Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-19T11:34:22.224Z Has data issue: false hasContentIssue false
  • English
  • Français

Psychobiology of Anxiety Disorders and Obsessive-Compulsive Spectrum Disorders

Published online by Cambridge University Press:  07 November 2014

Dan J. Stein
Dan J. Stein*
Affiliation:
Dr. Stein is professor and chair of the Department of Psychiatry at the, University of Cape Townin, South Africaand professor of psychiatry at the Mount Sinai School of Medicine in New York City
*
P.O. Box 19063, Tygerberg 7505, South Africa. Tel: 27-21-404-2164; Fax:, 27-21-448-8158; E-mail:, [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Obsessive-compulsive disorder is currently classified as an anxiety disorder. However, there is growing interest in the concept of an obsessive-compulsive spectrum of disorders (OCSDs). The relationship between anxiety disorders and OCSDs has been questioned. The psychobiology of anxiety disorders and OCSDs is briefly reviewed in this article. While there appear to be several distinct contrasts in the underlying psychobiology of these conditions, there is also evidence of overlapping mechanisms. In addition, there are crucial gaps in our current database, confounding nosological decision-making. Conceptualizing various anxiety disorders and putative OCSDs as lying within a broader spectrum of emotional disorders may be useful. However, clinicians must also recognize that individual anxiety and obsessive-compulsive spectrum conditions, including disorders characterized by body-focused repetitive behaviors, have distinct psychobiological underpinnings and require different treatment approaches.

Type
Research Article
Information
CNS Spectrums , Volume 13 , Issue S14 , 2008 , pp. 23 - 28
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Press; 1994.Google Scholar
2.Stein, DJ, Hollander, E. The spectrum of obsessive-compulsive related disorders. Hollander, E, ed. Obsessive-Compulsive Related Disorders. Washington, DC: American Psychiatric Press; 1993:241–273.Google Scholar
3.Stein, DJ. Neurobiology of the obsessive-compulsive spectrum disorders. Biol Psychiatry. 2000;47:296–304.CrossRefGoogle ScholarPubMed
4.Leckman, JF, Riddle, MA. Tourette’s syndrome: when habit-forming systems form habits of their own? Neuron. 2000;28:349–354.CrossRefGoogle ScholarPubMed
5.Phillips, KA, Pinto, A, Menard, W, et al.Obsessive-compulsive disorder versus body dysmorphic disorder: A comparison study of two possibly related disorders. Depress Anxiety. 2007;24:399–409.Google Scholar
6.Fallon, BA, Qureshi, AI, Laje, G, et al.Hypochondriasis and its relationship to obsessive-compulsive disorder. Psychiatr Clin North Am. 2000;23:605.Google Scholar
7.Stewart, SE, Jenike, MA, Keuthen, NJ. Severe obsessive-compulsive disorder with and without comorbid hair pulling: comparisons and clinical implications. J Clin Psychiatry. 2005;66:864–869.CrossRefGoogle ScholarPubMed
8.Stein, DJ, Garner, JP, Keuthen, NJ, Franklin, ME, Walkup, JT, Woods, DW. Trichotillomania, stereotypic movement disorder, and related disorders. Curr Psychiatry Rep. 2007;9:301–302.CrossRefGoogle ScholarPubMed
9.Lochner, C, Simeon, D, Niehaus, DJH, et al.Trichotillomania and skin-picking: a phenomenological comparison. Depress Anxiety. 2002;15:83–86.Google Scholar
10.Stein, DJ, Simeon, D. Pharmacotherapy of stereotypic movement disorders. Psychiatr Ann. 1998;28:327–334.Google Scholar
11.Bartz, JA, Hollander, E. Is obsessive-compulsive disorder an anxiety disorder? Prog Neuro-Psychopharmacol Biol Psychiatry. 2006;30:338–352.Google Scholar
12.Hollander, E, Braun, A, Simeon, D. Should OCD leave the anxiety disorders in DSM-V? The case for obsessive compulsive-related disorders. Depress Anxiety. 2008;25:317–329.Google Scholar
