Download PDF
Pharmacopsychiatry 1999; 32(6): 223-229
DOI: 10.1055/s-1999-7959
Original Paper
Georg Thieme Verlag Stuttgart · New York

Neurobiological and Anthropological Aspects of Compulsions and Rituals

A. Heinz
  • Department of Neurology of the Ruhr-University Bochum, Germany
Further Information

Publication History

Publication Date:
31 December 1999 (online)

Also available at
    Permissions and Reprints

Introduction

About two percent of the population suffer from Obsessive Compulsive Disorder (OCD; Rapoport, 1989). It has been postulated that OCD is caused by a cortical dysfunction and a disinhibition of subcortically programmed stereotypies (Schwartz et al., 1996). Within the framework of an evolutionary concept of brain development, compulsions may be interpreted as the manifestation of phylogenetically obsolete behavior patterns that are no longer under the control of cortical brain centers (Jackson, 1927). This hypothesis may help to explain similarities between compulsions and ritualistic behavior in so-called primitive cultures. To assess the plausibility of this hypothesis, current neurobiological findings on the pathogenesis of compulsions and stereotypic movements are reviewed and contrasted with anthropological descriptions of cultural rituals.

A phenomenological tradition within psychiatric psychopathology discriminates between obsessions, compulsions and "compulsive impulses." Obsessions are intrusive thoughts or images that, unlike the schizophrenic first rank symptom of thought insertion, are not felt to be caused by an outside agent (Fähndrich, 1981). Compulsive rituals are often carried out to ward off negative consequences of aggressive or obscene obsessions. Patients are, however, aware that these compulsive activities are irrational, useless or exaggerated (American Psychiatric Association, 1995). For instance, a female patient experienced the obsessive thought that God and the devil have intercourse, which intruded in a very drastic way. Although not particularly religious, the patient was shocked, retreated into an unobserved space and performed a ritualistic prayer to compensate for the blasphemy thought. With increasing frequency of the obsessive thought and compensatory ritual, she was ultimately unable to perform activities of daily life.

Compulsive impulses are phenomenologically placed between obsessions and compulsions. On the one hand, they are mental phenomena experienced by the patient, and are accordingly classified as obsessions by the American Psychiatric Association (1995). On the other hand, the impulses may induce simple behavior patterns. A typical example is coprolalia, the urge to utter curses when stressed (Fähndrich, 1981).

This paper will specifically examine current findings on the pathogenesis of Gilles de la Tourette Syndrome (GTS). GTS is a hereditary neuropsychiatric disorder characterized by motor and vocal tics and the frequent manifestation of obsessions and compulsions (Cummings and Frankel, 1985; Lajonchere et al., 1996). The co-occurrence of tics and OCD has stimulated the search for a common neuropathological correlate of both syndromes. Genetic studies support the notion of a spectrum disorder that may manifest as simple tics, “pure” obsessions and compulsions or GTS (Swedo and Leonard, 1994; Hyde and Weinberger, 1995). GTS has been called a model neuropsychiatric disorder (Hyde and Weinberger, 1994), which allows the examination of the pathogenesis of simple motor tics as well as the more complex obsessions and compulsions.

