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The neural bases of obsessive–compulsive disorder in children and adults

Published online by Cambridge University Press:  07 October 2008

Tiago V. Maia ,
Rebecca E. Cooney  and
Bradley S. Peterson
Tiago V. Maia
Affiliation:
Columbia University and New York State Psychiatric Institute
Rebecca E. Cooney
Affiliation:
Columbia University and New York State Psychiatric Institute
Bradley S. Peterson*
Affiliation:
Columbia University and New York State Psychiatric Institute
*
Address correspondence and reprint requests to: Bradley S. Peterson, Columbia University and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 78, New York, NY 10032; E-mail: petersob@childpsych.columbia.edu.
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Abstract

Functional imaging studies have reported with remarkable consistency hyperactivity in the orbitofrontal cortex (OFC), anterior cingulate cortex (ACC), and caudate nucleus of patients with obsessive–compulsive disorder (OCD). These findings have often been interpreted as evidence that abnormalities in cortico–basal ganglia–thalamo–cortical loops involving the OFC and ACC are causally related to OCD. This interpretation remains controversial, however, because such hyperactivity may represent either a cause or a consequence of the symptoms. This article analyzes the evidence for a causal role of these loops in producing OCD in children and adults. The article first reviews the strong evidence for anatomical abnormalities in these loops in patients with OCD. These findings are not sufficient to establish causality, however, because anatomical alterations may themselves be a consequence rather than a cause of the symptoms. The article then reviews three lines of evidence that, despite their own limitations, permit stronger causal inferences: the development of OCD following brain injury, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection, and neurosurgical lesions that attenuate OCD. Converging evidence from these various lines of research supports a causal role for the cortico–basal ganglia–thalamo–cortical loops that involve the OFC and ACC in the pathogenesis of OCD in children and adults.

Type
Research Article
Information
Development and Psychopathology , Volume 20 , Special Issue 4: Imaging Brain Systems in Normality and Psychopathology , Fall 2008 , pp. 1251 - 1283
Copyright
Copyright © Cambridge University Press 2008

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Footnotes

This work was partially supported by NIMH Grants K02 74677, 2T32 MH16434, and MH068318.

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