13.Stein, DJ. Is disorder x in category or spectrum y? General considerations and application to the relationship between obsessive-compulsive disorder and anxiety disorders. Depress Anxiety 2008;25:330–335.Google Scholar
14.Montgomery, SA. Obsessive compulsive disorder is not an anxiety disorder. Int Clin Psychopharmacol. 1993;Suppl 8:57–62.Google Scholar
15.Nutt, D, Malizia, A. Anxiety and OCD - the chicken or the egg? J Psychopharmacol. 2006;20:729–731.CrossRefGoogle ScholarPubMed
16.Storch, EA, Abramowitz, J, Goodman, WK. Where does obsessive-compulsive disorder belong in DSM-V? Depress Anxiety. 2008;25:336–347.CrossRefGoogle ScholarPubMed
17.Stein, DJ. Cognitive-Affective Neuroscience of Mood and Anxiety Disorders. London, Martin Dunitz; 2003.Google Scholar
18.Beyenburg, S, Mitchell, AJ, Schmidt, D, et al.Anxiety in patients with epilepsy: Systematic review and suggestions for clinical management. Epilepsy & Behavior. 2005;7:161–171.CrossRefGoogle ScholarPubMed
19.Cheyette, SR, Cummings, JL. Encephalitis lethargica: Lessons for contemporary neuropsychiatry. J Neuropsych Clin Neurosci. 1995;7:125–135.Google Scholar
20.Swedo, SE, Leonard, HL, Garvey, M, et al.Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases. Am J Psychiatry. 1998;155:264–271.Google Scholar
21.Gabbay, V, Asnis, GM, Bello, JA, et al.New onset of body dysmorphic disorder following frontotemporal lesion. Neurology. 2003;61:123–125.Google Scholar
22.Ferrão, YA, Scheidt, B. Basal ganglia hemorrhagic ablation causing temporary suppression of trichotillomania symptoms. Rev Bras Psiquiatr. 2003;25:262–263.Google ScholarPubMed
23.Stein, DJ, Wessels, C, Carr, J, et al.Hair pulling in a patient with Sydenham’s chorea. Am J Psychiatry. 1997;154:1320.Google Scholar
24.Le Doux, J. Fear and the brain: Where have we been, and where are we going? Biol Psychiatry. 1998;44:1229–1238.Google Scholar
25.Davis, M, Whalen, PJ. The amygdala: vigilance and emotion. Mol Psychiatry. 2001;6:13–34.CrossRefGoogle ScholarPubMed
26.Joel, D. Current animal models of obsessive compulsive disorder: a critical review. Prog Neuropsychopharmacol Biol Psychiatry. 2006;30:374–388.Google Scholar
27.Uys, JD, Daniels, WM, et al.Animal models of anxiety disorders. Curr Psychiatry Rep. 2003;5:274–281.Google Scholar
28.Mataix-Cols, D, van den Heuvel, OA. Common and distinct neural correlates of obsessive-compulsive and related disorders. Psychiatr Clin North Am. 2006;29:391–410.Google Scholar
29.Etkin, A, Wager, TD. Functional neuroimaging of anxiety: a meta-analysis of emotional processing in PTSD, social anxiety disorder, and specific phobia. Am J Psychiatry. 2007;164.Google Scholar
30.Karl, A, Schaefer, M, Malta, LS, et al.A meta-analysis of structural brain abnormalities in PTSD. Neurosci Biobehav Rev. 2006;30:1004–1031.CrossRefGoogle ScholarPubMed
31.Sareen, J, Campbell, DW, Leslie, WD, et al.Striatal function in generalized social phobia: a functional magnetic resonance imaging study. Biol Psychiatry. 2007;61:396–404.Google Scholar
32.Whiteside, SP, Port, JD, Abramowitz, JS. A meta-analysis of functional neuroimaging in obsessive-compulsive disorder. Psychiatry Research-Neuroimaging. 2004;132:69–79.Google Scholar
33.Menzies, L, Chamberlain, SR, Laird, AR, et al.Integrating evidence from neuroimaging and neuropsychological studies of obsessive-compulsive disorder: The orbitofronto-striatal model revisited. Neurosci Biobehav Rev. 2008;32:525–549.Google Scholar
34.Cannistraro, PA, Wright, CI, Wedig, MM, et al.Amygdala responses to human faces in obsessive-compulsive disorder. Biol Psychiatry. 2004;56:916–920.CrossRefGoogle ScholarPubMed