References

  • 1 Alexander G E, Long M R, Strick P L. Parallel organization of functionally segregated circuits linking basal ganglia and cortex.  Ann. Rev. Neurosci.. 1986;  9 357-381
    CrossrefPubMedGoogle Scholar
  • 2 American Psychiatric Association .Diagnostic and statistical manual of mental disorders. Fourth edition. American Psychiatric Association, Washington DC 1995
    Google Scholar
  • 3 Asberg M, Thoren L, Bertilsson L. Clomipramine treatment of obsessive-compulsive disorder: Biochemical and clinical aspects.  Psychopharmacol Bull. 1982;  18 13-21
    PubMedGoogle Scholar
  • 4 Baumgarten H G, Grozdanovic Z. Anatomy of central serotonergic projection system. In: Baumgarten HG, Göthert M Handbook of experimental pharmacology. Serotonergic neurons and 5-HT receptors in the CNS. Springer, Berlin, Heidelberg 1997 129: -89
    Google Scholar
  • 5 Baxter L R Jr, Phleps M E, Mazziotta J C, Guze B H, Schwarzt J M, Selin C E. Local cerebral glucose metabolic rates in obsessive-compulsive disorder. A comparison with rates in unipolar depression.  Arch. Gen. Psychiat.. 1987;  44 211-218
    PubMedGoogle Scholar
  • 6 Baxter L R Jr, Schwartz J M, Bergman K M, Szuba M P, Guze B H, Mazziotta J C, Akazraju A, Selin C E, Ferng H K, Munford P, Phleps M E. Caudate glucose metabolic rate changes with both drug and behavior therapy for obsessive-compulsive disorder.  Arch. Gen. Psychiat.. 1992;  49 681-689
    CrossrefPubMedGoogle Scholar
  • 7 Böll H. Nicht nur zur Weihnachtszeit. In: Dr. Murkes gesammeltes Schweigen and andere Satiren. Kiepenheuer and Witsch, Köln 1977: 54-106
    Google Scholar
  • 8 Brodie M S, Bunney E B. Serotonin potentiates dopamine inhibition of ventral tegmental area neurons in vitro.  J. Neurophys.. 1996;  76 2077-2082
    PubMedGoogle Scholar
  • 9 Brooks A, Pigott T A, Hill J L, Canter S, Grady T A, L'Heureux F, Murphy D L. Acute intravenous administration of ondansetron and m-CPP, alone and in combination, in patients with obsessive-compulsive disorder (OCD): behavioral and biological results.  Psychiat. Res.. 1998;  79 11-20
    CrossrefPubMedGoogle Scholar
  • 10 Cohen D J, Shaywitz B, Caparulo B, Young J G, Bowers M B. Chronic, multiple tics of Gilles de la Tourette disease. CSF acid monoamine metabolites after probenecid administration.  Arch. Gen. Psychiat.. 1978;  35 245-250
    PubMedGoogle Scholar
  • 11 Cummings J L. Frontal-subcortical circuits and human behavior.  Arch. Neurol.. 1993;  50 873-880
    CrossrefPubMedGoogle Scholar
  • 12 Cummings J L, Frankel M. Gilles de la Tourette Syndrome and the neurological basis of obsessions and compulsions.  Biol. Psychiat.. 1985;  20 1117-1126
    PubMedGoogle Scholar
  • 13 Devinsky O. Neuroanatomy of Gilles de la Tourette's syndrome. Possible midbrain involvement.  Arch. Neurol.. 1983;  40 508-514
    PubMedGoogle Scholar
  • 14 Dewey S L, Smith G S, Logan J, Alexoff D, Ding Y S, King P, Pappas N, Brodie J D, Ashby C R. Serotonergic modulation of striatal dopamine measured with positron emission tomography (PET) and in vivo microdialysis.  J. Neurosci.. 1995;  15 821-829
    PubMedGoogle Scholar
  • 15 Duerr H P. Sedna oder die Liebe zum Leben. Suhrkamp, Frankfurt/M. 1984
    Google Scholar
  • 16 Evans-Pritchard E E. Theories of primitive religion. Oxford University Press, Oxford 1981
    Google Scholar
  • 17 Fähndrich E. Arbeitsgemeinschaft für Methodik and Dokumentation in der Psychiatrie. Das AMDP-System. Manual zur Dokumentation psychischer Befunde. Springer, Berlin, Heidelberg, New York 1981
