Obsessive-compulsive disorder, also known as OCD, can be described as an obsession that a person cannot stop thinking about, even though they know they are unreasonable, they are still affected by them (Vidich, 1968, p. 245). An obsession is a constant, invasive thought or idea that causes concern and compulsion is a repetitive behavior that a person feels the need to perform in order to reduce anxiety. This disorder causes significant distress and interference in the person's daily life (Griggs, 2017, p. 439-440). Obsessive-compulsive disorder is a general category, but it in itself is a very large spectrum. There are many different types of OCD and can be determined by observing the person's behaviors associated with obsessive-compulsiveness (Vidich, 1968, p. 246).

A person with obsessive-compulsive disorder will often times repeat thoughts or behaviors over and over again. Some common symptoms of OCD include an extreme fear of germs, destructive thoughts towards themselves or to others, or even having things in a symmetrical, organized, and patterned manner. Some people with obsessive-compulsive disorder even have the urge to clean things or wash their hands excessively, order things in a special way, compulsive counting, or even frequently checking things like making sure you locked the door or unplugging things to prevent an unwanted result (The National Institute of Mental Health, 2016).

Causes

Researchers trying to find the root cause of OCD have observed that certain areas of the brain work differently in people with obsessive-compulsive disorder. Some have found that there are communication errors between the different parts of the brain including the orbitofrontal cortex, the striatum, and the thalamus. Some research even suggests that there could be irregularity in neurotransmitter systems, involving chemicals like serotonin, dopamine, and glutamate. These chemicals are responsible for sending messages throughout the brain (Beyond OCD). Also, people who have experienced abuse during childhood are at an increased risk for developing obsessive-compulsive disorder. In some cases, children may develop OCD following a streptococcal infection. There is still not a definitive cause of OCD (The National Institute of Mental Health) .

Effects

Obsessive-compulsive disorder can have negative effects on the person diagnosed with the disorder and the people around them. The disorder can worsen without correct treatment. The person may develop wounds on the skin from irritable scratching or over washing and scrubbing. The person could have trouble maintaining and exceeding in their professional, academic, or social life. They could begin to isolate themselves from others close to them due to the fear of spreading germs or because they are too consumed in their own thoughts to think about interactions with others. They may start to have recurring suicidal thoughts or tendencies due to OCD. Some people may even turn to alcohol or illegal drugs for relaxation, resulting in substance abuse. The obsession can take up a big portion of the person's day which can interfere with their family and social life. The person may begin to have more conflicts with friends and family and may even lose the relationship as a whole. Some family members may blame the person with OCD for their obsessive behaviors, which in turn can anger the person with OCD. Due to this intense anger, the person with obsessive-compulsive disorder may try to inflict pain onto others that are close to them (Belmont Behavioral Hospital).

Treatments

OCD is usually treated with medications, psychotherapy, or both. Some antidepressant medications can inhibit serotonin reuptake in the neurotransmitters, reducing the symptoms of the disorder. If symptoms do not improve with these types of medicines, some doctors will prescribe antipsychotic medications. These medications can help the person cope with the symptoms, but will not permanently relieve the effects of OCD. Psychotherapy is another alternative to treat obsessive-compulsive disorder. Research shows that certain types of psychotherapy, including cognitive behavior therapy (CBT) and other related therapies can be as effective as medication for many individuals (The National Institute of Mental Health). CBT can help the patient become aware of their obsessive or compulsive thoughts so that they can respond to them in an efficient way. Researchers also found that Exposure and Response Prevention can help reduce compulsive behaviors, even in people who did not respond well to serotonin-inhibiting medication. Some patients choose to try medications first and then result to psychological therapy. There is still research being done to determine more alternatives to treatment for people with OCD. At the moment, it is unclear which treatment is the best. Scientists believe that it depends on how extreme the patient has the disorder and the location of the brain affected by OCD (The National Institute of Mental Health).

Statistics

OCD was once believed to be a rare disorder, but recent years have shown that more people may have OCD than previously estimated. According to a research study done by The American Psychiatric Association, about three million people of the United States population are diagnosed with obsessive-compulsive disorder every year. It was also found that women are at a higher risk of developing OCD, but the disorder is more common in men during childhood ages. People who suffer from OCD also tend to struggle with anxiety disorders, too. About 76% of people with obsessive-compulsive disorder are also diagnosed with anxiety as well (Belmont Behavioral Hospital).

