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Toward a Neuroanatomy of Obsessive-Compulsive Disorder

Thomas R. Insel, MD
Arch Gen Psychiatry. 1992;49(9):739-744. doi:10.1001/archpsyc.1992.01820090067011.
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This issue of the ARCHIVES includes three new reports of functional brain imaging studies in patients with obsessive-compulsive disorder (OCD).1-3 These 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,4 there 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.5 With time, many different forms of evidence have been marshalled to support a neurologic origin for OCD,6-8 including recent reports9,10 that more than 90% of patients with OCD have "soft signs" consistent with some subtle neurologic disorder. In addition, several true neurologic


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