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Towards an Integration of Psychological and Biological Models of Obsessive-Compulsive Disorder: Phylogenetic Considerations

Published online by Cambridge University Press:  07 November 2014

Abstract

In the past 10 to 15 years, advances in psychopharmacology and research on the neurobiological basis of obsessive-compulsive disorder (OCD) have led to the currently predominant biological model of OCD. Nevertheless, the centrality of complex ideation in OCD supports the usefulness of a psychological approach.

In this article, we propose an integrated psychobiological model that presumes a biological etiology without assuming biological reductionism. We hypothesize that the relationship between biological and psychological organization is best explained in the context of emergent systems theory, and that the psychological meaning of OCD reflects development across phylogeny as opposed to ontogeny. Finally, we propose that OCD reflects disruption of a behavioral inhibition/harm assessment system that incorporates brain structures from different points across human phylogeny. Hence, complex psychological symptoms of a biological etiology are generated.

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Feature Articles
Copyright
Copyright © Cambridge University Press 1997

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References

1.Freud, S. Three Case Histories: The “Wolf Man,” The “Rat Man,” and the “Psychotic Doctor Schreber.” New York, NY: Collier Books; 1963.Google Scholar
2.Stein, DJ, Hollander, E. Cognitive science and obsessive-compulsive disorder. In: Stein, DJ, Young, JE, eds. Cognitive Science and Clinical Disorders. San Diego, Calif: Academic Press; 1992.Google Scholar
3.von Bertolanffy, L. General Systems Theory: Essays on Its Foundation and Development. New York, NY: Braziller; 1968.Google Scholar
4.Weiss, P. The living system: determinism stratified. In: Koestler, A, Smythies, JR, eds. Beyond Reductionism. New York, NY: MacMillan; 1969.Google Scholar
5.Weiss, P. The system of nature and the nature of systems: empirical holism and practical reductionism harmonized. In: Schaefer, KE, Hensel, H, Brody, R, eds. Toward a Man-Centered Science. Mt Kisco, NY: Futura Publishing; 1977.Google Scholar
6.Marmor, J. Systems thinking in psychiatry: some theoretical and clinical implications. Am J Psychiatry. 1983;140:833838.Google Scholar
7.Sabelli, HC, Carlson-Sabelli, L. Biological priority and psychological supremacy: a new integrative paradigm derived from process theory. Am J Psychiatry. 1989;146:15411551.Google Scholar
8.Schwartz, GE. A systems analysis of psychobiology and behavior therapy: implications for behavioral medicine. Psychother Psychosom. 1981;36:159184.Google Scholar
9.Soubrie, P. Reconciling the role of central serotonin neurones in human and animal behavior. Behav Brain Sci. 1986;9:319364.CrossRefGoogle Scholar
10.Engel, GL. The clinical application of the biopsychosocial model. Am J Psychiatry. 1980;137:535544.Google Scholar
11.Schwartz, G. Testing the biopsychosocial model: the ultimate challenge facing behavioral medicine? J Consult Clin Psychol. 1983;50:10401053.Google Scholar
12.Baxter, LR, Phelps, ME, Mazziotta, JC, Guze, BH, Schwartz, JM, Seline, CE. Local cerebral glucose metabolic rates in obsessive-compulsive disorder: a comparison with rates in unipolar depression and in normal controls. Arch Gen Psychiatry. 1987;44:211218.Google Scholar
13.Hollander, E, Prohovnik, I, Stein, DJ. Effects of m-CPP induced obsessions on cortical blood flow. J Neuropsychiatry Clin Neurosci. 1995;7:485490.Google Scholar