    Google Scholar
  • 18 Farde L, Halldin C, Mueller L, Suhara T, Karlsson P, Hall H. PET study of [C-11]β-CIT binding to monoamine transporters in the monkey and human brain.   Synapse. 1994;  16 93-103
    CrossrefPubMedGoogle Scholar
  • 19 Fisher R E, Morris E D, Alpert N M, Fischman A J. In vivo imaging of neuromodulatory synaptic transmission using PET: a review of relevant neurophysiology.  Human Brain Map.. 1995;  3 24-34
    PubMedGoogle Scholar
  • 20 Freddman M, Black S, Ebert P, Binns M. Orbitofrontal function, object alteration and perseveration.  Cereb. Cortex. 1998;  8 18-27
    CrossrefPubMedGoogle Scholar
  • 21 Goodman W K, Price L H, Delgado P L, Palumbo J, Krystal J H, Nagy L M, Rasmussen S A, Heninger G, Charney D S. Specificity of serotonin reuptake inhibitors in the treatment of obsessive-compulsive disorder. Comparison of fluvoxamine and desipramine.  Arch. Gen. Psychiat.. 1990;  47 577-585
    PubMedGoogle Scholar
  • 22 Grace A A. Phasic versus tonic dopamine release and the modulation of dopamine system responsivity: a hypothesis for the etiology of schizophrenia.  Neurosci.. 1991;  41 1-24
    CrossrefPubMedGoogle Scholar
  • 23 Gross-Iseroff R, Sasson Y, Voet H, Hendler T, Luca-Haimovici K, Kandel-Sussman H, Zohar J. Alteration learning in obsessive-compulsive disorder.  Biol. Psychiat.. 1996;  39 733-738
    PubMedGoogle Scholar
  • 24 Hall L M, Anderson G M, Cohen D J. Acute and chronic effects of fluoxetine and haloperidol on mouse brain serotonin and norepinephrine turnover.  Life Sci.. 1995;  57 791-801
    CrossrefPubMedGoogle Scholar
  • 25 Heinz A. Savage thought and thoughtful savages. On the context of the evaluation of logical thought by Levy-Bruhl and Evans-Pritchard.  Anthropos. 1997;  92 165-173
    PubMedGoogle Scholar
  • 26 Heinz A. Colonial perspectives in the construction of the psychotic patient as primitive man.  Critique Anthropol.. 1998;  18 421-444
    PubMedGoogle Scholar
  • 27 Heinz A, Knable M B, Wolf S S, Jones D W, Gorey J, Hyde T S, Weinberger D R. Tourette's syndrome: serotonin transporters predict severity of vocal tics.  Neurology. 1998a;  51 1069-1074
    PubMedGoogle Scholar
  • 28 Heinz A, Higley J D, Jones D W, Gorey J G, Saunders R, Zajicek K, Suomi S S, Knable M B, Weinberger D R, Linnoila M. In vivo observation of an association between serotonin transporters and sensitivity to alcohol intoxication.  Am. J. Psychiat.. 1998b;  155 1023-1028
    CrossrefPubMedGoogle Scholar
  • 29 Heinz A, Saunders R C, Kolachana B S, Jones D W, Gorey J G, Bachevalier J, Weinberger D R. Striatal dopamine receptors and transporters in monkeys with neonatal temporal limbic damage.  Synapse. 1999;  39 71-79
    PubMedGoogle Scholar
  • 30 Hyde T M, Weinberger D R. Tourette's Syndrome. A model neuropsychiatric disorder.  J.A.M.A.. 1995;  273 498-501
    CrossrefPubMedGoogle Scholar
  • 31 Insel T R, Mueller E A, Alterman I, Linnoila M, Murphy D L. Obsessive-compulsive disorder and serotonin: is there a connection?.  Biol. Psychiat.. 1985;  20 1174-1185
    CrossrefPubMedGoogle Scholar
  • 32 Jackson J H. Die Croon-Vorlesungen über Aufbau and Abbau des Nervensystems. Springer, Berlin 1927
    Google Scholar
  • 33 Kreiss D S, Lucki I. Effects of acute and repeated administration of antidepressant drugs on extracellular levels of 5-hydroxytryptamine measured in vivo.  J. Pharmacol. Exp. Ther.. 1995;  274 866-876
