Functional neural mechanisms of sensory phenomena in obsessive-compulsive disorder
Open accessAbstract
Sensory phenomena (SP) are aversive or uncomfortable sensations that accompany and/or drive repetitive behaviors in obsessive-compulsive disorder (OCD). Although SP are associated with significant distress and may respond less well to standard treatments than harm-related obsessions, little is known about their underlying neurobiology. The present study used functional magnetic resonance imaging (fMRI) to measure brain functioning related to severity of SP during a "body-focused" videos task designed to elicit activation in sensorimotor brain regions. Regression analysis examined the relationship between severity of SP and activation during task using permutation analysis, cluster-level corrected for multiple comparisons (family-wise error rate p < 0.05). The distribution of SP severity was not significantly different from normal, with both high- and low-severity scores represented in the OCD sample. Severity of SP was not correlated with other clinical symptoms in OCD including general anxiety, depression, or harm avoidance. When viewing body-focused videos, patients with greater severity of SP showed increased activity in the mid-posterior insula, a relationship that remained significant when controlling for other clinical symptoms, medication status, and comorbidities. At uncorrected thresholds, SP severity was also positively related to somatosensory, mid orbitofrontal, and lateral prefrontal cortical activity. These data suggest that SP in OCD are dissociable from other symptoms in the disorder and related to hyperactivation of the insula. Future work examining neural mechanisms of SP across different disorders (tics, trichotillomania) as well as with other imaging modalities will be needed to further understand the neurobiology of these impairing symptoms.
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SP in obsessive-compulsive disorder (OCD) involves the sensorimotor cortex, mid-posterior insula, somatosensory area, orbitofrontal cortex (OFC) and dorsolateral prefrontal cortex (DLPFC).
“Several neuroimaging studies have shown that SP in OCD involves the sensorimotor cortex, mid‐posterior insula, somatosensory area, orbitofrontal cortex (OFC) and dorsolateral prefrontal cortex (DLPFC) (Brown et al., 2019; Subira et al., 2015).”
From Differences in response inhibition between medication-free patients with obsessive-compulsive disorder with and without sensory phenomena (2026) · cites this paper as Brown et al., 2019
The Discussion reports associations between SP severity in OCD and activity in the mid-posterior insula, somatosensory cortex, middle OFC, and left dorsal prefrontal regions; the Introduction also cites a prior sensorimotor-cortex finding. However, the paper does not specifically identify the prefrontal finding as DLPFC, and it cautions that the reported clusters other than mid-posterior insula were not corrected for multiple comparisons and need replication. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe mid-posterior insula has more increased activity in patients with OCD with a greater severity of SP while viewing body-focused videos.
“Using a task‐based functional MRI study, Brown et al. (2019) found that the mid‐posterior insula had more increased activity in patients with OCD with a greater severity of SP while viewing body‐focused videos.”
From Differences in response inhibition between medication-free patients with obsessive-compulsive disorder with and without sensory phenomena (2026) · cites this paper as Brown et al., 2019
SP severity positively correlates with activity in the left mid-posterior insula, right mid-anterior insula, bilateral somatosensory cortex, left posterior temporal cortex, middle OFC and left DLPFC.
“They also showed that SP severity positively correlated with activity in the left mid‐posterior insula, right mid‐anterior insula, bilateral somatosensory cortex, left posterior temporal cortex, middle OFC and left DLPFC.”
From Differences in response inhibition between medication-free patients with obsessive-compulsive disorder with and without sensory phenomena (2026) · cites this paper as Brown et al., 2019
Activation in these areas remained correlated with sensory phenomena severity after controlling for medication status, comorbidity, and overall obsessive-compulsive symptom severity.
“Activation in these areas remained correlated with SP severity after controlling for medication status, comorbidity and overall OC symptom severity, suggesting that these effects were specific to SP.”
From Toward a neurocircuit-based taxonomy to guide treatment of obsessive-compulsive disorder (2021) · cites this paper as [87]
Greater sensory phenomena severity correlated with greater activity in mid-posterior insula and, at a lower statistical threshold, bilateral postcentral gyri, orbitofrontal cortex, and lateral prefrontal cortex in OCD patients viewing body-focused videos.
