Neurosurgery for Obsessive-Compulsive Disorder: Problems With Comorbidity

Ms. A, a 32-year-old single woman with long-standing OCD, had symptoms including cleaning compulsions, buying things on the “right day,” and the drive to eliminate “bad” or imperfect aspects of herself and her environment. Ten years of treatment, including behavior therapy and serotonin reuptake inhibitors with augmentation, resulted in no improvement. She depended on her family for financial support and could not complete her college degree. Her clinical picture was complicated by bulimia, kleptomania, and borderline personality disorder. There was a previous history of major depressive disorder, but she was not having an episode before the surgery.

Ms. A underwent bilateral anterior capsulotomy and had almost complete elimination of her OCD symptoms. Over the next several months, however, her kleptomanic and bulimic behaviors increased, despite some evidence suggesting these “OCD spectrum disorders” might respond to treatments for OCD (1). She also had a recurrence of severe major depression, which had thus far been unresponsive to four antidepressant trials.