Works Cited

1. Belmont Behavioral Hospital. Obsessive-Compulsive Disorder Causes, Signs, & Effects. Belmont Behavioral Hospital. (n.d.). Retrieved November 11, 2018, from https://www.belmontbehavioral.com/disorders/ocd/causes-effects/
2. Beyond OCD. What Causes Obsessive Compulsive Disorder (OCD)? (n.d.). Retrieved November 11, 2018, from https://beyondocd.org/ocd-facts/what-causes-ocd
3. Griggs, R. A. (2017). Psychology: A concise introduction (5th ed., pp. 439-440). New York, NY: Worth.
4. The National Institute of Mental Health. Obsessive-Compulsive Disorder. (n.d.). Retrieved November 13, 2018, from https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml
5. Vidich, A. J. (1968). Obsessive-Compulsive Disorder. In D. L. Sills (Ed.), International Encyclopedia of the Social Sciences (Vol. 11, pp. 245-246). New York, NY: Macmillan.Retrieved from https://link.galegroup.com.lsproxy.austincc.edu/apps/doc/CX3045000882/GVRL?u=txshracd2487&sid=GVRL&xid=3e1c649f

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Charles Darwin coined disgust as a sensation rather more distinct in its nature in which an individual has an aversion to negative stimuli deemed to be revolting primarily in the sense of taste and alternately to anything that evokes feelings akin to disgust (Darwin, 1872). Evolutionarily, disgust is accompanied by a distinct facial expression, the closing of the nares, nausea, and distancing oneself from the aversive stimuli (Haidt, McCauley, & Rozin, 1994). While disgust has traditionally been linked with ingestion and excretion from Tomkins (1963) viewing it as a recognition of competition to our food drive to Angyal (1941) deeming body wastes as the prime negative stimuli to elicit disgust, the emotion of disgust has broadened to include aversions to certain people, places, and things. Disgust has since been broken into four major categories: core disgust, animal-nature disgust, interpersonal disgust, and moral disgust (Rozin, Haidt, & McCauley, n.d.) Yet, there is not resounding confidence for what motivates the emotion of disgust beyond the traditional view of avoidance of harmful pathogens.

Emerging research suggests that there is a link between the emotion of disgust and Obsessive Compulsive Disorder (OCD) (Pittenger, 2017). OCD is a common, chronic disorder characterized by uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions) that the individual feels compelled to complete (National Institute of Mental Health, 2016). Obsessive compulsive disorders can be grouped based on the nature of their symptoms with the five most common subtypes being: contamination obsession OCD with washing/cleaning compulsions; harm obsession OCD with checking compulsions, obsessions without visual components (e.g. sexual, religious, aggressive themes); symmetry obsessions with ordering, arranging, and counting compulsions; and, hoarding (Owen, 2018).

It has been suggested that appraisals of disgust could play a major role in obsessive contamination patterns and washing compulsions often exhibited in patients with contamination type OCD (Berle & Phillips, 2006). Researchers have also found that individuals with OCD have a deficiency for recognizing facial expressions of disgust (Pittenger, 2017). Finally, researchers have found similar brain pathways are activated for disgust and OCD pathology (Berle & Phillips, 2006). The frontal-striatal regions of the brain for individuals with OCD symptoms were found to be affected with the emotion of disgust which implies that the discomfort associated with disgust could be connect to the pathogenesis of common OCD behaviors (Sprengelmeyer et al., 1997). This relationship lends to the notion that patients with OCD (specifically contamination-type) will have stricter qualifications for what they deem as disgusting; and, therefore exhibit harsher views on stimuli, people, or situations considered disgusting in their schema.

Additionally, disgust has many similarities to how an individual experiences fear. Both are characterized by withdrawal or avoidance from a certain aversive stimuli. Researchers indicate evaluative conditioning (EC), a version of classical conditioning, as how we are conditioned to be fearful or disgusted by a certain stimuli. Evaluative conditioning proposes that we make hedonic judgements about stimuli, events, etc. to label a formerly neutral stimuli as positive or negative while combining it with an aversive stimuli (Berle & Phillips, 2006). Hence, it only takes one occurrence for this combination aversion to create an engrained state of fear or disgust thereby directly affecting our future behavior. This rationale led our team to question if sufferers from harm obsession OCD would make harsher moral judgements.

