Obsessive-compulsive disorder patients with washing symptoms show a specific brain network when confronted with aggressive, sexual, and disgusting stimuli

Psychoanalytic theories of obsessive-compulsive disorder (OCD) suggest that underlying conflicts about aggression or sexuality drive a variety of obsessive-compulsive behaviors. This study aimed to explore the possible neural correlates of these processes in OCD patients in response to emotion-evoking stimulus material. A total of 15 unmedicated OCD patients primarily with washing symptoms and 15 healthy control participants underwent functional magnetic resonance imaging analysis while confronted with neutral pictures and emotion-evoking pictures (aggression, disgust, water, sexuality). The choice of the stimuli explicitly took into account the psychoanalytical model of OCD. While viewing aggressive pictures compared to neutral stimuli, OCD patients demonstrated greater activation than controls in the right frontal gyrus, posterior cingulate cortex, insula, claustrum, and in parietal areas of the left hemisphere. In the disgust condition OCD patients demonstrated greater activation than controls in right frontal gyrus, right precentral gyrus, and in left inferior parietal lobule. These results furnish evidence that OCD patients with washing symptoms show a different pattern of processing of aggressive and disgusting stimuli at the brain level. The implicated networks involved suggest that OCD patients have a more self-referential response than in healthy controls. Focusing on the processing of specific negative emotions may help in the enhancement of psychotherapy for OCD.