Obsessive-Compulsive Disorder and Self-confidence

Patients with Obsessive-Compulsive Disorder (OCD) experience undesirable, intrusive thoughts (obsession) reflecting their anxious relationship with the world, and they feel a strong urge to do recurrent, ritual-like behaviors (compulsion).

Deep Brain Stimulation (DBS) has been proven to be an effective treatment for treatment-resistant obsessive-compulsive disorder.   A spike in self-confidence is the striking change described frequently by patients with Obsessive-Compulsive Disorder after a Deep Brain Stimulation treatment.

In the Medical Center of the University of Amsterdam, 80 treatment-resistant patients with Obsessive-Compulsive Disorder were treated with Deep Brain Stimulation, an innovative method of treatment in which a “neurostimulator” stimulating the brain is surgically implanted.  In this study, the stimulation was applied on the areas close to “the ventral anterior extremity of the internal capsule (vALIC) / nucleus accumbens” in ventral striatum.

In a clinical study where striatal-DBS was administered for Obsessive-Compulsive Disorder, a 72% decrease in symptoms was observed in those who were responsive to the treatment.

Unlike pharmacotherapy, when adequate parameters of simulation were determined, patients with Obsessive-Compulsive Disorder instantaneously (sometimes within minutes) responded to Deep Brain Stimulation.  A sudden and permanent rise in self-confidence is one of the most dramatic changes described by the patients.

Simultaneously, while the patients reported a decrease in anxiety-related obsessions, an additional behavioral therapy was typically needed for improvement in the symptoms of compulsivity.  In this study, it is believed that the primary effect of the Deep Brain Stimulation was a spike in the patient’s self-confidence.  Moreover, when the DBS stimulation parameters were set at quite high levels, the patient was observed to act more impulsively, which is a sign of excessive self-confidence.

What is Self-confidence?

When people trust their abilities and environment, they also tend to believe in themselves. Self-confidence enables people to be open to various possibilities of actions that concern themselves.  Therefore, we are going to discuss self-confidence in respect of one’s experience regarding the power to act in the world.  For self-confidence, it is possible to provide a neurocognitive definition in terms of “active inference”, which is the process of selecting actions that minimize the “surprise” expected as a consequence of the action.

Active inference is the process of selecting actions that minimize the long-term surprises and have sensory results. “Surprise” is measured as an incorrect estimation, which is the discrepancy between the estimations of the action and the current sensory inputs.  The individual expects his future sensory states to match what he values or desires, and he becomes anxious when such expectations are violated.  As per active inference, one acts with self-confidence when he believes that his actions will lead to the results he expects, which would minimize the surprise in turn.

Self-confidence declines in Obsessive-Compulsive Disorder. The individual’s power to act in the world declines seriously due to his disorder. Dangers like meeting up, activities like harming others, or situations like doing activities they find morally disgusting, are envisaged by patients with Obsessive-Compulsive Disorder in a threatening manner.  As a result, they show behaviors aimed at preventing possible threats that are interpreted incorrectly.

The decline in self-confidence reported by patients with Obsessive-Compulsive Disorder is a consequence of the actions being guided by the expectations of possible threats or dangers.  It is believed that Deep Brain Stimulation increases self-confidence by letting the patient be open to other possibilities of action, not just to those that are related to his fears or anxieties.

REFERENCES:
– Kiverstein, J., Rietveld, E., Slagter, H. A., & Denys, D. (2019). Obsessive Compulsive Disorder: A Pathology of Self-Confidence? Trends in Cognitive Sciences. doi:10.1016/j.tics.2019.02.005.