical Psychiatry,55, 18–23.PubMedGoogle Scholar
  5. Barlow, D. H. (1988).Anxiety and its disorders: The nature and treatment on anxiety and panic. New York: Guilford Press.Google Scholar
  6. Baxter, L. R., Schwartz, J. M., Bergman, K. S., Szuba, M. P., Guze, B. H., Mazziotta, J. C., Alazraki, A., Selin, C. E., Ferng, H.-K., Munford, P., &Phelps, M. E. (1992). Caudate glucose metabolic rate changes with both drug and behavior therapy for obsessive-compulsive disorder.Archives of General Psychiatry,49, 681–689.PubMedGoogle Scholar
  7. Baxter, L. R., Schwartz, J. M., Guze, B. H., Bergman, K. S., &Szuba, M. P. (1990). Neuroimaging in obsessive-compulsive disorder: Seeking the mediating neuroanatomy. In M. Jenike, L. Baer, & W. Minichiello (Eds.),Obsessive-compulsive disorders: Theory & management (pp. 167–188). St. Louis: Mosby.Google Scholar
  8. Baxter, L. R., Schwartz, J. M., Mazziotta, J. C., Phelps, M. E., Pahl, J. J., Guze, B. H., &Fairbanks, L. (1988). Cerebral glucose metabolic rates in nondepressed patients with obsessive-compulsive disorder.American Journal of Psychiatry,145, 1560–1563.PubMedGoogle Scholar
  9. Baxter, L. R., Thompson, J. M., Schwartz, J. M., Guze, B. H., Phelps, M. E., Mazziotta, J. C., Selin, C. E., &Moss, L. (1987). Trazodone treatment response in obsessive-compulsive disorder—correlated with shifts in glucose metabolism in the caudate nuclei.Psychopathology,20 (Suppl. 1), 114–122.CrossRefPubMedGoogle Scholar
  10. Behar, D., Rapoport, J. L., Berg, C. J., Denckla, M. B., Mann, L., Cox, C., Fedio, P., Zahn, T., &Wolfman, M. G. (1984). Computerized tomography and neuropsychological test measures in adolescents with obsessive-compulsive disorder.American Journal of Psychiatry,141, 363–369.PubMedGoogle Scholar
  11. Benkelfat, C., Nordahl, T. E., Semple, W. E., &King, A. (1990). Local cerebral glucose metabolic rates in obsessive-compulsive disorder: Patients treated with clomipramine.Archives of General Psychiatry,47, 840–848.PubMedGoogle Scholar
  12. Black, A. (1974). The natural history of obsessional neurosis. In H. R. Beech (Ed.),Obsessional states (pp. 19–54). London: Methuen.Google Scholar
  13. Boone, K. B., Ananth, J., Philpott, L., Kaur, A., &Djenderedjian, A. (1991). Neuropsychological characteristics of nondepressed adults with obsessive-compulsive disorder.Neuropsychiatry, Neuropsychology, & Behavioral Neurology,4, 96–109.Google Scholar
  14. Breiter, H. C., Rauch, S. L., Kwong, K. K., Baker, J. R., Weisskoff, R. M., Kennedy, D. N., Kendrick, A. D., Davis, T. L., Jiang, A., Cohen, M. S., Stern, C. E., Belliveau, J. W., Baer, L., O’Sullivan, R. L., Savage, C. R., Jenike, M. A., &Rosen, B. R. (1996). Functional magnetic resonance imaging of symptom provocation in obsessive-compulsive disorder.Archives of General Psychiatry,53, 595–606.PubMedGoogle Scholar
  15. Brown, H. D., Kosslyn, S. M., Breiter, H. C., Baer, L., &Jenike, M. A. (1994). Can patients with obsessive-compulsive disorder discriminate between percepts and mental images? A signal detection analysis.Journal of Abnormal Psychology,103, 445–454.CrossRefPubMedGoogle Scholar
  16. Calabrese, G., Colombo, C., Bonfanti, A., Scotti, G., &Scarone, S. (1993). Caudate nucleus abnormalities in obsessive-compulsive disorder: Measurements of MRI signal intensity.Psychiatry Research: Neuroimaging,50, 89–92.CrossRefPubMedGoogle Scholar
  17. Christensen, K. J., Kim, S. W., Dysken, M. W., &Hoover, K. M. (1992). Neuropsychological performance in obsessive-compulsive disorder.Biological Psychiatry,31, 4–18.CrossRefPubMedGoogle Scholar