Disgust sensitivity describes the extent to which someone feels disgusted about a specific aversion. It is thought that an individual with high levels of disgust sensitivity would more likely be disgusted by other stimuli and situations (Berle & Phillips, 2006). Research has found that individuals with OCD are likely to show high levels of disgust sensitivity. Deacon and Olatunji (2006) studied the effect of disgust sensitivity on predicting contamination anxiety and avoidance, and found that disgust sensitivity was significantly related to anxious and avoidant behavior for all three contamination-related behavioral avoidance tasks (BATs) (Deacon & Olatunji, 2007).

There is additional evidence that moral judgements are correlated with the emotion of disgust. Jonathan Haidt's Moral Foundations Theory lists six foundations of morality: harm, fairness, loyalty, authority, purity, and liberty; with purity having links to disgust sensitivity (Haidt et al., 1994). Leeuwen and colleagues (2016) found that individuals with higher degrees of disgust sensitivity exhibited harsher moral judgments even when controlling for variables like political ideology. This indicates that moral judgements would be driven by an individual's perception of disgust sensitivity in accordance to certain aversive stimuli. Contrastingly, Kurt Gray's Theory of Dyadic Morality suggests that moral judgements are a social construct of a combination of two units: an intentional agent causing damage to a vulnerable patient which when put together causes harm. Hence, moral judgements would be the consequence of harm, with disgust acting as a situational byproduct (Gray, Young, et al., 2012).

The present study is focused on the effect of contamination obsession OCD and harm obsession OCD and their implications on disgust sensitivity and overall moral judgement. If disgust can be attributed to the judgement of morally disgusting scenarios aligned with Haidt's Moral Foundations Theory, it is predicted that people with contamination OCD will make harsher moral judgements on purity scenarios than people with harm obsession OCD and people without OCD. Patients with contamination OCD tend to have a higher disgust sensitivity which may apply to disgust in a moral context and therefore yield harsher judgements as they will reject the scenarios more strongly. In response to moral scenarios that are not related to purity or disgust, both groups of OCD patients should perform similarly because both groups are concerned with potential harm, more so than the group without OCD.

Alternatively, if moral judgement is mediated by harm instead of disgust as posed by Gray's Theory of Dyadic Morality, both groups of OCD patients, (contamination OCD and harm obsession OCD) will make harsher moral judgements on all types of moral dilemmas than people without OCD because patients with OCD have a higher concern for potentially harmful stimuli and will tend to reject those scenarios more strongly.

Participants were recruited through posters and online advertisements. Participation was limited to individuals currently diagnosed with OCD in between the ages of 18 and 30. A total of ninety individuals ( 5 females and 45 males) participated in this study with thirty individuals in each group (Mage = 25 years, SD = .503 years ) All testing occurred on site and in person. Participation was voluntary, and participants received no compensation for their time.

Obsessive Compulsive Disorder. We used Goodman, Price, and Rasmussen's (1989) Yale-Brown Obsessive Compulsive Scale (Y-BOCS) to first determine what type and how severe each individual's OCD was. Participants indicated the degree to which a series of situations occurred over the past week (e.g. How much control do you have over your obsessive thoughts?, How much time do you spend performing compulsive behaviors?). Our team added addendums to the original questions to differentiate between the different types of obsessive compulsive disorders we were interested in for our study (e.g. How much do you think about harming yourself or others, Do you feel you repeatedly wash your hands to protect for contamination?). Based on the results of this test, the participants were divided into one of three groups: a) contamination obsession OCD; b) harm obsession OCD; and, c) control group with no exhibited OCD tendencies.

Disgust Sensitivity. We used Olatunji and colleagues' (2007) Disgust Scale- Revised (DS-R) to assess the participant's individual differences in disgust sensitivity. Participants indicated how much they agreed with 27 scenarios from the seven domains of disgust elicitors by rating scenarios (e.g. It would bother me tremendously to touch a dead body) on a scale of 0 (strongly disagree, very untrue about me) to 4 (strongly agree, very true about me. The Disgust Sensitivity Scale has been found to have respectable internal consistency (Cronbach's ??? = .80) and test-retest reliability (0.79 for 4-5 month intervals) (Berle & Phillips, 2006). Higher scores on the Disgust Sensitivity Scale indicates that an individual would experience similar levels of disgust to varying situations and stimuli.