35.Atmaca, M, Yildirim, H, Ozdemir, H, et al.Hippocampus and amygdalar volumes in patients with refractory obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry. In Press.Google Scholar
36.van den Heuvel, OA, Veltman, DJ, Groenewegen, HJ, et al.Amygdala activity in obsessive-compulsive disorder with contamination fear: a study with oxygen-15 water positron emission tomography. Psychiatry Res: Neuroimaging. 2004;132:225–237.CrossRefGoogle Scholar
37.Shapira, NA, Liu, Y, He, AG, et al.Brain activation by disgust-inducing pictures in obsessive-compulsive disorder. Biol Psychiatry. 2003;54:751–756.CrossRefGoogle ScholarPubMed
38.Stein, DJ, Arya, M, Pietrini, P, et al.Neurocircuitry of disgust and anxiety in obsessive-compulsive disorder: A positron emission tomography study. Metabolic Brain Disease. 2006;21:267–277CrossRefGoogle ScholarPubMed
39.Frey, KA, Albin, RL. Neuroimaging of Tourette syndrome. J Child Neurol. 2006;21:672–677.Google Scholar
40.Peterson, BS, Choi, HA, Hao, X, et al.Morphologic features of the amygdala and hippocampus in children and adults with Tourette syndrome. Arch Gen Psychiatry. 2007;64:1281–1291.Google Scholar
41.Rauch, SL, Phillips, KA, Segal, E, et al.A preliminary morphometric magnetic resonance imaging study of regional brain volumes in body dysmorphic disorder. Psychiatry Res: Neuroimaging. 2003;122:13–19.Google Scholar
42.Feusner, JD, Townsend, J, Bystritsky, A, et al.Visual information processing of faces in body dysmorphic disorder. Arch Gen Psychiatry. 2007;64:1417–1426.Google Scholar
43.O’Sullivan, RL, Rauch, SL, Breiter, HC, et al.Reduced basal ganglia volumes in trichotillomania measured via morphometric magnetic resonance imaging. Biol Psychiatry. 1997;42:39–45.Google Scholar
44.Stein, DJ, Coetzer, R, Lee, M, et al.Magnetic resonance brain imaging in women with obsessive-compulsive disorder and trichotillomania. Psychiatry Res. 1997;74:177–182.Google Scholar
45.Stein, DJ, van Heerden, B, Hugo, C, et al.Functional brain imaging and pharmacotherapy in trichotillomania: Single photon emission computed tomography before and after treatment with the selective serotonin reuptake inhibitor citalopram. Prog Neuropsychopharmacol Biol Psychiatry. 2002;26:885–890.Google Scholar
46.Rauch, SL, Wright, CI, Savage, CR, et al.Brain activation during implicit sequence learning in individuals with trichotillomania. Psychiatry Res: Neuroimaging. 2007;154:233–240.CrossRefGoogle ScholarPubMed
47.Carey, P, Seedat, S, Warwick, J, van Heerden, B, Stein, DJ. SPECT imaging of body dysmorphic disorder. J Neuropsychiatry Clin Neurosci. 2003.Google Scholar
48.Keuthen, NJ, Makris, N, Schlerf, JE, et al.Evidence for reduced cerebellar volumes in trichotillomania. Biol Psychiatry. 2007;61:374–381.CrossRefGoogle ScholarPubMed
49.van den Heuvel, OA, Veltman, DJ, Groenewegen, HJ, et al.Disorder-specific neuroanatomical correlates of attentional bias in obsessive-compulsive disorder, panic disorder, and hypochondriasis. Arch Gen Psychiatry. 2005;62:(8):922–933.CrossRefGoogle ScholarPubMed
50.Kopell, BH, Greenberg, B, Rezai, AR. Deep brain stimulation for psychiatric disorders. J Clin Neurophysiol. 2004;21:51–67.CrossRefGoogle ScholarPubMed
51.Linden, DEJ. How psychotherapy changes the brain--the contribution of functional neuroimaging. Mol Psychiatry. 2006;1111(6):528–538.Google Scholar
52.Bandelow, B, Zohar, J, Hollander, E, Kasper, S, Moller, H-J, and WFSBP Task Force on Treatment Guidelines for Anxiety, Obsessive-Compulsive and Posttraumatic Stress Disorders. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders. World J Biol Psychiatry. 2002;3:171–199.Google Scholar
53.Baldwin, DS, Anderson, IM, Nutt, DJ, et al.Evidence-based guidelines for the pharmacological treatment of anxiety disorders: recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2005;19:567–596.Google Scholar
