Plans


So, here I am.

Two times I tried to start a new blog on OCD, with the intent to make that more structured, hierarchical, more accessible.

It did not work out.

First thing is: you have to re-write so many things you already talked about, and that is boring. I re-read numerous entries with the benefit of a perspective from  huge distance in time. And hey! I could well live with what I wrote. People with OCD tend to be afraid of the unknown (in many walks of life). I thought beforehand: hm, what bloopers will I encounter?

I was pleasantly surprised. So I think it’s more fruitful to diligently work my way forward. And I want to construct a handy search/index function to help readers get immediate access to a topic of special interest.

There have been fine new discoveries in the scientific field of OCD. ‘Fine’, in terms of providing hope for better treatment. I will write about that.

Another field of interest, relatively new to me, is: autism, or rather: autism spectrum disorders (ASD), as it’s called now in DSM-V, the diagnostical manual in psychiatry. Autistic conditions share quite some ground with OCD. I will delve into that shortly. Even more broadly speaking: there are canny similarities between ASD, OCD, and substance use disorders (SUD). I think that the two disorders apart from OCD will get an important place in the blog.

Finally: what struck me in the study of the above three conditions was that one inevitably gets confronted with the question: what is free will? I don’t think I will solve this question that is as old as mankind itself. But there are intriguing indications from neuroscience, that give us a bit of insight into brain areas that have to do with aspects of our will, with our ability to make choices, informed choices.

People with OCD know that that what they do is odd, unnecessary, not normal. That is has the potential to damage their relationship, their occupational life, perhaps their own life, in the end. But they can’t stop their compulsive behaviours. Same goes for people who drink way too much alcohol. The proper balance has gone out of the window. One can say: I can see that my excessive washing behaviour makes me unable to keep appointments. My boss is complaining. He’s losing his patience. I may get unemployed. So from a rational point of view, I know that I’d be better off to limit my showering to ten minutes in the morning. But I can’t stop! I begin, and suddenly it’s 90 minutes later! I just can’t stop! It’d even be better to go to work with only my face cleansed and some deo on, than have to live this dangerous way! Help!

Free will is impaired. That person does something he very consciously does not want to do.

A conundrum, in many respects – and an unseen, but terrible human drama.

Existence may be at stake.

Edit:

I just discovered a new science article of great interest. I will read it; for now I will leave you with its abstract:

Neuromodulation. 2016 Feb 21. doi: 10.1111/ner.12405. [Epub ahead of print]

Psychosurgery Reduces Uncertainty and Increases Free Will? A Review.

Abstract

OBJECTIVE:

A definition of free will is the ability to select for or against a course of action to fulfill a desire, without extrinsic or intrinsic constraints that compel the choice. Free will has been linked to the evolutionary development of flexible decision making. In order to develop flexibility in thoughts and behavioral responses, learning mechanisms have evolved as a modification of reflexive behavioral strategies. The ultimate goal of the brain is to reduce uncertainty inherently present in a changing environment. A way to reduce the uncertainty, which is encoded by the rostral anterior cingulate, is to make multiple predictions about the environment which are updated in parallel by sensory inputs. The prediction/behavioral strategy that fits the sensory input best is then selected, becomes the next percept/behavioral strategy, and is stored as a basis for future predictions. Acceptance of predictions (positive feedback) is mediated via the accumbens, and switching to other predictions by the dorsal anterior cingulate cortex (ACC) (negative feedback). Maintenance of a prediction is encoded by the pregenual ACC. Different cingulate territories are involved in rejection, acceptance and maintenance of predictions. Free will is known to be decreased in multiple psychopathologies, including obsessivecompulsive disorder and addictions.

METHODOLOGY:

In modern psychosurgery three target structures exist for obsessive compulsive disorder and addiction: the dorsal ACC, the nucleus accumbens, and/or the anterior limb of the internal capsula. Research in all three areas reports favorable results with acceptable side effects. Psychosurgical interventions seem to exert their effect by a common final common pathway mediated via the pregenual ACC.

CONCLUSION:

Successful neuromodulation increases the capacity to choose from different options for the affected individual, as well as inhibiting unwanted options, therefore increasing free will and free won’t.

© 2016 International Neuromodulation Society.

