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OCD and Traumatic Brain Injury

Injury to the Brain Can Cause Symptoms of OCD

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Updated August 22, 2010

Traumatic brain injury (TBI) caused by motor vehicle accidents, falls or other accidents and firearms is a major source of disability and suffering worldwide. In addition to cognitive problems, it is not uncommon for individuals who have suffered a TBI to develop symptoms consistent with one or more forms of mental illness including obsessive-compulsive disorder (OCD).

What Is a Traumatic Brain Injury?

TBI occurs when the brain is injured or damaged by an outside force such as a blow to head or a gunshot. TBIs can occur as a closed head injury in which the skull and brain remain intact or as a penetrating head injury in which an object penetrates the skull and brain. TBI can also be classified according to the severity of injury; physicians often refer to TBIs as being either mild, moderate or severe.

TBI Causes Changes in Both Thinking and Behavior

Not surprisingly, following a TBI it is not uncommon for the affected person to experience changes in cognitive function. After a TBI, performance on everyday tasks requiring memory, language, spatial and/or verbal ability may be negatively affected either temporarily or permanently.

If the TBI affects motor centers within the brain, mobility may also be impaired, forcing the person to use a wheelchair or depend on others for transportation or to carry out basic day-to-day tasks such bathing or preparing food.

TBI can also affect behavior, causing changes in personality such that a previously calm individual may become impulsive or aggressive. Likewise, an outgoing individual may become shy and withdrawn.

TBI Can Cause Symptoms of OCD

In addition to changes in cognitive function, behavior and mobility, TBI appears to trigger symptoms of OCD including obsessions and compulsions in some people. OCD following a TBI usually occurs soon (if not immediately) after the event has taken place; however, there have been reports of TBI-induced OCD being diagnosed months after the initial injury. In each case, localized brain damage may or may not be present when viewing a brain scan.

Research has indicated that OCD following a TBI is usually accompanied by symptoms of major depression. Whether this depression is a result of the TBI, the psychosocial stress caused by the injury or the onset of OCD or a combination of these factors is unclear.

How Is OCD Following a TBI Treated?

Treatment with selective serotonin reuptake-inhibitors such as Prozac (fluoxetine) or tricyclic antidepressants such as Anafranil (clomipramine) may be recommended.

Psychotherapy for OCD following a TBI may also be helpful; however, given the high potential for cognitive impairment in this population, the viability of this treatment strategy needs to be evaluated on a case-by-case basis. In many cases, supportive therapy which assists the individual in simply coping with both the practical and emotional challenges associated with both TBI and OCD can be beneficial.

Sources:

Coetzer, B.R.“Obsessive-compulsive disorder following brain surgery” International Journal of Psychiatry and Medicine 2004 34: 363-377.

Grados, M.A. “Obsessive-compulsive disorder after traumatic brain injury” International Review of Psychiatry 2003 15: 350-358.

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