Category Archives: OCD

OCD and related talks at this year’s International Congress by the Royal College of Psychiatrists

This year’s International Congress is already set to become the most attended RCPsych conference outside London. It is also going to set another record, albeit on a much smaller scale. RCPsychIC 2018 will host the most OCD related talks ever in its history. In total there are going to be nine talks about OCD, with two full symposiums dedicated to the subject area. You will get to hear not just from psychiatrists but also from neurosurgeons, cognitive neuroscientists and academic psychologists and nurses in the field.

As OCD usually does not get its fair share in clinical and academic worlds, it really feels good to see it thrive at a major international conference. By actively encouraging participation of non-psychiatrists, RCPsychICs (aka organising committee) have ensured that this year’s conference is also going to be the most diverse platform for ideas and education in its history. As one of the speakers, I have to declare a conflict of interest as this post can be seen as a a promotional plug for the conference. But I guess I would be fine as the conference is already fully sold out for the first four days meaning any more promotion won’t make a difference in attendance.  One thing I do wish we could have done is to organise a tenth talk, not just to make it a nice round figure. Compiling the list of OCD talks at this conference (below) also made me realise the lack of a talk from an OCD sufferer. As we have seen at last years congress, patient voices are several orders of magnitude more powerful than anything else and can shift attitudes faster than anything else. Hindsight tells me that this is a grave oversight on our part, something I definitely wish to correct for the next congress.

You can see the full RCPsychIC 2018 program here. For those who do not want to trawl through the whole program to find OCD related stuff I have summarised it in a concise list below:

  • The Neurocomputational Role of Corticostriatal Networks in OCD by Tobias Hauser (Seminar S6; 24th June 2018)
  • Thalamo–cortico–striatal mechanisms of deep brain stimulation for OCD by Annemieke Apergis–Schoute (Seminar S6; 24th June 2018)
  • Evolution of Our Understanding of the Neural Circuitry Dysfunction in OCD by Himanshu Tyagi (Seminar S6; 24th June 2018)
  • Neurosurgery for Psychiatric Disorders including OCD by Ludvic Zrinzo (Seminar S10; 24th June 2018)
  • Lesion Surgery & Deep Brain Stimulation for OCD by Keith Matthews (Seminar S10; 24th June 2018)
  • New psychopharmacology models for OCD by Naomi Fineberg (Seminar S24; 26th June 2018)
  • New behavioural and cognitive models for OCD by Lynne Drummond (Seminar S24; 26th June 2018)
  • Invasive and non–invasive brain stimulation for OCD by Eileen Joyce (Seminar S24; 26th June 2018)
  • Twelve Month Treatment Outcomes for Intensive Psychological Therapy and Anterior Cingulotomy for Severe OCD by Karen Walker (Rapid Fire Presentation; 26th June 2018)

Enjoy #RCPsychIC 2018! See you at ICC Birmingham.

By Soon-Beom HongAndrew ZaleskyLuca CocchiAlex FornitoEun-Jung ChoiHo-Hyun KimJeong-Eun SuhChang-Dai KimJae-Won KimSoon-Hyung Yi [CC-BY-SA-3.0 (], via Wikimedia Commons

Connecting the Behavioural Dots – Childhood Rituals and OCD

Usually I do not get enough time to read all latest research papers in the field of OCD, but I always make it a point to read any paper published by the group at Tel Aviv University. I find their work very interesting as most of their experiments are about improving our understanding of OCD at a fundamental level. Their papers are eminently readable and that works out as a bonus! Recently they published a paper in The Journal of Behaviour Therapy and Experimental Psychiatry which seems to give us some more clues about the development of OCD. This research seems to suggest that healthy childhood rituals (like regular schedules for meal, bath, and bed times) when combined with oral and tactile sensitivities (such as discomfort at the dentist or irritation caused by specific fabrics) could potentially be an early warning sign of adult OCD. Before you jump to any premature conclusions as I did initially, this work is not about pathologising normal behaviour. If still in doubt, do read the paper firsthand.

Prof. Reuven Dar of Tel Aviv University’s Department of Psychology suspected this particular link from astute clinical observations. This comprehensive study, only one of its types so far, followed and provided a proof of “direct correlation” (always with a pinch of salt! See my posts on the correlation fallacy in medicine) between our sensory processing and ritualistic behaviours. Their hypothesis is that when children experience heightened levels of sensitivity, they develop ritualistic behaviours to better cope with their environment. When children are extremely sensitive to certain types of touch or smell, they can feel that they are being attacked, or that their environment is threatening them. Ritualism could develop as a defence mechanism, helping these children to regain a sense of control, which is also a symptom of adults with OCD. So in the long term, this is one “potential” pathway to OCD. Simplistic, but a logical hypothesis. Always a good sign.

To prove this hypothesis this group devised two studies to map the connection between sensory processing, rituals, and OCD. In the first, parents of kindergarten children were asked to complete three questionnaires on their child’s behaviour:

1. Their level of ritualism, such as the need to repeat certain acts or to order objects in a particular way.

2. Their level of anxiety, with questions relating to reaction to strangers, worrying about outcomes of events, and attachment to family members.

3. Their reactions to everyday sensory events such as being touched or exposed to unusual tastes or smells.

In the second study, 314 adults answered an online survey of their OCD tendencies, their anxiety levels, and their past and current sensitivity to taste or touch.

In children, hypersensitivity was an indicator of ritualism, whereas in adults it was related to OCD symptoms. However all children have particular habits and preferences, and they’re not all precursors to OCD. Also, age is a factor. A habit exhibited by a five or six-year-old is not necessarily a predictor of OCD. If the same behaviour continues to the ages of eight and above, it could be a warning sign, especially if accompanied by anxiety or distress. As a whole, these findings provide preliminary support for the idea that such sensitivities are a precursor to OCD symptoms.

Obviously, this is just a single study supporting a lone idea and there are plenty of ideas doing their rounds in the field of pathogenesis of OCD. I would wait for validation from future longitudinal trials before drawing my conclusions. However this study did provide me with a lot of food for thought. It made me to focus on some fundamental but unanswered questions in the development of OCD i.e. what are the factors which would tip a ritual into compulsion, could there be a way to identify the turning (tipping) point in development of OCD and when/how does it happen in the lifecycle of OCD? As a clinician, I think that now I would be more inclined to explore such areas in a greater detail while assessing someone’s OCD. And for the budding researcher inside me, it highlighted just how important it is to keep research work rooted in direct clinical observations. Not doing that would run the risk of alienating the ordinary clinicians like me, who is trying to deal with the ever-growing burden of information by learning to ignore the stuff that isn’t a systematic review of meta-analyses!