 

 

 

 

 

Thanks To All, I Made A Decision


Hi dear friends, followers, and incidental tourists –

I won’t bother you with this blog’s history. I had periods when I wanted to re-write the whole affair. I had other periods when I wanted to ‘loot’ my own work and build a new blog on OCD in a different way.

Then I realized: I got thoughtful and positive replies. Some 80,000 folks took the trouble to take a look. Probably it was the OCD itself that made me think: hey Frank, it’s not good enough… you can do better! Make the perfect blog that will be perfect forever!

Now I think: aw, why take all that unnecessary trouble? Continue this baby, man, you may well cite yourself every now and then, there’s a lot in there already, and there are many new developments as for the research in the neurobiology of OCD, and its treatment.

So: cheers for all your comments and your praise. This is the one. It will be maintained and expanded.

Best from Dutch Frank!

Dear faithful followers, please take notice (OCDINFORMATION getting awake again)


Hello everyone –

new additions to this site have been very scarce. The main reasons for this virtual hibernation are OCD-related, but also a late diagnosis of ASD (autism spectrum disorder) played a huge part. I hope to write some chapters dedicated to these matters – because I think we can learn from such issues, and thereby turn not-so-positive experiences into helpful stuff.

I played around with starting a new blog, and integrate my older postings into the new one, which should be more structured. But this project didn’t have a real lift-off, for the above – yet.

Now that my circumstances got more stable, I just said to myself: please, Frank, don’t ruminate on how it should turn out, that new blog, don’t get stuck in the planning phase (hallmarks of OCD).

So I just started.

So I have the pleasure of inviting you to the new beast. It’s scope is wider: since OCD has a few pretty close brethren, it will also be about ASD, and SUD (substance use disorder, or addiction). In addition, I will write about clinical depression (major depressive disorder, MDD), and schizophrenia (SCZ).

Yes, it’s much, very much. It’s about disorders that are devastating and incapacitating, I can’t emphasize that enough. I hope to raise awareness about these diseases a bit.

But it is also rewarding. Insight means knowledge. It also offers mental handles to properly and decently deal with patients. The knowledge will eventually become part of one’s intuition. I went through this process myself, and it’s a great route to go.

Together we can gradually eliminate misconceptions, misunderstandings, ignorance, things that can have damaging consequences for sufferers of the above afflictions.

Now I have the honour to re-direct you, readers, to the Son Of This Site, namely: That Site:

http://www.antidisestablishmentarianismology.wordpress.com

(Please don’t laugh…)

It’s in its infancy, of course.

Finally, I want to thank all of you for tuning in again and again. And sending nice compliments… only yesterday I found a sidebar with your messages, and I must admit that I shed a couple of tears, because my first effort meant something to people out there.

Thank you. Very much so.

Best to all, Frank.

An Article On Hoarding in ‘The New Yorker’


Hi folks –

in my book the New Yorker is the finest magazine on Earth.

They published an article on hoarding; the seemingly endless collecting of things that the patient won’t, or is unable to, do away with. ‘Things’ is a broad concept here. It can comprise objects its owner holds dear, the way any collector loves his stuff: books, paintings, furniture, watches, cameras, ah well, why not include butterflies, pressure cookers, or coffee beans?

In hoarding, however, it’s gone out of hand, in two senses: the objects clutter precious living space, they’ve become obstacles, they can lead to accidents, to social isolation, up to making any kind of normal life impossible.

The second sense: hoarding often isn’t limited to meaningful objects alone, or even is all about being unable to discard things that others would have gotten rid of long ago in no time. The typical hoarder is vexed by doubt: can I throw this or that away, or is it of any value still? What should I do?

The rather problematic outcome is that the hoarder ends up with keeping everything. To end the doubt, and to end the worries about possibly getting rid of worthwhile stuff.

And the picture isn’t complete yet. Many hoarders are sentenced to live in ever more squalid surroudings; food residues, with vermin in and around them, are not an exception. Because getting evicted from their living quarters frequently is the result of their mental inability, they may end up homeless.

It’s nothing to laugh about, and in my opinion, sensational real-life TV garbage (how fitting a term!) about the disorder (that is what it is) are completely inappropriate, untoward. One should never derive feelings of pleasure from, or let oneself be entertained by the misfortune of others.