Procedure

Moral Dilemmas. After signing the informed consent form, each group was presented with examples of moral dilemmas taken from Gray, Schein, and Ward's (2009) study on how harm can mediate a link between disgusting and immoral acts. Participants were provided with and asked to read a summary of a total of eight moral dilemmas: four purity moral scenarios (e.g. incest, getting a blood transfusion from a child molester) and four harm/non-purity moral scenarios (e.g. domestic violence, adultery) to measure the participant's disgust sensitivity levels. Each group was given an equal number of scenarios (eight) in a randomized order.

The participants were presented with a moral scenario one at a time and were allotted five minutes per moral dilemma to read and reflect. After reading each scenario, the participants rated each moral dilemma on a Likert scale of 1 (completely and morally acceptable) to 7 (completely and morally unacceptable). The purpose of this test was to determine if people with a certain type of OCD (contamination versus harm) would have different reactions to the provided moral dilemmas, thereby indicating harsher moral judgements.

After the participants finished their tasks and supplemental tests, they were debriefed on the purpose of the experiment and provided with contact information for counsel if the subject matter evoked feelings that warranted attention.

Statistical Analyses

The scenario type and OCD diagnosis type were submitted to a two-way 2 (scenario type: disgust, harm) x 3 (OCD diagnosis: contamination OCD, harm OCD, no OCD) mixed analysis of variance (ANOVA). The scenario type (purity vs non-purity) acted as the within-subjects factor and the OCD diagnosis type (contamination OCD, harm OCD, or no OCD) acted as the between-subjects factor. The analysis was followed up with three independent t-tests to identify any significant relationships between the means of the within-subjects' factors and between-subjects' factors.

Results

The two-way 2 x 3 ANOVA yielded a significant difference for the condition of purity vs non-purity moral dilemmas (Figure 1). There was a significant difference between purity moral dilemmas and non-purity moral scenarios between the three groups , F(2, 87) = 15.389, p < .05. For the purity moral scenario condition, there was a significant difference found between both contamination obsession OCD participants and the control group, t(58) = -10.501, p < .05; and, contamination obsession OCD participants and harm obsession OCD participants, t(58) = 6.657, p <.05. Consistent with the hypothesis, participants with contamination obsession OCD recorded harsher moral judgements against the control group and harm obsession OCD group when presented with purity moral scenarios. For the non-purity moral scenario condition, there was a significant difference found between contamination OCD participants and the control group, t(58) = -7.173, p < .05; and, harm obsession OCD patients and the control group, t(58) = -8.740, p <.05. Consistent with the hypothesis, participants in both the contamination obsession and harm obsession participant pools recorded harsher moral judgments against the control group when presented with non-purity moral scenarios. There was an insignificant relationship found between contamination obsession OCD and harm obsession OCD for appraisals of non-purity moral dilemmas, t(58)= -.773, p = .443. Contrary to the original hypothesis, the type of OCD a participant had did not affect their final moral judgement recordings when presented with a non-purity moral scenario. Instead, participants who exhibited any subset of OCD tended to make harsher moral judgements in both conditions.

Discussion

This study provides new evidence to support the relationship between disgust and tendencies of individuals with Obsessive Compulsive Disorders. As hypothesized, Haidt's Moral Foundations Theory was supported by individuals with OCD reporting harsher moral judgements than the control group with no OCD tendencies. Specifically, when confronted with purity moral dilemmas, sufferers of contamination obsession OCD tended to make harsher moral judgements on the scenario over and above individuals with harm obsession OCD and the control group. This association between disgust sensitivity and contamination obsession OCD is aligned with previous researcher's findings (Haidt et al., 1994; Horberg, Oveis, Keltner, & Cohen, 2009; Sprengelmeyer et al., 1997; van Leeuwen, Dukes, Tybur, & Park, 2017). Horberg and colleagues (2009) found that disgust had the power to moralize or amplify the moral significance on matters of purity with the emotion of disgust being a stronger indicator over fear and anger on condemnation of morally impure situations (Horberg et al., 2009).

