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You've Heard of OCD, but Do You Really Understand It?
Dr. Helen Blair Simpson of Columbia University Medical Center continues our series "Big Thinkers on Mental Health" with an informative crash course on the intricacies of Obsessive-Compulsive Disorder.
Helen Blair Simpson, M.D., Ph.D., is Professor of Psychiatry at Columbia University Medical Center and Director of The Center for Obsessive-Compulsive and Related Disorders. She is also the Director of the Anxiety Disorders Clinic at the New York State Psychiatric Institute. Dr. Simpson’s research program focuses on how to improve treatments for people with obsessive-compulsive disorder (OCD) and related disorders so that these people can live productive lives.
Dr. Helen Blair Simpson: We all have intrusive thoughts from time to time and many of us, for example, will check whether we have our airplane ticket before going to the airport more than once. That isn’t OCD.
To have OCD, you have to have obsessions and compulsions that impair your life and are highly distressing. And a sort of a rulebook would be maybe at least an hour a day, but most of the patients that I work with will obsess and compulse for hours a day and really their life can be ruined. I have some patients that will come to me and say look, I know I don’t need to be washing my hands like this, but I can’t stop. And I have other patients who are really not sure, really not sure — I mean they really believe that if they don’t wash maybe they’ll actually get ill.
So there’s that sort of range of insight. It’s also true that someone in my office can say, you know, I know the subway is safe and I could touch that pole, but if I walk onto the subway with them doing an exposure and ask them to touch the pole in front of me they lose their ability to, you know, remember that this isn’t going to kill them.
So Obsessive-Compulsive Disorder or OCD is a disorder where patients have obsessions and compulsions. And obsessions are intrusive thoughts, images, or urges that they find very distressing and are very repetitive. And compulsions are behavioral acts or mental acts, things they do in their head over and over again to try to reduce the distress that obsessions cause or to follow specific rules. So while all patients with OCD have obsessions and compulsions, the content of the obsessions and compulsions can really vary.
So one type of patient can have intrusive concerns about contamination and they may be washing, doing elaborate washing rituals. A different patient might have intrusive thoughts about harming either other people or harm befalling themselves. And they, for example, might have rituals of checking to make sure that the harm didn’t happen. Yet another type of OCD patient might have what’s called just-so OCD where everything has to be either arranged or ordered in a certain way or they have to actually do things in a certain way. And they may be repeating and rearranging and organizing all day long. And finally there’s a group of people who have what we call intrusive taboo thoughts. It can be about sex or religion or violence. And often these are images that they have and again they might have elaborate rituals to reassure themselves that they actually didn’t actually commit any of these acts.
Now it’s not like OCD patients only have one, you know. Often OCD patients have more than one of these types of obsessions and compulsions together. But that’s sort of a flavor. So there’s a sort of a simple version, right. Fear of contamination with washing rituals. But OCD can get really, you know, sort of far out so, for example, I once worked with someone who believed California was contaminated. And so what it meant was she couldn’t have anything in her apartment that had the name California in it. If an envelope had once arrived to her mailbox that had California on it her mailbox then became contaminated. Or, for example, intrusive harm befalling.
I’ve had patients who worry that maybe they’ve driven over someone as they drive and so they can’t make it to work because they’re going around and around the intersection to make sure that they haven’t run someone over. But the harm can also be very, very abstract — not as concrete as that, but very, very abstract. So, you know, there are many, many, many versions of OCD. What we know is that when you do brain-imaging studies of people with OCD and you compare their brain to the brain of people who don’t have OCD, that there’s a hyperactive circuit in the brain that’s been linked to OCD and that hyperactivity in that circuit has been confirmed through animal studies. And we don’t think it’s only that circuit.
We think there are other circuits that are likely involved as well, but there’s a real clear neuroscience of this behavior of obsessions and compulsions. How did the brain get that way? And here we know less about that. What we do know is that in some families, but not in all families, OCD seems to run in those families. And certain genetic studies suggest that there is a familial contribution to OCD, but again, not in all cases. But exactly how that particular brain circuit went awry in that particular patient, we don’t know that. We’re working on it, but we don’t know yet.
Big Think and the Mental Health Channel are proud to launch Big Thinkers on Mental Health, a new series dedicated to open discussion of anxiety, depression, and the many other psychological disorders that affect millions worldwide.
In the second video in the series, Dr. Helen Blair Simpson, director of the Center for Obsessive-Compulsive and Related Disorders at Columbia University, paints a vivid portrait of the many different versions of OCD. Even though it's a well-known anxiety disorder, OCD is also one of the most misunderstood, so it's important to educate ourselves on what our peers who suffer from it are going through. Dr. Simpson runs through variations of OCD, offers some extreme examples from her patients, and details what we've learned from brain scans of OCD sufferers.