“Greater SP severity was correlated with greater activity in mid-posterior insula and, at a lower statistical threshold, bilateral postcentral gyri, orbitofrontal cortex (OFC), and lateral PFC.”
From Toward a neurocircuit-based taxonomy to guide treatment of obsessive-compulsive disorder (2021) · cites this paper as [87]
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Neural Circuitry of Interoception: New Insights into Anxiety and Obsessive-Compulsive Disorders
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Self-citationAltered emotional and BOLD responses to negative, positive and ambiguous performance feedback in OCD
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High-dose ondansetron reduces activation of interoceptive and sensorimotor brain regions
Stern, E. R., Shahab, R., Grimaldi, S. J., Leibu, E., Murrough, J. W., Fleysher, L., Parides, M. K., Coffey, B. J., Burdick, K. E., & Goodman, W. K. (2019) · Neuropsychopharmacology · doi:10.1038/s41386-018-0174-x · Cited by 27 · see citing works
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Toward a neurocircuit-based taxonomy to guide treatment of obsessive-compulsive disorder
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Interoception and Obsessive-Compulsive Disorder: A Review of Current Evidence and Future Directions
Bragdon, L. B., Eng, G. K., Belanger, A., Collins, K. A., & Stern, E. R. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.686482 · Cited by 35 · see citing works
Self-citationThe buildup of an urge in obsessive–compulsive disorder: Behavioral and neuroimaging correlates
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Self-citationDimensions of interoception in obsessive-compulsive disorder
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Self-citationIncompleteness and Disgust Predict Treatment Outcome in Pediatric Obsessive-Compulsive Disorder
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da Silva, R. D. M. F., Batistuzzo, M. C., Shavitt, R. G., Miguel, E. C., Stern, E. R., Mezger, E., Padberg, F., D’Urso, G., & Brunoni, A. R. (2019) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2019.1637257 · Cited by 17 · see citing works
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Associations between suicidality and interoception in obsessive-compulsive disorder
Belanger, A., Timpano, K. R., Eng, G. K., Bragdon, L. B., & Stern, E. R. (2023) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2023.100844 · Cited by 8 · see citing works
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“, physical tension associated with anxiety).(2) OCD is the fourth most frequent mental disorder, with equal proportions between males and females, and prevalence between 1 and 3% of the world population.”
Identifying subgroups of urge suppression in Obsessive-Compulsive Disorder using machine learning
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Self-citationSensory over-responsivity and orbitofrontal cortex connectivity in obsessive-compulsive disorder
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Self-citation
- Authors
- Brown, C., Shahab, R., Collins, K., Fleysher, L., Goodman, W. K., Burdick, K. E., & Stern, E. R.
- Affiliations
- Nathan Kline Institute for Psychiatric Research (US)
- Icahn School of Medicine at Mount Sinai (US)
- Baylor College of Medicine (US)
- Brigham and Women's Hospital (US)
- Corresponding author
- Stern, Emily R.
- ORCID
- Venue
- Journal of Psychiatric Research
- Publisher
- Elsevier BV
- Published
- 2019-02
- Volume
- 109
- Pages
- 68-75
- ISSN
- 0022-3956 (ISSN-L)
- PMC
- PMC6347462
- OpenAlex
- W2900490688
- Cited by
- 52
- References
- 88
- Citations by year
- 2026: 5 · 2025: 10 · 2024: 4 · 2023: 5 · 2022: 13 · 2021: 3 · 2020: 8 · 2019: 4
- FWCI
- 4.40
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Psychiatric Research (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01MH111794)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- sensory phenomena, obsessive-compulsive disorder, posterior insula, sensorimotor cortex, somatosensory cortex, orbitofrontal cortex, prefrontal cortex, symptom severity, neural mechanisms, trichotillomania, tics
- MeSH terms
- Adult, Brain Mapping, Cerebral Cortex, Humans, Magnetic Resonance Imaging, Obsessive-Compulsive Disorder, Severity of Illness Index, Somatosensory Cortex, Prefrontal Cortex, Touch Perception, Interoception
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