For the non-purity moral dilemmas, both contamination obsession and harm obsession OCD suffers reported harsher moral judgements when compared to the control group, but there was no indication to support Gray's dyadic view that harm obsession OCD participants would report harsher moral judgements over contamination obsession OCD sufferers. Other findings have found that appraisals of moral dilemmas when considering disgusting stimuli cannot be restricted to purity or bodily norms; rather, disgust should be viewed as dyadic with other components, like physical disgust (e.g. sex crimes), affecting an individual's moral judgements (Chapman & Anderson, 2014). Further supplemental tests for alternate components of disgust, namely studying the dyadic view, could aid in further increasing the internal validity of this study in the future.

It would be intriguing to incorporate the element of sexual disgust to the current study. Leeuwen and colleagues (2017) found that scores of higher sexual disgust were more indicative for purity/sanctity scores over pathogen disgust. It would be interesting to determine whether OCD patients would be more concerned with the threat of sexual reproduction or sexually transmitted disease, and how that would relay to their subsequent moral judgements on similar moral dilemmas. Additionally, the study could be improved by researching the implications of disgust sensitivity across cultures. Spiritual impurity was cited as more distressful over contamination and harm for OCD patients hailing from Iran. This suggests that triggers for OCD in more Western cultures may not have the same gravity or effect for sufferers of OCD globally (Shams, Foroughi, Moretz, & Olatunji, 2013).

A limitation to the present study is the crossover of multiple subtypes of OCD. Seldomly do sufferers with OCD fall directly into one specific subtype of OCD, so our study would need to be updated to include a large population size in order to be more generalizable. In summary, our study's results support previous research that there is a relationship between high levels of disgust sensitivity and appraisals of purity-type moral dilemmas seen in individuals with OCD.

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According to the National Institute of Mental Health ("Obsessive-Compulsive Disorder"), Obsessive-Compulsive Disorder (OCD) is a disorder that can last your entire life. The main symptoms are uncontrollable, reoccurring thoughts and behaviors that makes you feel the urge to repeat over and over. OCD can manifest itself in the form of behaviors such as repetitive actions that a person cannot control or tics. Some common examples are people that constantly wash their hands, check doors repetitively to see if they are locked or light switches to see if they are off. A key part of this being a disorder is when it interferes with daily life. In this paper, I will examine and describe OCD, its signs and symptoms, causes, treatments and the long term prognosis of the disorder.

Obsessive-compulsive disorder (OCD) is when you have a pattern of unreasonable thoughts and fears that lead you to do certain things repetitively. These disorder may interfere with your everyday life and can be a horrible distraction to things you have to do. According to Rachman (2009), people with OCD are afflicted with disturbing unwanted thoughts and feel compelled repeatedly to carry out activities that they know to be irrational. It is difficult for them to understand, and equally difficult to explain to other people, why they repeatedly engage in senseless behavior. According to the Anxiety and Depression Association of America, approximately 2.2 million adults or about 1% of the population of the United States has OCD (https://adaa.org). This includes approximately 1 in every 40 adults and 1 in every 100 children.

Some of the more common symptoms of OCD cited by the National Institute of Mental Health (NIH) are categorized into Obsessions and Compulsions. Obsessions can include things like fear of germs, unwanted and forbidden thoughts, being aggressive towards other people and needing to have things in a perfect order. On the other hand, Compulsions are the behaviors that a person with OCD feels they need to do all the time or it gets in the way of them accomplishing what they set out to do. Examples can include behaviors such as excessive cleaning, ordering things in a certain way and repeatedly checking on things like locked doors and light switches. While people without OCD may do some of these things, the NIH (nimh.nih.gov) states that a person with OCD can't control his or her thoughts or behaviors, even when those thoughts or behaviors are recognized as excessive.

There is no known exact cause of OCD. However, much of the research has identified that people with OCD have brains that work differently than those without it. Research has also shown that OCD can be genetic. The International OCD Foundation (https://iocdf.org) states that OCD does run in families, and that genes likely pay a role in the development of the disorder.