  18. Cohen, J. D., &Servan-Schreiber, D. (1992). Context, cortex, and dopamine: A connectionist approach to behavior and biology in schizophrenia.Psychological Review,99, 45–77.CrossRefPubMedGoogle Scholar
  19. Cummings, J. L. (1993). Frontal-subcortical circuits and human behavior.Archives of Neurology,50, 873–880.PubMedGoogle Scholar
  20. Cummings, J. L., &Cunningham, K. (1992). Obsessive-compulsive disorder in Huntington’s disease.Biological Psychiatry,31, 263–270.CrossRefPubMedGoogle Scholar
  21. Cummings, J. L., Gosenfeld, L. F., Houlihan, J. P., &McCaffrey, T. (1983). Neuropsychiatric disturbances associated with idiopathic calcification of the basal ganglia.Biological Psychiatry,18, 591–601.PubMedGoogle Scholar
  22. Fenichel, O. (1945).The psychoanalytic theory of neurosis. New York: Norton.Google Scholar
  23. Flor-Henry, P., Yeudall, L. T., Koles, Z. J., &Howarth, B. G. (1979). Neuropsychological and power spectral EEG investigations of the obsessive-compulsive syndrome.Biological Psychiatry,14, 119–130.PubMedGoogle Scholar
  24. Garber, H. J., Ananth, J. V., Chiu, L. C., Griswold, V. J., &Oldendorf, W. H. (1989). Nuclear magnetic resonance study of obsessive-compulsive disorder.American Journal of Psychiatry,146, 1001–1005.PubMedGoogle Scholar
  25. Hantouche, E. G., &Lancrenon, S. (1996). Typologie moderne des symptomes et des syndromes obsessionnels-compulsifs: Résultats [Modern typology of obsessive-compulsive symptoms and syndromes: Results].Encephale,22, 9–21.PubMedGoogle Scholar
  26. Head, D., Bolton, D., &Hymas, N. (1989). Deficit in cognitive shifting ability in patients with obsessive-compulsive disorder.Biological Psychiatry,25, 929–937.CrossRefPubMedGoogle Scholar
  27. Hembree, E. A., Foa, E. B., &Kozak, M. J. (1994). Obsessive-compulsive disorder. In B. B. Wolman & G. Stricker (Eds.),Anxiety and related disorders: A handbook (pp. 177–193). New York: Wiley.Google Scholar
  28. Hoehn-Saric, R., Harris, G. J., Pearlson, G. D., Cox, C. S., Machlin, S. R., &Camargo, E. E. (1991). A fluoxetine-induced frontal lobe syndrome in an obsessive compulsive patient.Journal of Clinical Psychiatry,52, 131–133.PubMedGoogle Scholar
  29. Hoehn-Saric, R., Pearlson, G. D., Harris, G. J., Machlin, S. R., &Camargo, E. E. (1991). Effects of fluoxetine on regional cerebral blood flow in obsessive-compulsive patients.American Journal of Psychiatry,148, 1243–1245.PubMedGoogle Scholar
  30. Insel, T. R. (1992). Toward a neuroanatomy of obsessive-compulsive disorder.Archives of General Psychiatry,49, 739–744.PubMedGoogle Scholar
  31. Insel, T. R., Donnelly, E. F., Lalakea, M. L., Alterman, I. S., &Murphy, D. L. (1983). Neurological and neuropsychological studies of patients with obsessive-compulsive disorder.Biological Psychiatry,18, 741–751.PubMedGoogle Scholar
  32. Jenike, M. A., Baer, L., Ballantine, T., Martuza, R. L., Tynes, S., Giriunas, I., Buttolph, M. L., &Cassem, N. H. (1991). Cingulotomy for refractory obsessive-compulsive disorder: A long-term follow-up of 33 patients.Archives of General Psychiatry,48, 548–555.PubMedGoogle Scholar
  33. Jenike, M. A., Breiter, H. C., Baer, L., Kennedy, D. N., Savage, C. R., Olivares, M. J., O’Sullivan, R. L., Shera, D. M., Rauch, S. L., Keuthen, N., Rosen, B. R., Caviness, V. S., &Filipek, P. A. (1996). Cerebral structural abnormalities in obsessive-compulsive disorder.Archives of General Psychiatry,53, 625–632.PubMedGoogle Scholar
  34. Kellner, C. H., Jolley, R. R., Holgate, R. C., Austin, L., Lydiard, R. B., Laraia, M., &Ballenger, J. C. (1991). Brain MRI in obsessive-compulsive disorder.Psychiatry Research,36, 45–49.CrossRefPubMedGoogle Scholar
