OCD, Why Is It A Neurological Disorder?

At the risk of repeating myself: OCD is a neurological illness. That is something I find important to emphasize. OCD and other anxiety and mood disorders are still viewed by many to be the product of a ‘warped mind’, something immaterial. Something that cannot be seen, not even if you were to lift the skull of a person; a figment of the imagination. Perhaps even something simulated by persons who want to exempt themselves from society, in one way or another. I happen to know of politicians who really use such an opinion to win over voters who are at best ignorant, and at worst really malicious and greedy (after all: treatment and benefits for patients with mental problems cost taxpayers’ money).

People can’t simulate a disorder like OCD. No one ever can be always ‘on guard’, and continuously monitor themselves as to their ‘performance’ of the role of patient.

Moreover, OCD does have a biological substrate, or better: it does have several biological substrates in the brain; areas that are affected, that are associated with the disorder. Note the use of the word ‘associated’, it’s important. Scientists use it to make clear that one state of things is somehow occurring together with another state of affairs, without assuming causality in one direction or another. Something that co-occurs with something else can be the cause of that other phenomenon; or it can be the consequence; or both can be related to a third and as yet unknown, unidentified substrate or state.

Many findings in research are suggestive; if a certain area of the brain is known to be involved in the processing of fear, and we present a photo of a fearful event to a test person; and if that area in our subject gets very active in our laboratory, as seen on some scanning picture – then it is highly tempting to jot down: fearful photo causes hyperactivity in this or that area.

That is not totally wrong, but it’s overenthusiastic in its claim. We don’t know all the variables. We don’t know whether the subject will react that way with only this type of photo, or with just any photo (perhaps the person has a hitherto unknown disorder called ‘photophobia’…). Or he/she is very afraid of having a scan made of the brain. Or the researcher just brings about a lot of fear after a certain amount of time. Or second, third, fourth as yet unknown brain areas are the true cause of our ‘suspect’ area showing a lot of activity.

And that is why we must be cautious with assuming direct causality. Therefore, we use terms like ‘association’, or ‘correlation’. Yes, we keep our options open that way, but it’s not because we are cowards. We are careful.

Now, what do we know about brain areas (also called: ‘regions of interest’, ROIs) potentially involved in OCD? A lot, in fact. What’s more: despite all due caution we have to observe, the actual function of several brain areas, and the symptoms observed in OCD lend credibility to what we can see in scientific assessments. The results of these are related to:

  • the metabolism of nerve cells
  • the viability of nerve cells
  • the activity in a number of ROIs
  • the size of some ROIs
  • the shape of some ROIs
  • the connections between different ROIs
  • the actual parts that ROIs play in complex circuits

For now, I will leave you with some posh names to remember: major brain ‘players’ in OCD are:

  • the cortex
  • the basal ganglia
  • the thalamus
  • the insula
  • the corpus callosum
  • the amygdala
  • the cerebellum


Most likely, there are more ROIs.  But this list will suffice for now.












6 responses to “OCD, Why Is It A Neurological Disorder?

  1. citation please?

    • Hi Meky –

      I have no reference here. Because the idea is my own. The problem is: in psychiatry, one always is steering somewhere between ‘mind’ and ‘matter’. It is like tightrope walking.

      Consider how we talk about these things. Veering too much toward the ‘matter’ side, one may lose onself in reductionism, in obsessing (sic) over molecules, and how they interact – and it’s a pitfall to forget that a whole human being is involved.

      Bending over toward the mind/spiritual side, talk may get woolly. This approach can be responsible for rather vague discourse, that is potentially endless. Concepts get introduced that lack a proper definition.

      I experienced that naming OCD (or, for that matter, depression, schizophrenia, and more) neurological diseases has one important effect on people who are full of shame, anxious for that alone, feel totally isolated from ‘the normal ones outside’: the feel a certain relief, ease of mind, even in all their trouble. That is because where they formerly thought: what’s wrong with me? Am I mad (or bonkers, in the U.K.)? Help! Where will it all end? And presenting OCD this way, they feel ‘normally ill’, if such a term is apt. Parkinson’s is neurological. OCD certainly has serious biological associations in the brain (differently working routes between cortex, striatum, thalamus, and back to cortex); the orbitofrontal cortex (OFC), anterior cingulate cortex (ACC), and dorsolateral prefrontal cortex (DLPFC) work different. Neurotransmitter levels and their functioning is different. The metabolism of neurons is different in many regions. I find all of this more than convincing enough to call OCD a neurological disorder.

      I hope I could be of some service to you here, and: thanks for dropping by and asking, of course!

      Best, Frank in Holland.

  2. christel klein

    Hi Frank in Holland!
    My daughter suffers from OCD and receives treatment. I spent this weekend at a Fascia and Trauma Release Course in South Africa. We also very briefly touched on the subject of of neurology and pain management and somehow it dawned on me that the key for my daughters suffering is in neurology.
    Your post is from 2011.
    Please give some advice on reading material or where to go from here!
    Thank you
    Regards Chris, South Africa

    • Hello Christel –

      thank you for your nice post. As you may have noticed, I returned in January after quite an absence. I will delve into your question, and write back.

      Best, Frank.

  3. Hi Frank.
    Thanks for feedback.
    I’m busy reading Bessel v. d. Kolk’s “The Body keeps the score” as well as David Berceli “Shake it off Naturally”. Mind blowing! My daughter is having TRE sessions once a week and Fascia realease treatment when ever she feels stressed and cant get out of OCD thoughts. Its so easy to do at home and became a really importent part of her “tool box”!
    We still have bad days but in general she is able to cope thanks to sessions with the psychologist and what we learned with TRE and Fascia Release. The TRE makes a big difference and we haven’t been to the psychologist since beginning of December. And despite several recommedations from the psychologist we are still without drugs!
    I just wish all the different “specialists” would appriciate each other more and work together in a holistic way of matter/mind/and spirit. How amazingly we could all move forward …
    Regards from SA

    • Hello Christel –

      …and thanks to you for your quick heads-up! I am happy that your daughter is coping well with her symptoms, without having to resort to medication. I will look into the books and the treatments you mention – I am always eager to learn new things. And most of the times, drugs are a rather quick fix to remedy the symptoms, which they certainly not always do… what they always bring, however, are side-effects, and these are never positive.

      In our times, quick effects are desirable, for nearly everywhere in the world there have been serious, and often damaging cuts in mental health care. So long-term treatments become less and less available (in terms of: being re-funded by medical insurance for the average citizen). And many people’s work security has gotten eroded by politics of austerity, so they feel threatened by prospects of an imminent loss of their job, which is a motive for seeking precisely the ‘quick fix’ for mental problems.

      I will return to you in the future.

      Meanwhile, I wish you and yours all the best,


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