The Science & Treatment of Obsessive Compulsive Disorder (OCD) | Huberman Lab Essentials

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Welcome to Huberman Lab Essentials, [music] where we revisit past episodes for the most potent and actionable science-based tools for mental health, physical health, and performance. I’m Andrew Huberman and I’m a professor of neurobiology and opthalmology at Stanford School of Medicine. Today we are talking about obsessivempulsive disorder or OCD. First of all, as the name suggests, OCD includes thoughts or obsessions and compulsions which are actions. The obsessions and the compulsions are often linked.

In fact, most of the time the obsessions and the compulsions are linked such that the compulsion, the behavior is designed to relieve the obsession. However, one of the hallmark themes of obsessivecompulsive disorder is that the obsessions are intrusive. People don’t want to have them. They don’t enjoy having them. They just seem to pop into people’s minds and they seem to pop into their mind recurrently.

And the compulsions unlike other sorts of behaviors provide brief relief to the obsession but then very quickly reinforce or strengthen the obsession. OCD is extremely common. In fact, current estimates are that anywhere from 2. 5% to as high as three or even 4% of people suffer from true OCD. That is an astonishingly high number.

Another thing to point out is that OCD is currently listed as number seven in terms of the most debilitating illnesses. Not just mental illnesses or disorders, but all types of illnesses, including things like asthma and cancer, etc. So, you can imagine with that standing at number seven that it is both extremely common and extremely debilitating. And as a consequence, it’s now realized that many hours, days, weeks, months, or even years of work performance or showing up at work of relational interactions really suffer as a consequence of people having OCD. With recurrent intrusive thoughts happening at very high frequency or even at moderate frequency, people are spending a lot of time thinking about this stuff and they’re thinking about the behaviors they need to engage in and then engaging in the behaviors which, as I mentioned before, just serve to strengthen the compulsions.

And so they’re not actually doing the other things that make us functional human beings like commuting to work or doing homework or doing work or listening when people are talking or interacting or sports or working out. All the things that make for a rich quality life are taken over by OCD in many cases. Another thing you’ll soon learn is that sadly a lot of the obsessions and compulsions in OCD often relate to taboo topics. And that’s because the general categories of OCD fall into three different bins. checking obsessions and compulsions, repetition obsessions and compulsions, and order obsessions and compulsions.

The checking ones are somewhat obvious, checking the stove or checking the locks. Repetition obsessions and compulsions obviously can dovetail with the the checking ones, but those tend to be things like counting off of a certain number of numbers like 1 2 3 4 5 6 7 6 5 4 3 2 1. People perform that repeatedly, repeatedly repeatedly or feel that they have to. So we have checking, we have repetition, and then there’s order. Order often times is thought of as putting cleanliness or making sure everything is aligned and perfect and orderly.

And often times that is the case. But there are other forms of order that people with OCD can focus on in a obsessive and compulsive way. Things like incompleteness, the idea that one can’t walk away from something or stop doing something because something’s not right or complete in that picture. It could be the way the table is set. It could be the way that something’s written on a page.

It could be an email. It can also be in terms of symmetry that everything be aligned and symmetric in some way. This could be uh seen perhaps in young kids. This is one example that I read in the literature of children that need to arrange their stuffed animals in exact same order every day and in a particular order uh to the point where if you were to move the little stuffed frog over next to the stuffed rabbit that the child will have a an anxiety reaction to that and feel literally compelled driven to fix that maybe even multiple times over and over again. And then the other aspect of order which is a little bit less than intuitive is this notion of disgust.

This idea that something is contaminated. So we often think about OCD and handwashing behavior in response to people feeling that something is contaminated, a space, a towel, etc. or even simply somebody else’s hand and so they’re unwilling to shake somebody’s hand. You can imagine how these different bins of obsessions and compulsions, checking, repetition, and order could be extremely debilitating depending on how severe they are and how many different domains of life they show up in. And I know I’ve said it multiple times now, but I’m going to say it many times throughout this episode in a somewhat obsessive, but I believe justified way that every time that one engages in the compulsion related to the obsession, the obsession simply becomes stronger.

So you can imagine what a what a powerful and debilitating loop that really is. So let’s drill a little bit deeper into how the obsessions and compulsions relate to one another. If we were to draw a line between the obsessions and the compulsions, that line could be described as anxiety. Now, we need to define what anxiety is. And to be quite honest, most of psychology and science can’t agree on exactly what anxiety is.

Typically the way we think about fear is that it’s a heightened state of autonomic arousal. So increased heart rate, increased breathing, sweating etc. in response to an immediate and present threat or perceived threat. Whereas anxiety generally speaking in the scientific literature relates to the same sorts of thought patterns and somatic bodily responses, heart rate, breathing, etc. But without a clear and present danger being in the environment or right there.

So that’s the way that we’re going to talk about anxiety. Now, and anxiety is really what binds the obsessions and compulsions such that someone will have an intrusive thought. Some people are probably wondering if there’s a genetic component to OCD. And indeed, there is. Although the nature of it isn’t exactly clear, based on twin studies where researchers have examined identical twins, fraternal twins, even identical twins that share the same sack in uterero, the what we call monocorionic, so sitting in the same little bag during pregnancy or in different little bags, you can see different levels of what’s called genetic concordance.

But if we were to just sort of cut a cut a broad swath through all of the genetic data, it’s fair to say that about 40 to 50% of OCD cases are have some genetic component, some mutation or some inherited aspect that’s genetic and that one could point to if they got their genome mapped. Now, while that’s interesting, I don’t think it’s terribly useful for most people. First of all, you can’t really control your genes. It can’t pick who your parents were, as they say. So, just know that there is a genetic component in about half of people with OCD, but not always.

Now, as is typical for this podcast, I want to focus on some of the neural mechanisms and chemical systems in the brain and body that generate obsessivempulsive disorder. So, let’s take a step back and look at the neural circuitry. What’s going on in the brain and body of people with OCD? Why the intrusive recurrent thoughts? Many studies, we can fairly say dozens, if not hundreds of studies have now identified a particular circuit or loop of brain areas that are interconnected and very active in obsessivempulsive disorder.

That loop includes the cortex which is kind of the o