Lecture – The Circuits That Underlie Deep Brain Stimulation Targets for OCD

Presented by Suzanne N. Haber, PhD, and Jason Krompinger, PhD, McLean Hospital – Crossroads in Psychiatry lecture

Deep brain stimulation is a promising therapeutic approach for patients with treatment-resistant obsessive compulsive disorder (OCD). Moreover, when patients are encouraged to look at OCD as a biological brain disorder that can be addressed through biological interventions, they are often more open to treatment.

Dr. Suzanne Haber is a McLean Hospital visiting scientist from the University of Rochester. Dr. Jason Krompinger is the director of Psychological Services and Clinical Research at McLean’s OCD Institute. Together, they share perspectives on this topic.

Watch now to learn more about:

• Brain structures and circuits involved in OCD
• The circuits affected by deep brain stimulation (DBS) for OCD
• How anatomy can inform diffusion MRI studies and help focus DBS targets
• The role that understanding neurobiological bases of OCD plays in helping patients make sense of their condition
• How the “compulsive obsessive disorder” model of conceptualizing OCD may help patients understand ego-dystonic experiences.
• The ways that seeing OCD as a biological brain disorder can help patients access core processes in augmentative treatment, such as acceptance and commitment therapy

In this lecture, Haber explains how OCD is linked to abnormalities in certain cortico-basal ganglia networks in the brain. She reviews the circuits most often associated with OCD and explains how deep brain stimulation can impact these targeted circuits. Haber studies a combination of nonhuman primate anatomy and diffusion MRI in both nonhuman primates and humans. She examines the similarities and differences of the connections in these four circuits.

Building on Haber’s remarks, Krompinger discusses how thinking of OCD as a biological brain disorder helps patients better understand their condition and take part in treatment. The symptoms of OCD can be particularly isolating, he reports. This sense of isolation can lead to behaviors and thoughts that are inconsistent with beliefs. This is also known as ego-dystonia.

By thinking of the condition as compulsive obsessive disorder rather than OCD, Krompinger says that patients can come to better understand their symptoms and address their ego-dystonic feelings.

Moreover, emphasizing the neurological underpinnings of OCD can help reduce the stigma and shame often associated with the condition. For patients who are resistant to medications or intensive treatments for OCD, “just knowing that there’s a brain explanation” can increase patients’ willingness to engage in therapy, Krompinger says.