Additionally, WebMD (https://www.webmd.com) states that OCD is slightly more common in women than in men. The site also states that certain things can make a person more likely to get the disorder. This includes having an immediate family member with OCD, developing another psychological disorder such as depression, anxiety or tics, if a person experiences trauma or has a history that includes physical or sexual abuse when the person was a child.

Some other research has suggested that there are environmental factors that can lead to the development of OCD. BeyondOCD (2018) states that some triggers that have been associated with the start of OCD are traumatic brain injuries or a severe illness in children. This can include such sicknesses that people feel are common like strep throat or the flu. They make clear that while these illnesses themselves do not cause OCD, they can be triggers for the development of the disorder. Other environmental factors may include stress and the style of parenting a child is raised under, but this has not yet been definitively proven.

While there is no cure for OCD, treatment mostly involves Cognitive Behavior Therapy (CBT) and/or medication (Koran, 2017). Treatment should also involve what they call Exposure and Response Prevention (ERP). ERP means having the person with OCD be exposed to their thoughts and recognizing that they have them and it is part of their disorder. The Response Prevention part of this therapy is for the counseling to work that allows the person to make the choice not to do the compulsive behavior once it is recognized. It is important to know that the most effective treatment is a combination of all of these strategies. Another treatment for OCD is called Habit Reversal Training. According to the Anxiety and Depression Association of America (https://adaa.org), this training involves practicing of the tic or habit in front of a mirror and figuring out what situation causes the tic you have. By doing this, it will help you gain awareness of when and why the habit or tic happens and start to help avoid the things that trigger them. Habit reversal training takes patience and time as you are trying to get rid of an addictive tic or habit. Having family around to support you during this is an important part fo this treatment method.. Cognitive therapy could also be used to help you with your disorder. A therapist will help you understand when your tics or habits may happen and he/she will help you respond in different ways.

There are also medications that can help with OCD. Many of the medications used to treat people with OCD are the same that are used to treat people with depression. These medications are classified as selective serotonin reuptake inhibitors (SSRIs). The National Institute of Mental Health (https://www.nimh.nih.gov/) states that these medications can take up to 10-12 weeks to actually start working. They go on to say that, even thought there is no cure, people under treatment can learn to live full and productive lives. Additionally, the most successful treatment of OCD combines both of the above methods, CBT and Medication.

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Obsessive Compulsive Disorder (OCD) is currently one of the most common anxiety disorders in the United States, affected around 40 million adults in the US alone. This includes people from the ages of 18 and older, however OCD symptoms begin developing at ages as young as 7 years of age (ADAA 2018).

As time goes on, more and more videos and images are posted, described to trigger your OCD or give you OCD. These images and videos usually consist of unorganised rooms or other things that are just slightly off on aspects such as symmetry and/or order. It is popular amongst adolescents to use the term OCD casually in situations where an individual feels the need to clean something up. Even though this appears to be rather harmless conversational slang, over time this idea of OCD solidifies itself as its common definition. I too used the term OCD loosely to describe some of my family members' behaviors, but after having seen the extent to which OCD can affect an individual's life, I became more critical of my use thereof. I have also had personal experiences with depression, which made me more cognisant of my use of terms with clinical meaning. Therefore, I not only wanted to uncover the ongoing misconceptions about Obsessive Compulsive Disorder, but I also wanted to investigate the biological mechanisms driving OCD.

However, when looking more closely at aspects of OCD I began realising its complexity. Although I will be investigating the biological side of OCD in this paper, it was interesting to get a look at the other perspectives of this complex disorder. No cure exists at this point in time, however there are a variety of different treatments that have been shown to ease symptoms, or at least give patients the feeling of relief, regardless of clinical efficacy. These treatments can range from psychotherapy to various medications that strive to modulate certain neurotransmitters (NT) in the brain.

I chose dopamine (DA), as it is known to be the neurotransmitter in charge of appetitive behaviors and plays roles in addictive behavior. This is important to consider when studying OCD, as the thoughts and behaviors that occur within the disorder consist of repeating thoughts, which are followed by actions to reduce the rising anxiety of the obsessions. Understanding OCD and its chemical mechanisms is a question of particular importance to people who suffer from severe OCD. These individuals will sometimes engage in self harm or in more extreme cases resort to suicide if the obsessive thoughts or compulsions become so bad that they can no longer be controlled. Being able to answer the question of biochemical interactions in key behavioral systems would help to understand OCD and how different symptoms could be treated to reduce or even eliminate them entirely. It is also important to me, as stated previously, to eradicate the notion that this disorder is entirely harmless, and that normal tendencies are in fact very different from the clinical disorder. It is also important that people understand the consequences of having this disorder and know that its origins and manifestations are not fabricated by those affected.

