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Treatment for ocd/obsessive thoughts

3K views 6 replies 4 participants last post by  Phantasm 
This old text from 1978 focuses on the obsessive dimension depersonalization disorder. Some of the terms of terms are not used today but it has for almost a century been described that there within depersonalization disorder is a very strong obsessive compulsive element. Some will say that it was also there prior to the outset with a personality very absorbed with feelings of incompleteness in relation to the world, high ambitions and demands of acceptance. With the outset of depersonalization it just shifted the focus of what to obsesses about and feelings of lack of control on depersonalization symptoms and not the relation with the world.

https://dacemirror.sci-hub.se/journal-article/65dd4a889ab693455a80941f3fd11552/torch1978.pdf
 
There have been several brain imaging studies done in emotional regulation done in the prefrontal cortex in depersonalization under the assumption that the emotional numbing is due to a over regulation of emotions done by the prefrontal cortex. At the depersonalization research unit they found that the right ventrolateral prefrontal cortex was active compared to normal in most of their studies. Their small rTMS trial is based on this location.

But, they also found that the anterior cingulate and the medial prefrontal was active. This locations have also been replicated by others. Overactivity in the anterior cingulate and the medial prefrontal cortex is also seen in obsessive compulsive disorder. There have almost been not brain imaging studies in depersonalization for the last 5.year and technology with deep TMS and rTMS have developed since. In 2015 the anterior cingulate and the medial prefrontal cortex was regarded as too deep in the prefrontal cortex for a rTMS coil to effect. So, there was some limitations back then in interventions that is not there today. A new coil for deeper stimulation has just been approved to treat OCD by the FDA. It's directed at this location.

A company, "Brainsway" making helmets or H-coil had in 2018 their H-coi for OCD approved. It is designed to stimulate the anterior cingulate and the medial prefrontal. I think there are currently 160 locations in the US who have this model and a very few in Europe. Some with depression and PTSD also respond to stimulation at this location. So, to try to address depersonalization as a disorder with a obsessive compulsive dynamic in it could be interesting to try.
 
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