Toward a Neuroanatomy of Obsessive-Compulsive Disorder

This issue of the ARCHIVES includes three new reports of functional brain imaging studies in patients with obsessive-compulsive disorder (OCD).¹⁻³These articles add to a growing literature on changes in either regional brain metabolism or blood flow in patients with OCD. Although the first such article was published only 5 years ago,⁴there is already a consensus developing toward a neuroanatomic model of the pathophysiologic characteristics of this mysterious syndrome. In this Comment, I examine the evidence for such a model in light of these new findings. BACKGROUND Proposals for a neurologic basis of OCD can be traced back to the last century.⁵With time, many different forms of evidence have been marshalled to support a neurologic origin for OCD,⁶⁻⁸including recent reports⁹,¹⁰that more than 90% of patients with OCD have "soft signs" consistent with some subtle neurologic disorder. In addition, several true neurologic