Genetic studies  have demonstrated that both biological and environmental factors are important in the etiology of OCD(1). With respect to environmental factors, stressful events have been associated with OCD onset in childhood (2), perinatal, and adult forms of the illness. With respect to nongenetic biological factors, several illnesses have also been associated with OCD, including temporal lobe epilepsy (3), autoimmune diseases such as systemic lupus erythematosus (4, 5) and Crohn’s disease (6, 7) and infectious processes (8 –10). With respect to potential genetic factors, family studies of OCD report increased prevalence of this disorder among relatives, and twin studies have confirmed that a genetic component underlies the illness.

Very interesting to see that there seems to be an infectious process, an autoimmune component, as well as a GI connection (Crohn’s) to OCD.  Here’s what else they report from that study:

Segregation analyses performed on multigenerational families suggest that this disorder is difficult to model using Mendelian approaches.

Spoiler Alert:  NO INHERITANCE HERE!  But see what another study shared:

….Eventually, as more pathogens are incorporated into the microbiome and levels of dysbiosis increase, people begin to present with symptoms characteristic of an autoimmune or inflammatory diagnosis......There is increasing evidence that autoimmune diseases run in families due to the sharing of common microbes.... The microbiome a child develops is a direct reflection of those harbored by the mother and close relatives.  Microbes are introduced by a multitude of sources including the placenta, sperm,egg, breast milk, and vaginal canal.[37] …. Autoimmune diseases are more likely passed in families due to inheritance of the familial microbiome than inheritance of Mendelian genetic abnormalities.  Is OCD connected in families due to this sharing of microbes, thus the microbiome created?

Freud: the Id, the Ego, and the OCD

So, what did Freud say back in the day about OCD as his words seem to still have a haunting influence today?

Freud gradually evolved a conceptualization  of OCD that influenced and then drew upon his ideas of mental structure, mental energies, and defense mechanisms. In Freud's view, the patient's mind responded maladaptively to conflicts between unacceptable, unconscious sexual or aggressive id impulses and the demands of conscience and reality. It regressed to concerns with control and to modes of thinking characteristic of the anal-sadistic stage of psychosexual development: ambivalence, which produced doubting, and magical thinking, which produced superstitious compulsive acts. The ego marshalled certain defenses: intellectualization and isolation (warding off the affects associated with the unacceptable ideas and impulses), undoing (carrying out compulsions to neutralize the offending ideas and impulses) and reaction formation (adopting character traits exactly opposite of the feared impulses). The imperfect success of these defenses gave rise to OCD symptoms: anxiety; preoccupation with dirt or germs or moral questions; and, fears of acting on unacceptable impulses.

This kind of Freudian thinking neglected true medical causes. Are we out of the woods yet?

As the twenty-first century begins, advances in pharmacology, neuroanatomy, neurophysiology and learning theory have allowed us to reach a more therapeutically useful conceptualization of OCD. Although the causes of the disorder still elude us, the recent identification of children with OCD caused by an autoimmune response to group A beta-hemolytic streptococcal infection promises to bring increased understanding of the disorder's pathogenesis. 

Getting Warmer?

…“the recent identification of children with OCD caused by an autoimmune response to group A beta-hemolytic streptococcal infection promises to bring increased understanding of the disorder's pathogenesis.”  That just might blow genes and Freud out of the water.  This too:

PET scans produce color-coded images of the brain’s metabolic activity. Baxter’s study    showed that patients with OCD had elevated brain activity in areas of the frontal lobes (particularly the orbital cortex) and the basal ganglia. Several other groups have since confirmed these findings. Other evidence for a causal role of the basal ganglia in OCD are accidents of nature, such as Sydenham’s chorea and von Ecomomo’s encephalitis that damage the basal ganglia and produce obsessive-compulsive symptoms.

Both Economo’s encephalitis (EL) and Sydenham’s chorea have been reported to be related to Streptococcus. 

What this means is that infections seem to be a trigger in many types of these OCD disorders. As far as being “accidents of nature,” it seems increasingly over the years that MAN needs to be in that equation, changing the microbiome, and not for the good, vaccines, mercury and pesticides being big culprits.