That stinks, folks.

Until a couple of years ago, hoarding firmly belonged to the core dimensions of OCD: contamination/washing, checking, order and symmetry, and religious/sexual preoccupations (with intrusive, unstoppable trains of thought).

But nowadays it’s seen as a disorder of its own, related to OCD (included in its spectrum). This on the grounds of several distinctive characteristics, e.g. the way hoarders respond to therapy and medication, possibly also genetic differences.

I myself had rather seen it stay within the ‘traditional’ group of ‘authentic OCD forms’, so to speak. There are phenomenogical reasons (obsessional and compulsive traits, avoidance behaviour); and also evolutionary correspondences that exist between hoarding and the other OCD dimensions. This is more than sufficient to keep it in its original class, I think that there are other and very convincing criteria apart from the way hoarders respond to treatment.

OK, enough for now, and here is the link to the New Yorker article. I would appreciate it very much if you, readers, would post your opinions about it, and also, should you feel like it, give a comment on my personal opinion about the place of hoarding in the scheme of things.

http://www.newyorker.com/magazine/2014/12/15/let-go

OCD and addiction disorders


Dear readers –

this is meant as a brief preview:

there seem to be intriguing similarities between OCD and substance use disorders (SUDs). One of the key terms here is: inhibition, or perhaps better: deficits in inhibition.

I won’t go into the question whether ‘free will’ plays a role here, that is for later. Folks having OCD, and these include yours truly, know that OCD never was ‘wanted’ in the first place; it is something that comes over you and that you can’t do anything about; eventually it may hijack that what others see as their personal freedoms, life choices, and it may severely incapacitate and impair one’s quality 0f life in all aspects.

Substance addiction is increasingly believed to limit the volitional capacities of an addict along similar lines, and seen in this light, expressions like ‘weak willpower’ or ‘lacking character’ are insults, and not to be used to coerce addicts into abstinence, or more sober life.

People with OCD, as well as those with SUDs, are, metaphorically speaking, ‘sentenced’ to do what they do. Their choices are limited. There are people who lose their partner, their job, perhaps more, through OCD, and the same applies to people who are addicted.

I think that both groups have, by some imbalance in their brain, to choose the short-term type of decreasing intense fears over other considerations. One may have important job application appointment, and still be under the shower for two hours after the appointment already was canceled by the potential employer (my example).  An addict may visualize his life partner leaving her/him, say, in two months time if she/he doesn’t stay sober, and still the drug has to be taken to find a form of inner peace.

These behaviours defy anything that is understood as: common sense, grip on reality, or, more precisely put: rational behaviour.

The rituals, be they intrusive thoughts and accompanying rituals (including habits in a motor system sense of the word) have to be performed first, no matter what, and even if the patient realizes in full what she/he is putting at stake. Fear and anxiety overrule reason, at great cost.

Now, I hear some people thinking: but hey, in how far are people with SUDs to be blamed for their behaviour? They started taking their substances themselves in a situation where their will was unimpaired, no?

That in itself might be true, but in a much more limited way than we thought,  is the modern take on these things.  People may have a disposition towards ingesting substances in ever increasing quantities; of a genetic and environmental nature, and as a means to suppress social anxiety, for instance.

There are many questions in this field, that may get partially resolved in the near future. I will return shortly with more detailed information on this topic.

Welcome again, thanks for visiting, and future plans


Hello all –

a fine day for everyone (it’s near 8 AM here in Holland).

In the near future I will include topics like: the things OCD and substance use disorders (SUDs) have in common, and links between OCD and autism spectrum disorders. Interesting new material on these matters has, um, materialized.

Meanwhile, progress has been made in treatment for refractory OCD (which is a difficult beast,  hardly responsive to cognitive behavioural therapy and current types of medication). Deep brain stimulation (DSB)  looks like an effective means for decreasing symptoms. Also, there is rTMS, transcranial magnetic stimulation (non-invasive), which seems to be a promising technique for combating OCD symptoms.

Best to all, hope to see you soon,

Frank.

It’s Nov 16, 2014, Folks


…apparently something went wrong with the date of my previous post.

It is Nov 16, 2014, now, and I just wrote that I will continue the present blog.

Best to all, Frank.