Table 1.
Case vignettes: translated reports from patients describing different clinical profiles of OCD that could reflect abnormalities in specific neurocircuits
| OCD Clinical Profile | Case vignette | Predominant neurocircuit involved |
|---|---|---|
| Dysregulated fear | Case vignette 1: A 13-year-old female without previous history of obsessive-compulsive symptoms (OCS). She describes the hardest period of her OCD as follows: | Fronto-limbic |
| “I thought I was pregnant. This made me feel really bad and fearful. It was a thought that used to come into my head all the time. This feeling started the day after I went to a party and kissed, for the first time, my boyfriend on the mouth. [The thought started] for now reason and I was suddenly feeling very bad about it – scared and distressed that I was pregnant. I wanted to lie in bed all day, I didn’t want to go to school, even though I knew I could feel better, but I didn’t feel like doing anything. When I had these thoughts [that I was pregnant] I felt unwell: chest pain, sometimes shortness of breath, my heart pounding and feeling sick, sometimes nauseated. To alleviate that discomfort I used to ask my mother or my best friend all the time if I was pregnant. I asked them to reassure me that I was not [pregnant] and then I used to feel a little better, but later everything started again. And when I thought I was going to get better, it got worse.” | ||
| Two years later she reported feeling fine without OCS. When asked about what made her feel she was pregnant she responded: | ||
| “I don’t know, I felt so bad that I thought it was true, I felt anxious, difficulty breathing, chest tightness, sweat, cold hands, I didn’t feel like eating. So I thought: If I wasn’t [pregnant] I wouldn’t be feeling like this.” | ||
| Intolerance of Uncertainty (IU) | Case vignette 2: An 18-year-old male with a history of panic attacks and generalized anxiety disorder describes an overlap of OCS (characterized by somatic obsessions) and IU: | Fronto-limbic |
| “Control for me is the essential basis for everything. I seek control in everything I do, otherwise I don’t do it. Either I have control or I don’t do it…. Because if I have control, there is no uncertainty, which is what I’m so afraid of, because if I have control I’ll be prepared, and it’s something that makes me more comfortable. For instance, I have the concern that I can feel dizzy or unwell when I leave home. What if I have not eaten enough or my body needs more while I am out? What if there is something wrong with my stomach and I get nauseated? Therefore, every time I leave home, I have to take some meals with me and specific medicines to make sure I have them all if I feel unwell. | ||
| Sensory phenomena (SP) | Case vignette 3: A 15-year-old male who also has Tourette syndrome reports: | Sensorimotor |
| “I felt my hands, like there is always some dirty thing stuck onto them bothering me. To relieve it, I wash them over and over again. It is this tactile sensation in my hands that drives me to wash them. I do not feel any type of fear or disgust associated to it”. | ||
| Altered habit-formation and impaired inhibition | Case vignette 4: A 28-year-old female, whose OCS started when she was 13 years old, describes her checking rituals: | Sensorimotor and Ventral cognitive |
| “At work I felt a need to check everything every time I was leaving, as I’m the last to leave. I checked if the windows were closed, if my computer was off, if the printers were off, if the fan was off… My concern was that something could happen, such as a short circuit, or that something could be left on and catch fire. I had a fear about it.” | Ventral cognitive | |
| “But then, over time, it became an automatic behavior, whenever I left I checked everything and no longer thought so much about the fears. I knew the consequences, it was clear to me what would happen if I didn’t do it [check everything], but I didn’t think so much, I did things automatically. Now I’ve been trying to avoid it [checking everything]… at first I was worried about what would happen, but then it became something a feeling that something was missing, that I forgot something, sometimes I checked if my backpack was with me when I was close to home because it seemed like I forgot something, something was missing, something was incomplete. I was no longer afraid, but it was a sense of incompleteness.” | Sensorimotor | |
| Altered reward responsiveness | Case vignette 5: An 18-year-old male (the same patient as in vignette 2) with somatic obsessions and intrusive thoughts about not being prepared with all he might need when leaving the house presents with altered reward responsiveness related to his OCS: | Ventral reward |
| “Just as it could potentially give me pleasure, it may potentially not give me pleasure, it could make me feel bad, so I prefer not to take that risk. Faced with new situations I prefer not to risk; I duck out and I assume in my head that I do not want that or that I wouldn’t like to do it. I feel like staying home is wonderful in this moment, my dream is to stay home because it is a safe haven. I don’t need to plan to stay home, I don’t need to be careful, I don’t need to check schedules, I don’t need to carry medicines with me, because I’m home and I have everything I need there, so I don’t have these worries and this psychological pressure. In this sense, staying at home and not having the uncomfortable feeling I experience when I leave the house is more pleasurable for me than doing something that could potentially be fun.” |