So what about the many who see stress also as a trigger?

There is now an expanding volume of evidence  to support the view that commensal organisms within the gut play a role in early programming and later responsivity of the stress system. The gut is inhabited by 10¹³-10¹⁴ micro-organisms, which is ten times the number of cells in the human body and contains 150 times as many genes as our genome. .....Moreover, increased evidence suggests that animals treated with probiotics have a blunted HPA response. Stress induces increased permeability of the gut allowing bacteria and bacterial antigens to cross the epithelial barrier and activate a mucosal immune response, which in turn alters the composition of the microbiome and leads to enhanced HPA drive. Increasing data from patients with irritable bowel syndrome and major depression indicate that in these syndromes alteration of the HPA may be induced by increased gut permeability. In the case of irritable bowel syndrome the increased permeability can respond to probiotic therapy. Detailed prospective studies in patients with mood disorders examining the gut microbiota, immune parameters and HPA activity are required to throw further light on this emerging area. It is however clear that the gut microbiota must be taken into account when considering the factors regulating the HPA.

Probiotics?

Can probiotics really help with the microbiome, the brain, and OCD, and yes, even Autism?

The idea that bacteria teeming in the gut—collectively known as the microbiome—can affect not only the gut, but also the mind, "has just catapulted onto the scene”   ….Research has found, for example, that tweaking the balance between beneficial and disease-causing bacteria in an animal's gut can alter its brain chemistry and lead it to become either more bold or more anxious. The brain can also exert a powerful influence on gut bacteria; as many studies have shown, even mild stress can tip the microbial balance in the gut, making the host more vulnerable to infectious disease and triggering a cascade of molecular reactions that feed back to the central nervous system. Such findings offer the tantalizing possibility of using beneficial, or probiotic, bacteria to treat mood and anxiety disorders….Gut bacteria also produce hundreds of neurochemicals that the brain uses to regulate basic physiological processes as well as mental processes such as learning, memory and mood. For example, gut bacteria manufacture about 95 percent of the body's supply of serotonin, which influences both mood and GI activity.

So 95% of serotonin in our bodies is made in the gut. Of course, everyone knows that serotonin is heavily involved in OCD which is why SSRI’s are usually prescribed.

Connecting the dots is important with these immune diseases.  OCD deserves true research, like autism and PANDAS/PANS.  Thousands upon thousands are affected and the right road to recovery and hope needs to be available.  I’m going to conclude with this story, a true one that should help tie this all together.

Gut feelings: the future of psychiatry may be inside your stomach 

Her parents were running out of hope. Their teenage daughter, Mary, had been diagnosed with a severe case of obsessive–compulsive disorder (OCD), as well as ADHD. They had dragged her to clinics around the country in an effort to thwart the scary, intrusive thoughts and the repetitive behaviors that Mary felt compelled to perform. Even a litany of psychotropic medications didn’t make much difference. It seemed like nothing could stop the relentless nature of Mary’s disorder.

Their last hope for Mary was Boston-area psychiatrist James Greenblatt…..Greenblatt started by posing the usual questions about Mary’s background, her childhood, and the onset of her illness. But then he asked a question that no psychiatrist ever had: How was Mary’s gut? Did she suffer digestive upset? Constipation or diarrhea? Acid reflux? Had Mary’s digestion seemed to change at all before or during her illness? Her parents looked at each other. The answer to many of the doctor’s questions was, indeed, “Yes.”

That’s what prompted Greenblatt to take a surprising approach: besides psychotherapy and medication, Greenblatt also prescribed Mary a twice-daily dose of probiotics, the array of helpful bacteria that lives in our gut. The change in Mary was nothing short of miraculous: within six months, her symptoms had greatly diminished. One year after the probiotic prescription, there was no sign that Mary had ever been ill…..Greenblatt’s provocative idea — that psychiatric woes can be solved by targeting the digestive system — is increasingly reinforced by cutting-edge science…….

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We, in the autism community, have known this for YEARS. We have had excellent, trailblazer researchers showing us the way.