  35. Kolb, B. (1977). Studies on the caudate-putamen and then dorsomedial thalamic nucleus of the rat: Implications for mammalian frontal-lobe functions.Physiology & Behavior,18, 237–244.CrossRefGoogle Scholar
  36. Lhermitte, F., Pillon, B., &Serdaru, M. (1986). Human autonomy and the frontal lobes: Part 1. Imitation and utilization behavior: A neuropsychological study of 75 patients.Annals of Neurology,19, 326–334.CrossRefPubMedGoogle Scholar
  37. Logue, V., Durward, M., Pratt, R. T. C., Piercy, M., &Nixon, W. L. (1968). The quality of survival after an anterior cerebral aneurysm.British Journal of Psychiatry,114, 137–160.CrossRefPubMedGoogle Scholar
  38. Lucey, J. V., Costa, D. C., Blanes, T., Busatto, G. F., Pilowsky, L. S., Takei, N., Marks, I. M., Ell, P. J., &Kerwin, R. W. (1995). Regional cerebral blood flow in obsessive-compulsive disorder patients at rest.British Journal of Psychiatry,167, 629–634.CrossRefPubMedGoogle Scholar
  39. Luxenberg, J. S., Swedo, S. E., Flament, M. F., Friedland, R. P., Rapoport, J., &Rapoport, S. I. (1988). Neuroanatomical abnormalities in obsessive-compulsive disorder detected with quantitative X-ray computed tomography.American Journal of Psychiatry,145, 1089–1093.PubMedGoogle Scholar
  40. Machlin, S. R., Harris, G. J., Pearlson, G. D., Hoen-Saric, R., Jeffery, P., &Camargo, E. E. (1991). Elevated medial-frontal cerebral blood flow in obsessive-compulsive patients: A SPECT study.American Journal of Psychiatry,148, 1240–1242.PubMedGoogle Scholar
  41. Martinot, J. L., Allilaire, J. F., Mazoyer, B. M., Hantouche, E. G., Huret, J., Legaut-Demare, F., Deslauriers, A., Hardy, P., Pappata, S., Baron, J., &Syrota, A. (1990). Obsessive-compulsive disorder: A clinical, neuropsychological, and positron emission tomography study.Acta Psychiatrica Scandanavica,82, 233–242.CrossRefGoogle Scholar
  42. Maxmen, J. S., &Ward, N. G. (1995).Essential psychopathology and its treatment. New York: Norton.Google Scholar
  43. McGuire, P. K., Bench, C. J., Frith, C. D., Marks, I. M., Frackowiak, R. S. J., &Dolan, R. J. (1994). Functional anatomy of obsessive-compulsive disorder.British Journal of Psychiatry,164, 459–468.CrossRefPubMedGoogle Scholar
  44. Mowrer, O. H. (1960).Learning theory and behavior. New York: Wiley.CrossRefGoogle Scholar
  45. Nelson, E., Early, T. S., &Haller, J. W. (1993). Visual attention in obsessive-compulsive disorder.Psychiatry Research,49, 183–196.CrossRefPubMedGoogle Scholar
  46. Nordahl, T. E., Benkelfat, C., Semple, W. E., Gross, M., King, A. C., &Cohen, R. M. (1989). Cerebral glucose metabolic rates in obsessive-compulsive disorder.Neuropsychopharmacology,2, 23–28.CrossRefPubMedGoogle Scholar
  47. Oppenheim, S., &Rosenberger, J. (1991). Treatment of a case of obsessional disorder: Family systems and object relations approaches.American Journal of Family Therapy,19, 327–333.CrossRefGoogle Scholar
  48. Pauls, D. L., Leckman, J. F., Towbin, K. E., Zahner, G. E., &Cohen, D. J. (1986). A possible genetic relationship exists between Tourette’s syndrome and obsessive-compulsive disorder.Psychopharmacology Bulletin,22, 730–733.PubMedGoogle Scholar
  49. Perani, D., Colombo, C., Bressi, S., Bonfanti, A., Grassi, F., Scarone, S., Bellodi, L., Smeraldi, E., &Fazio, F. (1995). [18F]FDG PET study in obsessive-compulsive disorder: A clinical/metabolic correlation study after treatment.British Journal of Psychiatry,166, 244–250.CrossRefPubMedGoogle Scholar
  50. Perse, T. L., Greist, J. H., Jefferson, J.W., Rosenfeld, R., &Dar, R. (1987). Flouvoxamine treatment of obsessive-compulsive disorder.American Journal of Psychiatry,144, 1543–1548.PubMedGoogle Scholar