54.Swinson, RP, Antony, MM, Bleau, PB, et al.Clinical Practice Guidelines: Management of Anxiety Disorders. Can J Psychiatry. 2006;51(Suppl 2):1–92.Google Scholar
55.Ipser, JC, Carey, P, Dhansay, Y, et al.Pharmacotherapy augmentation strategies in treatment-resistant anxiety disorders. Cochrane Database Syst Rev. 2006;CD005473.Google Scholar
56.Zohar, J, Hollander, E, Stein, DJ, Westenberg, HG; The Cape Town Consensus Group. Consensus statement. CNS Spectr. 2007;12(2 Suppl 3):59–63.Google Scholar
57.Hofmann, SG, Pollack, MH, Otto, MW. Augmentation treatment of psychotherapy for anxiety disorders with D-cycloserine. CNS Drug Rev. 2006;12:208–217.Google Scholar
58.Rothbaum, BO. Critical parameters for d-cycloserine enhancement of cognitive-behaviorial therapy for obsessive-compulsive disorder. Am J Psychiatry. 2008;165:293–296.Google Scholar
59.Phillips, KA. Body dysmorphic disorder: clinical aspects and treatment strategies. Bull Menninger Clin. 1998;62A4:33–48.Google Scholar
60.Bloch, MH, Landeros-Weisenberger, A, Dombrowski, P, et al.Systematic review: pharmacological and behavioral treatment for trichotillomania. Biol Psychiatry. 2007;62:839–846.Google Scholar
61.Schwartz, CE, Wright, CI, Shin, LM, Kagan, J, Rauch, SL. Inhibited and uninhibited infants “grown up”: adult amygdalar response to novelty. Science. 2003;5627:1952–1953.CrossRefGoogle Scholar
62.Hariri, AR, Holmes, A. Genetics of emotional regulation: the role of the serotonin transporter in neural function. Trends Cogn Sci. 2006;10(4):182–191.Google Scholar
63.Furmark, T, Tillfors, M, Garpenstrand, H, et al.Serotonin transporter polymorphism related to amygdala excitability and symptom severity in patients with social phobia. Neuroscience Letters. 2004;362:189–192.CrossRefGoogle ScholarPubMed
64.Guyer, AE, Nelson, EE, Perez-Edgar, K, et al.Striatal functional alteration in adolescents characterized by early childhood behavioral inhibition. J Neurosci. 2006;26:6399–6405.CrossRefGoogle ScholarPubMed
65.Smoller, JW, Rosenbaum, JF, Biederman, J, et al.Association of a genetic marker at the corticotropin-releasing hormone locus with behavioral inhibition. Biol Psychiatry. 2003;54:1376–1381.CrossRefGoogle ScholarPubMed
66.Hemmings, SMJ, Stein, DJ. The current status of association studies in obsessive-compulsive disorder. Psychiatr Clin North Am. 2006;29:411–444.Google Scholar
67.Delorme, R, Gouss, V, Roy, I, et al.Shared executive dysfunctions in unaffected relatives of patients with autism and obsessive-compulsive disorder. Eur Psychiatry. 2007;22:32–38.Google Scholar
68.Menzies, L, Achard, S, Chamberlain, SR, et al.Neurocognitive endophenotypes of obsessive-compulsive disorder. Brain. 2007;130(Pt 12):3223–3236.Google Scholar
69.Greer, JM, Capecchi, MR. Hoxb8 is required for normal grooming behavior in mice. Neuron. 2002;33:23–34.Google Scholar
70.Welch, JM, Lu, J, Rodriguiz, RM, et al.Cortico-striatal synaptic defects and OCD-like behaviours in Sapap3-mutant mice. Nature. 2007;448:894.Google Scholar
71.Pauls, DL, Towbin, KE, Leckman, JF, et al.Gilles de la Tourette’s syndrome and obsessive compulsive disorder: Evidence supporting a genetic relationship. Arch Gen Psychiatry. 1986;43:1180–1182.Google Scholar
72.Moriarty, J, Eapen, V, Costa, DC, et al.HMPAO SPET does not distinguish obsessive-compulsive and tic syndromes in families multiply affected with Gilles de la Tourette’s syndrome. Psychol Med. 1997;27:737–740.CrossRefGoogle Scholar
73.Menzies, L, Williams, GB, Chamberlain, SR, et al.White matter abnormalities in patients with obsessive-compulsive disorder and their first-degree relatives. Am J Psychiatry. 2008. [Epub ahead of print]Google Scholar
