Images of Obsessive Compulsive Spectrum Disorders

Table of Contents

• OCD brain images
• Oppositional Defiant Disorder (ODD)
• Road Rage brain images
• Gambling Addiction
• Chronic Pain

There are a number of SPECT studies that report hyperfrontality (increased right and left anterior prefrontal cortex activity and increased anterior cingulate gyrus activity) and increased basal ganglia activity in obsessive compulsive disorder (OCD). Of interest, hyperactivity in the anterior cingulate gyrus has also been noticed in oppositional defiant disorder and violence. The anterior cingulate gyrus, which is heavily innervated by serotonergic fibers, has been postulated as being involved with shifting attention and cognitive flexibility, deficient in all of these disorders. Treatment with serotonergic antidepressants such as fluoxetine and clomipramine decrease the hyperactivity in these areas.

active front-on view heavy increased cingulate activity and right and left anterior lateral prefrontal cortex activity (together termed hyperfrontality).

OCD, Obsessive Compulsive Disorder

On the outside, Gail was normal. She went to work every day, she was married to her high school sweetheart, and she had two small children. On the inside, Gail felt like a mess. Her husband was ready to leave her and her children were often withdrawn and upset. Gail was distant from her family and locked into the private hell of obsessive compulsive disorder. She cleaned her house for hours every night after work. She screamed at her husband and children when anything was out of place. She would become especially hysterical if she saw a piece of hair on the floor, and she was often at the sink washing her hands. She also made her husband and children wash their hands more than ten times a day. She stopped making love to her husband because she couldn’t stand the feeling of being messy.

On the verge of divorce, Gail and her husband came to see me. At first, her husband was very skeptical about the biological nature of her illness. Gail’s brain SPECT study showed marked increased activity in the cingulate system, demonstrating that she really did have trouble shifting her attention.

OCD active front-on view
heavy increased cingulate activity

With this information, I placed Gail on Zoloft. Within six weeks, she had significantly relaxed, her ritualistic behavior had diminished and she stopped making her kids wash their hands every time they turned around. Her husband couldn’t believe the change. Gail was more like the woman he married.

ODD – Oppositional Defiant Disorder

13 year old boy with severe oppositional defiant disorder

front-on active view		left top-side active view
left side active view		top down active view

Road Rage

side active view
increased cingulate and left temporal lobe activity

side active view
marked increased cingulate and left lateral temporal lobe activity

37 year old male attorney who, on several occasions, chased other drivers who had cut him off and on two occasions got out of the car and bashed their windows in with a baseball bat he kept in the car. After the second incident, he came to see me. He said, "If I don’t get help for this I’m sure I’ll end up in jail." His cingulate gyrus was markedly overactive, causing him to get locked into the negative thoughts and subsequently be less able to control his frustration. His SPECT scan shows: marked increased activity in the cingulate gyrus and left temporal lobe (arrows), which correlates with irritability and overfocus issues.

Pathological Gambling

top down active view
front on active view		side active view
marked increased cingulate activity

Adam came to our office when his wife left him. His gambling had gotten out of control. In the past few years he began neglecting his business spending more of his time at the racetrack and driving back and forth to the casinos in Reno and Lake Tahoe. "I feel compelled to gamble. I know it is ruining my life, but it seems I have to place a bet or the tension just builds and builds. It is all I think about!" Adam’s SPECT study showed heavy increased cingulate activity. Explaining the cingulate system to Adam was helpful. He could identify many people in his family who had problems shifting attention. You should see our family gatherings," he told me, "someone is always mad at someone else. People in my family can hold grudges for years and years." In addition to going to Gamblers Anonymous and being seen in psychotherapy I prescribed a small dose of Prozac for him to help him shift away from the obsessive thoughts about gambling. Eventually, he was able to reconnect with his wife and rebuild his business.

Chronic Pain

top down active view
front on active view		side active view
marked increased cingulate activity

Stewart, a 40-year-old roofer, hurt his back ten years ago when he fell off a roof. He underwent six back operations but remained in constant pain. He was essentially bedridden and about to lose his family because all he could think about was the pain. The threat of losing his family catalyzed him to get a psychiatric evaluation. His SPECT revealed marked overactivity in the cingulate system. He was placed on Anafranil 200 mg. a day. After 5 weeks, he reported that his back still hurt, but he was much less focused on the pain. He was able to get out of bed and start back to school. Other researchers have also reported several cases of intractable pain that were also responsive to treatment with anti-obsessive medications.

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