14.Amaral, DG, Price, JL, Pitkanen, A, Carmichael, ST. Anatomical organization of the primate amygdaloid complex. In: Aggleton, JP, ed. The Amygdala: Neurobiological Aspects of Emotion, Memory, and Mental Dysfunction. New York, NY: Wiley-Liss, Inc; 1992:166.Google Scholar
15. Ainsworth, MDS. Patterns of Attachment. Hillsdale, NJ: Erlbaum; 1978.Google Scholar
16.Greenspan, S. The Development of the Ego: Implications for Personality Theory, Psychopathology, and the Psychotherapeutic Process. Madison, Conn: International Universities Press; 1989.Google Scholar
17.Cicchetti, D, Aber, JL. Early precursors to later depression: an organizational perspective. In: Lipsett, L, Rovee-Collier, C, eds. Advances In Infancy. 4th ed. Norwood, NJ: Ablex; 1986:87137.Google Scholar
18.Piaget, J. The Construction of Reality in the Child. New York, NY: Basic Books; 1986.Google Scholar
19.Watt, DF. Higher cortical functions and the ego: explorations of the boundary between behavioral neurology, neuropsychology, and psychoanalysis. Psychoanalytic Psychology. 1990;7:487527.Google Scholar
20.Werner, H, Kaplan, B. Symbol Formation. Hillsdale, NJ: Erlbaum; 1984.Google Scholar
21.Hofer, M. An evolutionary perspective on anxiety: animal models. Presented at the Fourth Interdisciplinary Symposium on the Theory of Affects; April 11, 1992; New York, NY.Google Scholar
22.Damasio, A. The frontal lobes. In: Heilman, K, Valenstein, E, eds. Clinical Neuropsychology. New York, NY: Oxford University Press; 1985.Google Scholar
23.Heilman, KM, Bowers, D, Valenstein, E; Heilman, KM, Valenstein, E, eds. Emotional Disorders Associated With Neurological Diseases. New York, NY: Oxford University Press; 1985.Google Scholar
24.Foa, E, Steketee, G. Obsessive-compulsive disorder. In:Lindemann, C, ed. Handbook of Phobia Therapy: Rapid Symptom Relief in Anxiety Disorders. Northvale, NJ: Jason Aronson; 1989.Google Scholar
25.Gray, JA. The Psychology of Fear and Stress. New York, NY: Cambridge University Press; 1987.Google Scholar
26.Stein, DJ, Shoulberg, N, Helton, K, Hollander, E. The neuroethological approach to obsessive-compulsive disorder. Compr Psychiatry. 1992;33:274281.Google Scholar
27.Beck, AT, Friedman, A. Cognitive Therapy of Personality Disorders. New York, NY: Guilford Press; 1990.Google Scholar
28.Mahler, M, Pine, F, Bergman, A. The Psychological Birth of the Human Infant. New York, NY: Basic Books; 1975.Google Scholar
29.Slade, A, Cohen, LJ. The process of parenting and the remembrance of things past. Infant Mental Health Journal. In press.Google Scholar
30.Stern, D. The Interpersonal World of the Infant. New York, NY: Basic Books; 1986.Google Scholar
31.Fast, I, Marsden, G, Cohen, L, Heard, H, Kruse, S. The self as subject: a formulation and assessment strategy. Psychiatry. 1996;59:3447.Google Scholar
32.Mitchell, SA. Relational Concepts in Psychoanalysis: An Integration. Cambridge, Mass: Harvard University Press; 1988.Google Scholar
33.Kernberg, O.Borderline Conditions and Pathological Narcissism. Dunmore, Pa: Jason Aronson; 1975.Google Scholar
34.Kohut, H. The psychoanalytic treatment of narcissistic personality disorders: outline of a systematic approach. Psychoanal Study Child. 1968;23:86113.Google Scholar
35.Main, M, Kaplan, N, Cassidy, J. Security of attachment in childhood, adolescence, and adulthood: a move to the level of representation. In: Bretherton, I, Waters, E, eds. Growing Points of Attachment Theory and Research. Monographs of the Society for Research in Child Development. 1985;50:66104.Google Scholar
36.Bowlby, J. Loss: Sadness and Depression. New York, NY: Basic Books; 1980.Google Scholar
37.Markus, H. Self-schemata and processing information about the self. J Pers Soc Psychol. 1977;35:6378.Google Scholar