74.Keen-Kim, D, Freimer, NB. Genetics and epidemiology of Tourette syndrome. J Child Neurol. 2006;21:665–671.Google Scholar
75.Abelson, JF, Kwan, KY, O’Roak, BJ, et al.Sequence variants in SLITRK1 are associated with Tourette’s syndrome. Science. 2005;310:317–320.Google Scholar
76.Zuchner, S, Cuccaro, ML, Tran-Viet, KN, et al.SLITRK1 mutations in Trichotillomania. Mol Psychiatry. 2006;11:888–889.Google Scholar
77.Wendland, JR, Kruse, MR, Murphy, DL. Functional SLITRK1 var321, varCDfs and SLC6A4 G56A variants and susceptibility to obsessive-compulsive disorder. Mol Psychiatry. 2006;11:802–804.Google Scholar
78.Bienvenu, OJ, Samuels, JF, Riddle, MA, et al.The relationship of obsessive-compulsive disorder to possible spectrum disorders: results from a family study. Biol Psychiatry. 2000;48:287–293.Google Scholar
79.Hemmings, SMJ, Kinnear, CJ, Lochner, C, et al.Genetic correlates in trichotillomania--A case-control association study in the South African Caucasian population. The Israel Journal of Psychiatry and Related Sciences. 2006;43:93–101.Google Scholar
80.Nestadt, G, Samuels, J, Riddle, MA, et al.The relationship between obsessive-compulsive disorder and anxiety and affective disorders: results from the Johns Hopkins OCD Family Study. Psychol Med. 2001;31:481–487.Google Scholar
81.Stein, DJ. Evolutionary theory, psychiatry, and psychopharmacology. Prog Neuro-Psychopharmacol Biol Psychiatry. 2006;30:766–773.Google Scholar
82.Stein, DJ, Bouwer, C. A neuro-evolutionary approach to the anxiety disorders. J Anx Disord. 1997;11:409–429.Google Scholar
83.Stein, DJ, Liu, Y, Shapira, NA, et al.The psychobiology of obsessive-compulsive disorder: how important is the role of disgust? Curr Psychiatry Rep. 2001;3:281–287.Google Scholar
84.Boyer, P, Lienard, P. Precaution systems and ritualized behavior. Behav Brain Sci. 2006;29:635–650.Google Scholar
85.Stein, DJ. The Philosophy of Psychopharmacology: Smart Pills, Happy Pills, Pep Pills. Cambridge: Cambridge University Press; 2008.Google Scholar
86.Hemmings, SMJ, Kinnear, CJ, Lochner, C, et al.Early- versus late-onset obsessive-compulsive disorder: investigating genetic and clinical correlates. Psychiatry Res. 2004;128:175–182.Google Scholar
87.Mataix-Cols, D, Wooderson, S, Lawrence, N, et al.Distinct neural correlates of washing, checking, and hoarding symptom dimensions in obsessive-compulsive disorder. Arch Gen Psychiatry. 2004;61:564–576.Google Scholar
88.Saxena, S, Brody, AL, Maidment, KM, et al.Cerebral glucose metabolism in obsessive-compulsive hoarding. Am J Psychiatry. 2004;161:1038–1048.Google Scholar
89.Busatto, GF, Buchpiguel, CA, Zamignani, DR, et al.Regional cerebral blood flow abnormalities in early-onset obsessive-compulsive disorder: An exploratory SPECT study. J Am Acad Child Adolesc Psychiatry. 2001;40:347–354.Google Scholar
90.Giedd, JN, Rapoport, JL, Garvey, MA, et al.MRI assessment of children with obsessive-compulsive disorder or tics associated with streptococcal infection. Am J Psychiatry. 2000;157:281–283.Google Scholar
91.Mineka, S, Watson, D, Clark, LA. Comorbidity of anxiety and unipolar mood disorders. Ann Rev Psychol. 1998;49:377–412.Google Scholar
92.Stein, DJ. Comorbidity in generalized anxiety disorder: impact and implications. J Clin Psychiatry. 2001;62:29–34.Google Scholar
93.Mataix-Cols, D, Pertusa, A, Leckman, JF. Issues for DSM-V: How should obsessive-compulsive and related disorders be classified? Am J Psychiatry. 2007;164:1313–1314.Google Scholar
94.Hyman, SE. Can neuroscience be integrated into the DSM-V? Nat Rev Neurosci. 2007;8:725–732.Google Scholar
95.Stein, DJ, Lochner, C. Obsessive-compulsive spectrum disorders: a multidimensional approach. Psychiatric Clin North Am. 2006;29:343–351.Google Scholar