Real-World Hoarders and Obsessive-Compulsives: A Conversation with an OCD Expert

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Michael Cogliantry

Q: Are there any advances in treatment on the horizon?

A: There’s a lot [of interest] now in [the neurotransmitter] glutamate. It’s probably involved in a lot of different ways. We tend to use the drug Namenda [which is currently used for Alzheimer’s disease]. There are three main drugs: Namenda, riluzole and n-acetylcysteine [NAC, a supplement sold over the counter].

The theory is that there is glutamate hyperactivity in the synapse. Riluzole blocks release, Namenda acts post synaptically and NAC enhances uptake of glutamate [by brain cells called] glia. So you can cut glutamate hyperactivity via three different mechanisms.

There’s also brain surgery and deep brain stimulation where you can actually stimulate the brain in a way where you can shut down [the overactivity]. (More on ADHD: A Global Epidemic or Just a Bunch of Fidgety Kids?)

Q: What causes OCD?

A: I could give you a five-hour lecture on that, which basically means we don’t know. We know that it’s not a problem with toilet training. We know that it’s a brain-based disorder. Very rarely, it can be caused by a strep infection. It may turn out that the biggest cause is genetic. For a lot of people, it runs in the family.

Q: I’ll happily talk publicly about having been addicted to heroin, but I am usually too embarrassed to discuss OCD. Hiding it because it is shameful almost seems to be part of the disorder. Why is it so associated with shame?

A: It varies from person to person. Not everyone does have shame. In the early days, trying to get people to go on TV, there seemed to be a lot more shame. But now with all public attention to it, there’s less of that. Probably the reason for it is that you know that [the thoughts and rituals associated with it] are bizarre.

Part of your brain understands that, but the feeling part of the brain is not working so well. There’s something wrong with the connection between what you know and what you feel, and people find that very embarrassing.

Q: In the brain, then, are there corresponding problems in connection between the circuits involved in thought and those that process emotion?

A: When we stimulate OCD [symptoms] in [the brain], certain circuits are activated and those do seem to be involved in planning and worrying. However, we’re very early in our understanding of what’s going on the brain. The circuits involved go from the frontal cortex to the thalamus and up to the cingulate cortex.

Q: These are regions involved in both thought and emotion.

A: I’ve always wondered if these circuits are completely normal but are firing [too much] over time to make up for another part that is not working right. By working overtime, [this could] produce the worries. So we don’t know if the circuits we’re seeing are primarily the problem or not.

Q: Has the media attention to problems like hoarding been helpful or does it create more of a “freak show” effect that stigmatizes the disorder?

A: Hoarding is incredibly common. Now because of those shows, people are calling us all the time. When I look at the shows, I think most of them are pretty good. They clearly show the problem and show various approaches to dealing with it. I think there’s more positive than negative coming out of it. I know from doing Larry King that first time that there are thousands of people who would never have gotten treatment if they hadn’t seen that show.

Q: Are there treatments that can be harmful?

A: If you go in and hire a company to clean up while you take the person out to the movies, that will do all kinds of things [that could backfire]. One woman actually committed suicide [after this was done].

Q: How can people get help?

A: The International OCD Foundation website has lots of information and resources. And if you email me, I can help you get into treatment.

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