Understanding OCD

Obsessive Compulsive Disorder generally consists of two main parts: the obsessions, and the compulsions. According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) obsessions are recurrent and persistent thoughts, urges, or impulses that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress. Individuals will attempt to ignore or suppress such thoughts, urges, or images, or to neutralise them with some other thought or action; the actions associated with relieving these urges are called compulsions. Compulsions can be characterised as repetitive behaviors or mental acts that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly. Therefore, the obsessions can be defined as the mental aspect of this disorder and the compulsions as the physical aspect.

While most people have certain obsessive thoughts and possibly even compulsive behaviors at some points in their lives, it is important to distinguish that these are not equivalent to individuals who suffer from clinically diagnosed OCD. In order for these thoughts and behaviors to be defined as of OCD, the obsessions and compulsions must to become so extreme that they consume larger amounts of time, thus disrupting daily life and other activities.

Generally there are two types of treatment for OCD: psychotherapy or medication. The five most commonly used medication for OCD are the antidepressants Clomipramine, Fluoxetine (Prozac„?), Fluvoxamine, Paroxetine, and Sertraline, all of which are serotonin reuptake inhibitors (SRIs). These medications were tested in a randomised placebo control study and were shown to have a significant effect on OCD symptoms as compared to the placebo (Jefferson, James W. et al). Medications consisting of SRIs and serotonin reuptake inhibitors (SSRIs) do show a positive effect on OCD symptoms, however medications that consisted of just SRIs or SSRIS were significantly less effective in reducing OCD symptoms, rather than medications that inhibit the reuptake of multiple NTs. It is now important to consider why current medication focuses on serotonin reuptake inhibitors (SRIs), rather than directly trying to regulate DA, and why DA still plays a key role.

Understanding Dopamine

Dopamine is a monoamine neurotransmitter that is produced in several areas of the brain including the substantia nigra (SN) and the ventral tegmental area (VTA), and is then released from the hypothalamus into various parts of the frontal lobe. Its main job revolves around controlling the brain's reward and pleasure centers, thus modulating systems of reinforcement. DA controls the brain's reward and pleasure centers by producing both excitatory and inhibitory postsynaptic potentials, depending on the postsynaptic receptor. This is important to be considered, as DA is released when an action or activity is completed, leading to long term potentiation.

Studies have shown dopamines relation to craving, such as drug cravings for example nicotine addiction (Franken, 2003). These studies demonstrated that conditioned drug stimulus produces an increase in DA levels. (Franken). Therefore, it was concluded that DA suppression drives behaviors associated with cravings. Other studies such as Olds' and Milner's 1954 DA research have demonstrated that the stimulation of the nucleus accumbens–an area from which DA is released–caused extreme repetitive behavior in rats. Rats would push a lever, which stimulated the nucleus accumbens, leading to DA release and an increase in synaptic DA concentration. They would even repeat this behavior until they would pass out from exhaustion. A follow up study also showed that they would cross electrified grids in order to push the lever, demonstrating DA's ability as a 'reward neurotransmitter.'

With this it can be suggested that dopamine could play a role in OCD, as DA has been demonstrated to play roles in behaviors similar to those of OCD. Franken demonstrated a relationship between DA and addiction, which share many of the similar features as obsessive thoughts do, while Olds and Milner demonstrated a relationship between DA and compulsive behavior. Therefore, it would not be illogical to consider whether a dysfunction in one of the dopaminergic systems could possibly play a role in parts of Obsessive Compulsive Disorder. It will be discussed to what extent DA plays a role in OCD. It will also be discussed how DA is possibly involved in systems of serotonin (5-HT) and/or norepinephrine (NE), which medical practitioners target for treatment with (S)SRIs and NRIs to decrease the severity of patient's OCD symptoms.

