Obsessivecompulsive disorder and traumatic brain injury: behavioral, cognitive, and neuroimaging findings.

OBJECTIVE The goal of this study was to evaluate behavior and cognition in a consecutive series of patients who developed obsessive-compulsive disorder (OCD) after suffering a traumatic brain injury (TBI). BACKGROUND Because OCD is a rare sequelae of TBI, the phenomenology of obsessions and compulsions, the comorbid psychiatric disorders, the performance on cognitive tests, and the neural correlates have not been well characterized. METHODS Ten adult patients who met DSM-IV diagnostic criteria for OCD after suffering either mild (6 cases), moderate (2 cases), or severe (2 cases) TBI were studied using structured psychiatric rating scales (i.e., Yale-Brown Obsessive Compulsive Scale), cognitive tests, and magnetic resonance imaging (MRI). RESULTS Global severity of OCD ranged from moderate to severe, and all patients had multiple obsessions and compulsions. There was a high frequency of aggressive, contamination, need for symmetry/exactness, somatic, and sexual obsessions as well as cleaning/washing, checking, and repeating compulsions. Unusual features such as obsessional slowness (3 cases) and compulsive exercising (3 cases) were also documented. Comorbid psychiatric diagnoses were common and included posttraumatic stress disorder, anxiety with panic attacks, depression, and intermittent explosive disorder. Compared with 10 age-matched normal controls, the OCD group had poor performance on tests of general intelligence, attention, learning, memory, word-retrieval, and executive functions; these cognitive deficits were more pervasive among patients displaying obsessional slowness. All OCD patients with mild TBI had normal MRI scans, whereas focal contusions in the frontotemporal cortices, subcortical structures (caudate nucleus), or both were found in OCD patients with moderate and severe TBI. CONCLUSIONS Posttraumatic OCD has a relatively specific pattern of symptoms even in patients with mild TBI and is associated with a variety of other psychiatric disorders, particularly non-OCD anxiety. The patterns of cognitive deficits and MRI findings suggest dysfunction of frontal-subcortical circuits.