Are we genetically inclined for superstition or just fearful of the truth?
- From secret societies to faked moon landings, one thing that humanity seems to have an endless supply of is conspiracy theories. In this compilation, physicist Michio Kaku, science communicator Bill Nye, psychologist Sarah Rose Cavanagh, skeptic Michael Shermer, and actor and playwright John Cameron Mitchell consider the nature of truth and why some groups believe the things they do.
- "I think there's a gene for superstition, a gene for hearsay, a gene for magic, a gene for magical thinking," argues Kaku. The theoretical physicist says that science goes against "natural thinking," and that the superstition gene persists because, one out of ten times, it actually worked and saved us.
- Other theories shared include the idea of cognitive dissonance, the dangerous power of fear to inhibit critical thinking, and Hollywood's romanticization of conspiracies. Because conspiracy theories are so diverse and multifaceted, combating them has not been an easy task for science.
A growing body of research suggests COVID-19 can cause serious neurological problems.
- The new study seeks to track the health of 50,000 people who have tested positive for COVID-19.
- The study aims to explore whether the disease causes cognitive impairment and other conditions.
- Recent research suggests that COVID-19 can, directly or indirectly, cause brain dysfunction, strokes, nerve damage and other neurological problems.
Brain images of a patient with acute demyelinating encephalomyelitis.
COVID-19 and the brain<p>A growing body of research reveals alarming neurological complications among COVID-19 patients. On Wednesday, for example, researchers from University College London published a <a href="https://academic.oup.com/brain/article/doi/10.1093/brain/awaa240/5868408" target="_blank">study</a> in the journal Brain that describes how some patients have suffered temporary brain dysfunction, strokes, nerve damage, and other neurological problems concurrent with COVID-19.</p><p>Some patients suffered brain inflammation as a result of a rare disease called acute disseminated encephalomyelitis, which can cause numbness, seizures, and confusion. One patient in the study even hallucinated monkeys and lions in her home.</p>
Photo by Mario Tama/Getty Images<p>A separate study published in the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7198407/" target="_blank">Journal of Clinical Neuroscience</a> notes that some COVID-19 patients have also suffered neurological complications like impaired consciousness and acute cerebrovascular disease. The study notes that past viruses like MERS and SARS also seemed to cause neurological problems.</p><p>A troubling finding among this growing body of research is that some patients seem to suffer neurological damage even when respiratory symptoms aren't obvious. Additionally, scientists aren't sure whether damage from the disease will be permanent.</p><p style="margin-left: 20px;">"Given that the disease has only been around for a matter of months, we might not yet know what long-term damage COVID-19 can cause," Dr. Ross Paterson, joint first author of the University College London study, said in a <a href="https://www.eurekalert.org/pub_releases/2020-07/ucl-iid070620.php" target="_blank">press release</a>. "Doctors needs to be aware of possible neurological effects, as early diagnosis can improve patient outcomes."</p><p>If you've been diagnosed with COVID-19 and want to enroll in the study, visit <a href="https://www.cambridgebrainsciences.com/studies/covid-brain-study" target="_blank">cambridgebrainsciences.com/studies/covid-brain-study</a>.</p>
Construction of the $500 billion dollar tech city-state of the future is moving ahead.
- The futuristic megacity Neom is being built in Saudi Arabia.
- The city will be fully automated, leading in health, education and quality of life.
- It will feature an artificial moon, cloud seeding, robotic gladiators and flying taxis.
The Red Sea area where Neom will be built:
Saudi Arabia Plans Futuristic City, "Neom" (Full Promotional Video)<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="c646d528d230c1bf66c75422bc4ccf6f"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/N53DzL3_BHA?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span>
Coronavirus layoffs are a glimpse into our automated future. We need to build better education opportunities now so Americans can find work in the economy of tomorrow.
- Outplacement is an underperforming $5 billion dollar industry. A new non-profit coalition by SkillUp intends to disrupt it.
- More and more Americans will be laid off in years to come due to automation. Those people need to reorient their career paths and reskill in a way that protects their long-term livelihood.
- SkillUp brings together technology and service providers, education and training providers, hiring employers, worker outreach, and philanthropies to help people land in-demand jobs in high-growth industries.
Source: McKinsey Global Institute analysis [PDF]<p>Work in understanding the skills at the heart of the new digital economy is leading to novel assessments that allow individuals to prove mastery to faithfully represent their abilities—but also to give weight and stackability to the emerging ecosystem of micro-credentials that make education more seamless across time and education providers. And we are seeing the beginnings of a renewal in the liberal arts, focused on building human skills in affordable ways that are accessible to many more individuals and far more effective.</p><p>Amidst these dark times, there is much opportunity to refresh the nation's education and training solutions to support the success of individuals and society writ large.</p>