38.MacLean, P. On the origin and progressive evolution of the triune brain. In: Armstrong, E, Falk, D, eds. Primate Brain Evolution: Methods and Concepts. New York, NY: Plenum; 1982;291316.Google Scholar
39.Armstrong, E. Evolution and the limbic system. Presented at Departmental Grand Rounds, Department of Psychiatry, Mount Sinai School of Medicine; June 27, 1995; New York, NY.Google Scholar
40.Armstrong, E. Evolution of the Brain. In: Paxinos, G, ed. The Human Nervous System. New York, NY: Academic Press; 1990:116.Google Scholar
41.Slade, A, Wolf, D, eds. Children at Play: Clinical and Developmental Approaches to Meaning and Representation. Oxford, England: Oxford University Press; 1994.Google Scholar
42.Fast, I. Event Theory: A Piaget-Freud Integration. Hillsdale, NJ: Erlbaum; 1985.Google Scholar
43.Cloninger, RC, Svrakic, DM, Przybeck, TR. A psychobiological model of temperament and character. Arch Gen Psychiatry. 1993;50:975990.Google Scholar
44.Slade, A, Aber, L. Attachments, drives and development: conflicts and convergences in theory. In: Barron, J, Eagle, M, Wolitsky, D, eds. Interface of Psychoanalysis and Psychology. Washington, DC: American Psychological Association; 1992.Google Scholar
45.Zigler, E, Glick, M. A Developmental Approach to Psychopathology. New York, NY: John Wiley & Sons; 1986.Google Scholar
46.Mishkin, M, Appenzeller, T. The anatomy of memory. SciAm. 1988;259:8089.Google Scholar
47.Cloninger, RC. Temperament and personality. Curr Opin Neurobiol. 1994;25:189196.Google Scholar
48.Svrakic, DM, Whitehead, C, Przybeck, TR, Cloninger, RC. Differential diagnosis of personality disorders by the seven-factor model of temperament and character. Arch Gen Psychiatry. 1993;50:991999.Google Scholar
49.Swedo, SE. Rituals and releasors: an ethological model of obsessive-compulsive disorder. In: Rapoport, JL, ed. Obsessive-Compulsive Disorder in Children and Adolescents: Washington, DC: American Psychiatric Press; 1989.Google Scholar
50.Winicott, DW. Maturational Processes and the Facilitating Environment. New York, NY: International Universities Press; 1965.Google Scholar
51.Freud, A. Normality and Pathology in Childhood: Assessment of Development. New York, NY: International Universities Press; 1965.Google Scholar
52.Group for the Advancement of Psychiatry. Psychopathological Disorders in Childhood: Theoretical Considerations and a Proposed Classification, VI. New York: Brunner/Mazel; 1966:62.Google Scholar
53.The Clomipramine Collaborative Study Group. Clomipramine in the treatment of patients with obsessive-compulsive disorder. Arch Gen Psychiatry. 1991;48:730738.Google Scholar
54.Turner, SM, Jacob, RG, Geidel, DC, Himmelhoch, J. Fluoxetine treatment of obsessive-compulsive disorder. J Clin Psychopharmacol. 1985;5:207212.Google Scholar
55.Perse, TL, Griest, JH, Jefferson, JW, Rosenfeld, R, Dar, R. Fluvoxamine treatment of obsessive-compulsive disorder. Am J Psychiatry. 1987;12:15431548.Google Scholar
56.Greist, JH, Jefferson, JW, Kobak, KA, Katzelnick, KJ, Serlin, RC. Efficacy and tolerability of serotonin transport inhibitors in obsessive-compulsive disorder: a meta-analysis. Arch Gen Psychiatry. 1995;52:5359.Google Scholar
57.Levin, BE, Duchowny, MS. Association of childhood obsessive compulsive disorder and cingulate epilepsy. Biol Psychiatry. 1991;30:10491055.Google Scholar
58.McKeon, J, McGuffin, P, Robinson, P. Obsessive-compulsive neurosis following head injury: a report of four cases. Br J Psychiatry. 1984;144:190192.Google Scholar
59.Johnson, J, Lucey, PA, Encephalitis lethargica, a contemporary cause of catatonic stupor: a report of two cases. Br J Psychiatry. 1987;151:550552.Google Scholar
