TOWARD A NEURODEVELOPMENTAL MODEL OF OBSE SSIVE-COMPULSIVE DISORDER

Background: Neurobiological models for obsessive-compulsive disorder ( OCD) have consistently implicated ventral prefrontal cortical and stri atal circuits in the pathophysiology of this disorder, but typically h ave not utilized a developmental framework for conceptualizing the ill ness. Methods: We describe an integrated senses of neurobiologic studi es aimed at testing the hypothesis that neurodevelopmental abnormaliti es of ventral prefrontal-striatal circuits may be involved in and cont ribute to the etiology and presentation of the illness. Results: Using studies of oculomotor physiology, we have identified a selective defi cit in neurobehavioral response suppression in OCD that may be related to failures in the developmental maturation of frontostriatal circuit ry. Magnetic resonance imaging studies showed that treatment-naive ped iatric OCD patients had significant volumetric abnormalities in ventra l prefrontal cortical and striatal regions but no abnormalities in dor solateral prefrontal cortex. Severity of OCD symptoms but not illness duration was related to ventral prefrontal cortical and striatal volum es. Conclusions: Critical neurodevelopmental changes in ventral prefro ntal-striatal circuitry may be associated with the initial presentatio n of OCD, and a developmentally mediated network dysplasia may underli e OCD. Such dysplasia in ventral prefrontal cortical circuits could ma nifest clinically by disrupting brain functions that mediate ongoing p urposive behaviors. Published 1998 Society of Biological Psychiatry.