Contemporary perspectives on cognitive-behavioral and neuropsychological models of Obsessive-Compulsive Disorder.

Obsessive compulsive disorder (OCD) is characterized by persistent, intrusive, and distressing obsessions (unwanted thoughts, impulses, or images) that may or may not be accompanied by compulsions (repetitive behaviors or mental acts). It is a severe and persistent psychological problem with significant negative effects on the individuals’ social, family, and occupational functioning. Biological models of OCD have strongly suggested an underlying brain dysfunction, centred primarily in the orbital frontal cortex and basal ganglia. As a consequence, many studies have been conducted to discover possible neurobiological deficits associated with OCD. On the other hand, psychological models have focused on cognitive appraisals of thoughts. This model posits that obsessions arise from the misinterpretation of normal intrusive thoughts (e.g., misinterpreting unwanted harm-related thoughts as a sign that one is going to act on them). This leads the person to perform compulsions in order to neutralize the thoughts (i.e., checking to ensure that a harm-related thought did not lead to harm befalling someone). Whereas biological and psychological models describing OCD have been developed, as yet none fully account for the diverse symptom presentation of the disorder. The present paper, therefore, has two primary aims. The first is to report on recent research examining neurobiological functioning in OCD, including neuropsychological test data and functional neuroimaging studies. In conjunction with the first aim, a summary of recent findings on the dominant psychological model will be reviewed. For each of these models, specific limitations in depicting the full scope of OCD will be highlighted. The second aim will focus on how each of these models may inform the other, in an effort to integrate and offer an early proposal for a new model of OCD that will better account for the diverse range of symptoms associated with the disorder. Included in this proposal will be the possibility of computational modeling of obsessive-compulsive symptoms (i.e., neural network, multinomial processing tree account), and recommendations for future research. In conclusion, with this paper we hope to offer a general view of the state-of-the art of the most recent psychological and neurobiological research on OCD and suggest how to go further in order to improve our comprehension and treatment procedures of this debilitating disorder.