Dopamine and Obsession

Dopamine plays a extremely large role in Motivation. Dopamine's chemical signal gets passed from one neuron to the next, and between those two neurons, DA interacts with various receptors inside the synapse. When these chemical signals are sent through the mesolimbic pathway, which comes from the middle of the brain and branches to various location including the cerebral cortex, they create a reward system, which plays the biggest role in motivation of an individual. What is very important, when considering DA being released for reward and motivation, is that these chemical signals are not sent out as a reward, but as a matter of fact before this. DA performs its tasks before we obtain rewards, meaning that its real job is to encourage one to act. DA is released in anticipation of these rewards. It is also very important to consider that DA is not in charge of pleasure, as studies have demonstrated, higher levels in dopamine being released in soldiers with PTSD for example, when they heard gunshots fired (Liberzon et al., 1999).

The dopamine reward pathways begin in the ventral tegmental area (VTA) and are mainly sent to the frontal cortex (FC). The FC controls important cognitive skills in humans, such as emotional expression, problem solving, memory, language, judgment, and other behaviors. It generally is in control of our personality and our ability to communicate.

One specific connection that we have seen of dopamine to an obsession/obsessive disorder, is in gambling disorders. The gambling disorder is classified as a substance-related and addictive disorder by the DSM-V. Evidence has suggested that individuals who suffer from a gambling disorder have a greater increase in DA levels, in response to gambling stimuli, compared to individuals who did not suffer from this disorder (Joutsa et al.). Here, it is also important to mention that 5-HT is considered to be the most significant NT in abnormal impulsive behaviours (Ib???±ez et al.), which specifically relates to gambling disorder. Evidence suggests that a 5-HT baseline deficit is associated with gambling disorders. In a study, DeCaria et al., interpreted the results, as indicating that individuals with a gambling disorder had a 5-HT postsynaptic receptor hypersensitivity. This demonstrated 5-HT's role in impulsive decision making, which could be translated to obsessive/compulsive behaviours in OCD, as similar 5-HT and DA depressions have been found in OCD patients. 5-HT's relationship to DA however, will be further discussed later in this paper.

On the other hand, a study found that in patients with general anxiety disorder (GAD) also had a decreased availability of the dopamine D2 receptors in the striatum, which was consistent to prior findings in GAD. GAD is an anxiety disorder characterized by excessive, uncontrollable and often irrational worrying about events or activities. With this it could be inferred that DA's effect on GAD could be translated to the obsessions in OCD, as obsessions are defined as recurrent and persistent thoughts, urges, or impulses that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress. (DSM-V) SRIs have also previously been used to treat GAD, which would imply that GAD and the obsessions in OCD affect similar systems in the brain.In Conclusion, evidence suggests that, while dopamine is not the main and only factor affecting OCD, it does play a major role as an intermediate messenger for the system that causes at least parts of OCD. Though there are also parts of DA that affect OCD and are not previously affected by other NTs, medication tests have shown that the relationship of DA to 5-HT and Norepinephrine is a vital part of OCD, as the most effective medications target these three and many more neurotransmitters.

Although this paper demonstrates the importance of dopamine in OCD and medications working against the symptoms of OCD, a better understanding of dopamine's interplay with other neurotransmitters, that play a role in OCD, has to be developed to create better working medications. Future medications that focuses more on dopamine itself for example could cause more problems such as, addiction to the drug itself, movement and motor problems which could either lead to uncontrolled movement similar to that of Parkinson's Disease or restraint of movement controls, and all together motivation loss in patients. Dopamine is such a complex neurotransmitter that affects so many aspects of physical and mental life, that drugs have to be able to limit only very specific dopamine systems if they want to work against OCD. Similarly to how Clomipramine works through serotonin and norepinephrine to control the correct systems of dopamine, still causing a plethora of side effects and not being fully successful in suppressing OCD behaviours/symptoms.

From a broader perspective, investigating solely Dopamine's role in OCD provides only a small insight into the complexities of the disorder. Nonetheless, this understanding adds to the existing knowledge of the neurobiology of OCD, which could ultimately help clarify correlations between other potential factors and OCD. Further research into other neurotransmitters associated with OCD would hopefully help for future advancements in the treatment of Obsessive Compulsive Disorder.

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