  51. Pitman, R. K. (1987). A cybernetic model of obsessive-compulsive psychopathology.Comprehensive Psychiatry,28, 334–343.CrossRefPubMedGoogle Scholar
  52. Posner, M. I., Nissen, M. J., &Ogden, W. C. (1978). Attended and unattended processing modes: The role of set for spatial location. In H. L. Pick, Jr., & I. J. Saltzman (Eds.),Modes of perceiving and processing information (pp. 137–157). Hillsdale, NJ: Erlbaum.Google Scholar
  53. Rapoport, J. L. (1991). Recent advances in obsessive-compulsive disorder.Neuropsychopharmacology,5, 1–10.PubMedGoogle Scholar
  54. Rasmussen, S. A., &Tsuang, M. T. (1986). Clinical characteristic and family history inDSM-III obsessive-compulsive disorder.American Journal of Psychiatry,143, 317–322.PubMedGoogle Scholar
  55. Rauch, S. L., Jenike, M. A., Alpert, N. M., Baer, L., Breiter, H. C. R., Savage, C. R., &Fischman, A. J. (1994). Regional cerebral blood flow measured during symptom provocation in obsessive-compulsive disorder using oxygen 15-labeled carbon dioxide and positron emission tomography.Archives of General Psychiatry,51, 62–70.PubMedGoogle Scholar
  56. Robins, L. N., Helzer, J. E., Weissman, M. M., Orvaschel, H., Gruenberg, E., Burke, J. D., &Regier, D. A. (1984). Lifetime prevalence of specific psychiatric disorders in three sites.Archives of General Psychiatry,41, 949–958.PubMedGoogle Scholar
  57. Robinson, D., Wu, H., Munne, R. A., Ashtari, M., Alvir, J. M.-J., Lerner, G., Koreen, A., Cole, K., &Bogerts, B. (1995). Reduced caudate nucleus volume in obsessive-compulsive disorder.Archives of General Psychiatry,52, 393–398.PubMedGoogle Scholar
  58. Rolls, E. T. (1985). Connections, functions and dysfunctions of limbic structures, the prefrontal cortex and hypothalamus. In M. Swash & C. Kennard (Eds.),Scientific basis of clinical neurology (pp. 201–213). New York: Churchill Livingstone.Google Scholar
  59. Rubin, R. T., Ananth, J., Villanueva-Meyer, J., Trajmar, P. G., &Mena, I. (1995). Regional133xenon cerebral blood flow and cerebral99mTc-HMPAO uptake in patients with obsessive compulsive disorder before and during treatment.Biological Psychiatry,38, 429–437.CrossRefPubMedGoogle Scholar
  60. Rubin, R. T., Villanueva-Meyer, J., Ananth, J., Trajmar, P. G., &Mena, I. (1992). Regional xenon 133 cerebral blood flow and cerebral technetium 99m HMPAO uptake in unmedicated patients with obsessive compulsive disorder and matched normal control subjects: Determination by high-resolution single-photon emission computed tomography.Archives of General Psychiatry,49, 695–702.PubMedGoogle Scholar
  61. Salkovskis, P. M., &Warwick, H. M. C. (1985). Cognitive therapy of obsessive-compulsive disorder: Treating treatment failures.Behavioral Psychotherapy,13, 243–255.CrossRefGoogle Scholar
  62. Scarone, S., Colombo, C., Livian, S., Abbruzzese, M., Ronchi, P., Locatelli, M., Scotti, G., &Smeraldi, E. (1992). Increased right caudate nucleus size in obsessive-compulsive disorder: Detection with magnetic resonance imaging.Psychiatry Research: Neuroimaging,45, 115–121.CrossRefPubMedGoogle Scholar
  63. Schwartz, J. M., Stoessel, P. W., Baxter, L. R., Martin, K. M., &Phelps, M. E. (1996). Systematic changes in cerebral glucose metabolic rate after successful behavior modification treatment of obsessive-compulsive disorder.Archives of General Psychiatry,53, 109–113.PubMedGoogle Scholar
  64. Stanley, M. A., &Prather, R. C. (1993). Obsessive-compulsive disorder. In A. S. Bellack & M. Hersen (Eds.),Psychopathology in adulthood (pp. 164–178). Boston: Allyn & Bacon.Google Scholar