    PubMedGoogle Scholar
  • 34 Lajonchere C, Nortz M, Finger S. Gilles de la Tourette and the discovery of Tourette Syndrome. Includes a translation of his 1884 article.  Arch. Neurol.. 1996;  53 567-574
    PubMedGoogle Scholar
  • 35 Laruelle M, Baldwin R M, Malison R T, Zea-Ponce Y, Zoghbi S S, Al-Tikriti M S, Sybirska M H, Zimmermann R C, Wiesniewski G, Neumeyer J L, Milius R A, Wang S, Smith E O, Roth R H, Charney D S, Hoffer P B, Innis R B. SPECT imaging of dopamine and serotonin transporters with [123-I]β-CIT: Pharmacological characterization of brain uptake in non-human primates.  Synapse. 1993;  13 295-309
    CrossrefPubMedGoogle Scholar
  • 36 Laruelle M, Wallace E, Seibyl J P, Baldwin R M, Zea-Ponce Y, Zoghbi S S, Neumeyer J L, Charney D S, Hoffer P B, Innis R B. Graphical, kinetic, and equilibrium analyses of in vivo [123-I]β-CIT binding to dopamine transporters in healthy human subjects.  J. Cerebr. Blood Flow Metab.. 1994;  14 982-994
    PubMedGoogle Scholar
  • 37 Leach E R. Ritualization in man in relation to conceptual and social development. In: Huxley J (ed.) Philosophical Transaction of the Royal Society of London. Biological Sciences. Royal Society, London, Series B 1966 251
    Google Scholar
  • 38 Lehmann A, Myers J. Magic, witchcraft and religion: an anthropological study of the supernatural. Mayfield Publishing, Mountain View CA 1989 251
    Google Scholar
  • 39 Lundmark J, Walinder J, Alling C, Manniche P M, Dalgaard L. The effect of paroxetine on cerebrospinal fluid concentrations of neurotransmitter metabolites in depressed patients.  Europ. Neuropsychopharmacol.. 1994;  4 1-6
    PubMedGoogle Scholar
  • 40 Malinowski B. Baloma - die Geister der Toten auf den Trobriand-Inseln. In: Magie, Wissenschaft und Religion. Fischer, Frankfurt/M. 1973: 172-173
    Google Scholar
  • 41 Marek G J, McDougle C J, Price L H, Seiden L S. A comparison of trazodone and fluoxetine: implications for a serotonergic mechanism of antidepressant action.  Psychopharmacol. Berlin. 1992;  109 2-11
    PubMedGoogle Scholar
  • 42 McCormick D A. Neurotransmitter actions in the thalamus and cerebral cortex.  J. Clin. Neurophys.. 1992;  9 212-223
    PubMedGoogle Scholar
  • 43 McDougle C J, Goodman W K, Price L H. Dopamine antagonists in tic-related and psychotic spectrum obsessive-compulsive disorder.  J. Clin. Psychiat.. 1994;  55 24-31
    PubMedGoogle Scholar
  • 44 McGuire P K, Bench C J, Frith C D, Marks I M, Franckowiak R S, Dolan R J. Functional anatomy of obsessive-compulsive phenomena.  Br. J. Psychiat.. 1994;  164 459-468
    PubMedGoogle Scholar
  • 45 McLean P. A triune concept of brain and behavior. University of Toronto Press, Toronto 1973
    Google Scholar
  • 46 Muck-Seler D, Jevric-Causevic A, Diksic M. Influence of fluoxetine on regional serotonin synthesis in the rat brain.  J. Neurochem.. 1996;  67 2434-2442
    PubMedGoogle Scholar
  • 47 Mumenthaler M, Mattle H. Neurologie. Syndrome des Frontallappens. Stuttgart, New York, Thieme 1997: 389-392
    Google Scholar
  • 48 Perani D, Colombo C, Bressi S, Bonfanti A, Grassi F, Scarone S, Bellodi L, Smeraldi E, Fazio F. [18F]FDG PET study in obsessive-compulsive disorder. A clinical/metabolic correlation study after treatment.  Br. J. Psychiat.. 1995;  166 244-250
    PubMedGoogle Scholar