60.George, MS, Kellner, CH, Fossey, MD. Obsessive-compulsive symptoms in a patient with multiple sclerosis. J Nerv Ment Dis. 1989;177:304305.Google Scholar
61.Swedo, SE, Rapoport, JL, Cheslow, DL, et al.High prevalence of obsessive compulsive symptoms in patients with Sydenham's chorea. Am J Psychiatry. 1989;146:246249.Google Scholar
62.Cummings, JL, Cunningham, D. Obsessive-compulsive disorder in Huntington's disease. Biol Psychiatry. 1992;31:263270.CrossRefGoogle ScholarPubMed
63.Pauls, DL, Towbin, KE, Leckman, JF, et al.Gilles de la Tourette's syndrome and obsessive compulsive disorder: evidence supporting a genetic relationship. Arch Gen Psychiatry. 1986;43:11801182.Google Scholar
64.Hollander, E, DeCaria, CM, Nitescu, A, et al.Serotonergic function in obsessive-compulsive disorder: behavioral and neuroendocrine responses to oral m-chlorylpiperazine and fenfluramine in patients and healthy volunteers. Arch Gen Psychiatry. 1992;49:2128.Google Scholar
65.Murphy, DL, Zohar, J, Benkelfat, C, Pato, MT, Pigott, TA, Insel, TR. Obsessive-compulsive disorder as a 5-HT subsystem-related behavioral disorder. Br J Psychiatry. 1989;155:1524.Google Scholar
66.Martinot, JL, Allilaire, JF, Mazoyer, BM, et al.Obsessive-compulsive disorder: a clinical, neuropsychological and positron emission tomography study. Acta Psychiatr Scand. 1990;82:233242.Google Scholar
67.Insel, TR. Toward a neuroanatomy of obsessive-compulsive disorder. Arch Gen Psychiatry. 1992;49:739744.CrossRefGoogle Scholar
68.Gray, JA. The Neuropsychology of Anxiety: An Enquiry into the Functions of the Septo-Hippocampal System. Oxford, England: Oxford University Press; 1982.Google Scholar
69.McDougle, CJ, Kresch, LE, Goodman, WK, et al.A case-controlled study of repetitive thoughts and behavior in adults with autistic disorder and obsessive-compulsive disorder. Am J Psychiatry. 1995;152:772777.Google Scholar
70.McFall, ME, Wollersheim, JP. Obsessive-compulsive neurosis: a cognitive-behavioral formulation and approach to treatment. Cog Therapy Res. 1979;3:333348.Google Scholar
71.Dodman, N, Baxter, I, Blier, P, Olivier, J, Rapoport, JL, Westenberg, H. Is there a valid animal model for OCD? Presented at the Second International Obsessive-Compulsive Disorder Conference; February 16–17, 1996; St. Francoise, Guadeloupe.Google Scholar
72.Rasmussen, SA, Eisen, JL. Assessment of core features, conviction, and psychosocial function in OCD. Presented at the First International OCD Conference; March 9–12, 1993; Isle of Capri, Italy.Google Scholar
73.Pigott, TA, L'Heureux, F, Dubbert, B, Bernstein, S, Murphy, DL. Obsessive compulsive disorder: comorbid conditions. J Clin Psychiatry. 1994;55(suppl 10): 1527.Google Scholar
74.Zohar, J, Mueller, EA, Insel, TR, et al.Serotonergic responsivity in obsessive-compulsive disorder: comparison of patients and healthy controls. Arch Gen Psychiatry. 1987;45:177188.Google Scholar
75.Hollander, E, Cohen, LJ, DeCaria, C, et al.Timing of neuroendocrine responses and effect of m-CPP and fenfluramine plasma levels in OCD and healthy subjects. Biol Psychiatry. 1993;34:407413.Google Scholar
76.Charney, DS, Heninger, GR, Breier, A. Serotonin function in obsessive-compulsive disorder: a comparison of the effects of tryptophan and m-CPP in patients and healthy subjects. Arch Gen Psychiatry. 1988;45:177185.Google Scholar
77.Goodman, WK, McDougle, CJ, Delgado, PL, Price, LH. Pharmacologic challenges in obsessive-compulsive disorder. Am J Psychiatry. 1989;146:13501351.Google Scholar
78.Thoren, R, Asberg, M, Bertilsson, L, Mellstrom, B, Syoquist, F, Trachman, L. Clomipramine treatment of obsessive-compulsive disorder: II. biochemical aspects. Arch Gen Psychiatry. 1980;37:12891294.Google Scholar