  65. Stein, D. J., &Hollander, E. (1992). Cognitive science and obsessive compulsive disorder. In D. J. Stein & J. E. Young (Eds.),Cognitive science and clinical disorders (pp. 235–246). San Diego: Academic Press.Google Scholar
  66. Stein, D. J., &Hollander, E. (1994). A neural network approach to obsessive-compulsive disorder.Journal of Mind & Behavior,15, 223–237.Google Scholar
  67. Stein, D. J. Hollander, E., Chan, S., Decaria, C. M., Hilal, S., Liebowitz, M. R., &Klein, D. F. (1993). Computed tomography and neurological soft signs in obsessive compulsive disorder.Psychiatry Research,50, 143–150.CrossRefPubMedGoogle Scholar
  68. Swedo, S. E., Pietrini, P., Leonard, H. L., Schapiro, M. B., Rettew, D. C., Goldberger, E. L., Rapoport, S. I., Rapoport, J. L., &Grady, C. L. (1992). Cerebral glucose metabolism in childhoodonset obsessive-compulsive disorder: Revisualization during pharmacotherapy.Archives of General Psychiatry,49, 690–694.PubMedGoogle Scholar
  69. Swedo, S. E., Rapoport, J. L., Cheslow, D. L., Leonard, H. L., Ayoub, E. M., Hosier, D. M., &Wald, E. R. (1989). High prevalence of obsessive-compulsive symptoms in patients with Sydenham’s chorea.American Journal of Psychiatry,146, 246–249.PubMedGoogle Scholar
  70. Swedo, S. E., Schapiro, M. B., Grady, C. L., Cheslow, D. L., Leonard, H. L., Kumar, A., Friedland, R., Rapoport, S. I., &Rapoport, J. (1989). Cerebral glucose metabolism in childhoodonset obsessive-compulsive disorder.Archives of General Psychiatry,46, 518–523.PubMedGoogle Scholar
  71. Sweeney, J. A., Palumbo, D. R., Halper, J. P., &Shear, M. K. (1992). Pursuit eye movement dysfunction in obsessive-compulsive disorder.Psychiatry Research,42, 1–11.CrossRefPubMedGoogle Scholar
  72. Swerdlow, N. R., Benbow, C. H., Zisook, S., Geyer, M. A., &Braff, D. L. (1993). A preliminary assessment of sensorimotor gating in patients with obsessive-compulsive disorder.Biological Psychiatry,33, 298–301.CrossRefPubMedGoogle Scholar
  73. Tien, A. Y., Pearlson, G. D., Machlin, S. R., Bylsma, F. W., &Hoehn-Saric, R. (1992). Oculomotor performance in obsessive-compulsive disorder.American Journal of Psychiatry,149, 641–646.PubMedGoogle Scholar
  74. Towey, J. P., Tenke, C. E., Bruder, G. E., Leite, P., Friedman, D., Liebowitz, M., &Hollander, E. (1994). Brain event-related potential correlates of overfocused attention in obsessive-compulsive disorder.Psychophysiology,31, 535–543.CrossRefPubMedGoogle Scholar
  75. Trivedi, M. H. (1996). Functional neuroanatomy of obsessive-compulsive disorder.Journal of Clinical Psychiatry,57 (Suppl.), 26–35.PubMedGoogle Scholar
  76. Turner, S. M., &Michelson, L. (1984). Obsessive-compulsive disorder. In S. M. Turner (Ed.),Behavioral theories and treatment of anxiety (pp. 239–277). New York: Plenum.Google Scholar
  77. Warren, R., &Zgourides, G. D. (1991).Anxiety disorders: A rational-emotive perspective. New York: Pergamon.Google Scholar
  78. Williams, K. E., &Chambless, D. L. (1994). Behavioral therapies. In B. B. Wolman & G. Strucker (Eds.),Anxiety and related disorders: A handbook (pp. 358–375). New York: Wiley.Google Scholar
  79. Zohar, J., Insel, T. R., Berman, K. F., Foa, E. B., Hill, J. L., &Weinberger, D. R. (1989). Anxiety and cerebral blood flow during behavioral challenge: Dissociation of central from peripheral and subjective measures.Archives of General Psychiatry,46, 505–510.PubMedGoogle Scholar

Copyright information

© Psychonomic Society, Inc. 1998

Authors and Affiliations

  1. 1.Department of PsychologyUniversity of PennsylvaniaPhiladelphia

Personalised recommendations