  • 49 Pirker W, Asenbaum S, Kasper S, Walter H, Angelberger P, Koch G, Pozzera A, Deecke L, Podreka I, Brücke T. β-CIT SPECT demonstrates blockade of 5HT-uptake sites by citalopram in the human brain in vivo.  J. Neural Transm.. 1995;  100 247-256
    CrossrefPubMedGoogle Scholar
  • 50 Rapoport J L. The biology of obsessions and compulsions.  Scientific Am.. 1989;  3 83-89
    PubMedGoogle Scholar
  • 51 Riederer P, Sofic E, Rausch D, Hebenstreit G, Bruinvels J. Pathobiochemistry of Parkinson's disease: a “short note” review. In: Przuntek H, Riederer P (eds) Early diagnosis and preventive therapy in Parkinson's disease. Springer, Wien, New York 1989: 139-150
    Google Scholar
  • 52 Sandyk R. A case of Tourette's syndrome with midbrain involvement.  Intern. J. Neurosci.. 1988;  43 171-175
    PubMedGoogle Scholar
  • 53 Schwartz J M, Stoessel P W, Baxter L R, Martin K M, Phleps M E. Systematic changes in cerebral glucose metabolic rate after successful behavior modification treatment of obsessive-compulsive disorder.  Arch. Gen. Psychiat.. 1996;  53 109-113
    PubMedGoogle Scholar
  • 54 Singer H S, Butler I J, Tune L E, Seifert W E, Coyle J T. Dopamine dysfunction in Tourette syndrome.  Ann. Neurol.. 1982;  12 361-366
    CrossrefPubMedGoogle Scholar
  • 55 Storozhuk V M, Sachenko V V, Kruchenko J A. Dependence of sensorimotor cortex neuron activity on noradrenergic and serotonergic transmission in unspecific thalamic nuclei.  Neurosci.. 1995;  68 315-322
    CrossrefPubMedGoogle Scholar
  • 56 Swedo S E, Pietrini P, Leonard H L, Shapiro M B, Rettow D C, Goldberger E L, Rapoport S I, Grady C L. Cerebral glucose metabolism in childhood-onset obsessive-compulsive disorder. Revisualization during pharmacotherapy.  Arch. Gen. Psychiat.. 1992;  49 690-694
    PubMedGoogle Scholar
  • 57 Swedo S E, Leonard H L. Childhood movement disorders and obsessive compulsive disorder.  J. Clin. Psychiat.. 1994;  55 (Suppl) 32-37
    PubMedGoogle Scholar
  • 58 Thoren P, Asberg M, Bertilsson B, Mellstrom B, Sjoqvist F, Traskman L. Clomipramine treatment of obsessive-compulsive disorder: II. Biochemical aspects.  Arch. Gen. Psychiat.. 1980;  37 1289-1294
    PubMedGoogle Scholar
  • 59 Trent F, Tepper J M. Dorsal raphe stimulation modifies striatal-evoked antidromic invasion of nigral dopaminergic neurons in vivo.  Exp. Brain Res.. 1991;  84 620-630
    PubMedGoogle Scholar
  • 60 Turner V. The anthropology of performance. PAJ Publications, New York 1988
    Google Scholar
  • 61 Wolf S, Jones D W, Knable M B, Gorey J G, Lee K S, Hyde T M, Coppola R, Weinberger D R. Tourette Syndrome: prediction of phenotypic variation in monozygotic twins by caudate nucleus D2 receptor binding.  Science. 1996;  273 1225-1227
    PubMedGoogle Scholar
  • 62 World Health Organization .Tenth revision of the International Classification of Diseases, chapter V (F). Mental and behavioral disorders. Huber, Göttingen 1991
    Google Scholar
  • 63 Zohar J, Insel T R. Obsessive-compulsive disorder: psychobiological approaches to diagnosis, treatment and pathophysiology.  Biol. Psychiat.. 1987;  22 667-687
    CrossrefPubMedGoogle Scholar
  • 64 Zohar J, Mueller E A, Insel T R, Rachel-Kadouch R C, Murphy D L. Serotonergic responsivity in obsessive-compulsive disorder. Comparison of patients and healthy controls.  Arch. Gen. Psychiat.. 1987;  44 946-951
    PubMedGoogle Scholar

Dr. Priv.-Doz. A. Heinz

Central Institute of Mental Health University of Heidelberg

J5

D-68159 Mannheim

Germany

Phone: 0621-1703-945

Email: JonesHeinz@aol.com

      >