79.Seiver, LJ, Davis, KL. A psychobiological perspective on the personality disorders. Am J Psychiatry. 1991;148:16471658.Google Scholar
80.Linnoila, M, Virkkunen, M, Scheinen, M, Nuutila, A, Rimon, R, Goodwin, FK. Low cerebrospinal fluid 5-hydroxyindoleacetic acid concentration differentiates impulsive from nonimpul-sive violent behavior. Life Sci. 1983;33:26092614.Google Scholar
81.Coccarro, EF, Siever, LJ, Klar, HM, et al.Serotonergic studies in affective and personality disorder patients: correlations with behavioral aggression and impulsivity. Arch Gen Psychiatry. 1989;46:587599.Google Scholar
82.Azmitia, EC, Ganon, PJ. Myoclonus. The primate serotonergic system: a review of human and animal studies and a report of Macaca fascicularis. In: Advances in Neurology. New York, NY: Raven Press; 1986;43:407468.Google Scholar
83.Azmitia, EC. The CNS serotonergic system: progression toward a collaborative organization. In: Meter, H, ed. Psychopharmacology: The Third Generation of Progress. New York, NY: Raven Press; 1987:6173.Google Scholar
84.Azmitia, EC. The serotonin-producing neurons of the midbrain median and dorsal raphe nuclei. In: Iversen, LL, Iversen, SD, Snyder, SH, eds. Chemical Pathways in the Brain. New York, NY: Plenum Press; 1978:233314.Google Scholar
85.Tork, I, Hornung, JP. Raphe nuclei and the serotonin containing systems. In: Paxinos, G, ed. The Human Nervous System. San Diego, Calif: Academic Press; 1990.Google Scholar
86.Mishkin, M, Malmut, B, Bachevalier, J. Memories and habits: two neural systems. In: Lynch, G, McGaugh, JL, Weinberger, NM, eds. Neurobiology of Learning and Memory. New York, NY: Guilford; 1984:6577.Google Scholar
87.Lehrman, OS, Brody, PN, Wortis, RP. The presence of the mate and nesting material as stimuli for the development of incubation behavior and for gonadotropin secretion for the ring dove (streptopelia risoria). Endocrinology. 1964;68:507516.Google Scholar
88.Korsgaard, S, Gerlach, J, Christensson, E. Behavioral aspects of serotonin-dopamine interaction in the monkey. Eur J Pharmacol. 1985;118:245252.Google Scholar
89.Baxter, LR Jr, Schwartz, JM, Mazziotta, JC, et al.Cerebral glucose metabolic rates in nondepressed patients with obsessive compulsive disorder. Am J Psychiatry. 1988;145:15601563.Google Scholar
90.Nordahl, TE, Benkelfat, C, Semple, WE, Brass, M, King, AC, Cohen, RM. Cerebral glucose metabolic rates in obsessive-compulsive disorder. Neuropsychopharmacology. 1989;2:2328.Google Scholar
91.Swedo, SE, Schapiro, MB, Brady, CL, et al.Cerebral glucose metabolism in childhood-onset obsessive compulsive disorder. Arch Gen Psychiatry. 1989;46:518523.CrossRefGoogle ScholarPubMed
92.Rubin, RT, Villaneuva-Meyer, J, Anath, J, Trajmar, PG, Mena, I. Regional xenon 133 cerebral blood flow and cerebral technetium Tc 99m-HMPAO uptake in unmedicated patients with obsessive-compulsive disorder and matched normal control subjects: determination by high-resolution single-photon emission computed tomography. Arch Gen Psychiatry. 1992;49:695702.CrossRefGoogle ScholarPubMed
93.Baxter, LR Jr, Schwartz, JM, Bergman, KS, et al.Caudate glucose metabolic rate changes with both drug and behavior therapy for obsessive-compulsive disorder. Arch Gen Psychiatry. 1992;49:681689.Google Scholar
94.Swedo, SE, Pietrini, P, Leonard, HL, et al.Cerebral glucose metabolism in childhood-onset obsessive-compulsive disorder: revisualization during pharmacotherapy. Arch Gen Psychiatry. 1992;49:690694.Google Scholar
95.Bordnick, BS, Thyer, BA, Itchie, BA. Feather picking disorder and trichotillomania: an avian model of human pathology. J Behav Ther Exp Psychiatry. 1994:25:189196.Google Scholar
96.Huebner, AA. Autistic disorder: a neuropsychological enigma. Am J Occup Ther. 1992;46:487501.Google Scholar