Neural correlates of obsessive–compulsive related dysfunctional beliefs

https://doi.org/10.1016/j.pnpbp.2013.07.016Get rights and content

Highlights

  • We investigated the neural correlates of OCD-related dysfunctional beliefs.

  • In healthy subjects, they were correlated with the volume of the anterior temporal lobe (ATL)

  • OCD patients showed a significant bilateral reduction of the ATL volume

  • Integrating biological and cognitive models can help to disentangle OCD

Abstract

There have been few attempts to integrate neurobiological and cognitive models of obsessive–compulsive disorder (OCD), although this might constitute a key approach to clarify the complex etiology of the disorder. Our study aimed to explore the neural correlates underlying dysfunctional beliefs hypothesized by cognitive models to be involved in the development and maintenance of OCD. We obtained a high-resolution magnetic resonance image from fifty OCD patients and 30 healthy controls, and correlated them, voxel-wise, with the severity of OC-related dysfunctional beliefs assessed by the Obsessive Beliefs Questionnaire-44. In healthy controls, significant negative correlations were observed between anterior temporal lobe (ATL) volume and scores on perfectionism/intolerance of uncertainty and overimportance/need to control thoughts. No significant correlations between OBQ-44 domains and regional gray matter volumes were observed in OCD patients. A post-hoc region-of-interest analysis detected that the ATLs was bilaterally smaller in OCD patients. On splitting subjects into high- and low-belief subgroups, we observed that such brain structural differences between OCD patients and healthy controls were explained by significantly larger ATL volumes among healthy subjects from the low-belief subgroup. Our results suggest a significant correlation between OC-related dysfunctional beliefs and morphometric variability in the anterior temporal lobe, a brain structure related to socio-emotional processing. Future studies should address the interaction of these correlations with environmental factors to fully characterize the bases of OC-related dysfunctional beliefs and to advance in the integration of biological and cognitive models of OCD.

Introduction

Obsessive–compulsive disorder (OCD) has a complex biopsychosocial etiology that no single theoretical model appears capable of explaining. Prevailing models are based on quite different approaches, ranging from neurobiological to cognitive explanations which, to date, have proven difficult to integrate. On the one hand, neurobiological models emphasize the involvement of different cortico-striatal circuits and possibly amygdalo-cortical connections in the pathophysiology of the disorder (Graybiel and Rauch, 2000, Milad and Rauch, 2011). Cognitive models, on the other hand, stress the importance of dysfunctional beliefs in the development and maintenance of the disorder (Clark and Purdon, 1995, Salkovskis, 1985). According to such models, anxiety and compulsive behaviors do not stem directly from the patient's obsessions but from the erroneous and maladaptive beliefs regarding the meaning and consequences of these intrusive phenomena (Abramowitz et al., 2007).

Studies that seek to reconcile both neurobiological and cognitive perspectives are likely to be relevant for further elucidating the etiology of OCD. Within the domain of dysfunctional beliefs, five have been specifically linked to the development and maintenance of OCD: 1) inflated responsibility, 2) thought–action fusion and other beliefs concerning the overimportance of the consequences of one's thoughts, 3) excessive concern about the importance of controlling one's thoughts, 4) overestimation of the probability and severity of threat, and 5) intolerance of uncertainty. Perfectionism is also considered an important belief domain, although not exclusive to OCD (Obsessive Compulsive Cognition Working Group, OCCWG, 1997). Although once hypothesized to relate almost exclusively to environmental factors (Rachman, 2004), a recent twin study suggests that these obsessive–compulsive (OC)-related dysfunctional beliefs may be significantly heritable, with genetic factors accounting for 32–40% of their variance (Taylor et al., 2010). This heredability is nevertheless controversial, since Jacobi et al. (2006) reported in a non-clinical family study that OC-related dysfunctional beliefs in parents did not predict obsessional beliefs in adolescents, while OCD symptoms in parents did. The presence of these cognitive biases has been related to certain neuropsychological alterations, specifically deficits in cognitive flexibility (Bradbury et al., 2011). From a neuroanatomical perspective, over-importance and over-control of thoughts have been linked to reductions in left amygdala volume (Nakamae et al., 2012) while intolerance of uncertainty has been associated with hyperactivation of a network of brain areas including ventromedial prefrontal cortex, parahippocampus, middle temporal cortex, orbitofrontal cortex, anterior cingulate cortex, ventral anterior insula and amygdala, both in OCD patients (Stern et al., 2012) and in adolescents with anxiety disorders (Krain et al., 2008). Finally, we have recently reported that heightened moral sensitivity, a concept intimately related to some cognitive distortions such as responsibility beliefs, appears to be associated with the dysfunctional engagement of medial orbitofrontal, left dorsolateral prefrontal and middle temporal cortices in OCD patients (Harrison et al., 2012). So, although scarce, results on neuroimaging correlates of obsessive–compulsive-related dysfunctional beliefs overlap with cortico-striatal and amygdalo-cortical circuits classically described as implicated in OCD (Milad and Rauch, 2011).

The above studies encourage further examination of the neural correlates of maladaptive cognitions in OCD patients. Because such cognitions are frequently reported in otherwise healthy individuals, it is also interesting to explore these neurobiological correlates in such population with regard to the identification of potential risk and resilience markers of OCD (Taylor and Jang, 2011). The current study was therefore designed to investigate whether individual differences in OC-related dysfunctional beliefs are associated with regional variations in brain anatomical measures in a large sample of OCD patients and healthy controls. To this end, a high-resolution magnetic resonance image (MRI) was obtained for each participant and correlated, voxel-wise, with the scores derived from the Obsessive Beliefs Questionnaire (OBQ-44). We expected OCD patients to show more dysfunctional beliefs than healthy controls, and, extending recent work by Nakamae et al. (2012) and Harrison et al. (2012), we hypothesized that OBQ-44 scores would correlate with regional gray matter volumes in orbitofrontal, dorsolateral prefrontal and temporal regions, as well as related subcortical structures.

Section snippets

Population

Fifty outpatients with OCD (25 females; mean age 34.08 ± 8.16 years) were recruited from the OCD Clinic at the Bellvitge University Hospital (Barcelona, Spain) between 2009 and 2011. All patients fulfilled DSM-IV criteria for OCD (APA, 1984) for a period of at least 1 year. Diagnoses were made on the basis of structured interviews conducted independently by two trained psychiatrists using the Structured Clinical Interview for DSM-IV Axis I Disorders-Clinician Version (SCID-CV) (First et al., 1997

Socio-demographic and clinical measurements

The socio-demographic and clinical characteristics of the study groups are summarized in Table 1. We observed no significant differences between OCD patients and healthy controls in terms of age and gender distribution, but patients scored higher than healthy controls on all three OBQ-44 dimensions.

The different OBQ-44 dimensions were intercorrelated both in OCD patients and in healthy subjects, with r values above 0.5 and p < 0.01 in all cases, with the exception of the correlation between

Discussion

In an effort to integrate biological and cognitive models of OCD this study sought to explore the neural correlates underlying the dysfunctional beliefs hypothesized by current cognitive theories to play a role in the development and maintenance of the disorder. To address this question we performed a voxel-based morphometry (VBM) analysis of high-resolution MRIs from a relatively large sample of OCD patients and healthy controls. We did not find any significant relationship between OC-related

Conclusions

We have been able to detect meaningful associations between OC-related dysfunctional beliefs and morphometric variability in the anterior temporal lobe, a brain structure related to socio-emotional processing. While the combination of larger ATL volumes and minimal dysfunctional beliefs appears to characterize the “healthiest” subjects, the greater presence of dysfunctional cognitions in OCD patients can be hypothesized to be related to their reduced ATL volumes, although other variables may

Role of the funding source

This work was supported in part by the Carlos III Health Institute (PI09/01331 and CP10/00604, PI10/01753, PI10/01003, CIBER-CB06/03/0034) and by Agencia de Gestió d’Ajuts Universitaris i de Recerca (AGAUR; 2009SGR1554). Dr. Soriano-Mas is funded by a Miguel Servet contract from the Carlos III Health Institute (CP10/00604). Dr. Harrison is supported by a National Health and Medical Research Council of Australia (NHMRC) Clinical Career Development Award (I.D. 628509). The sponsors had no role in

Acknowledgements

The authors thank all the study participants and the staff from Department of Psychiatry of “Hospital de Bellvitge” who have collaborated to obtain the sample of this study; and Michael Maudsley from the Linguistic Services of University of Barcelona for revising the manuscript.

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