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L'Encéphale
Volume 39, n° 1
pages 44-50 (février 2013)
Doi : 10.1016/j.encep.2012.06.016
Received : 3 August 2011 ;  accepted : 6 Mars 2012
Place de l’inhibition dans le trouble obsessionnel-compulsif
The role of inhibition in obsessional-compulsive disorders
 

M. Dupuy a, b, , F. Rouillon b, C. Bungener a
a LPPS EA 4057, IUPDP, université Paris Descartes, 75014 Paris, France 
b Clinique des maladies mentales et de l’encéphale, centre hospitalier Sainte-Anne, université Paris 5 René-Descartes, 1, rue Cabanis, 75014 Paris, France 

Auteur correspondant.
Résumé

La nature des mécanismes neuropsychologiques sous-jacents à l’expression symptomatique du trouble obsessionnel-compulsif reste encore à déterminer. Nombreuses sont les études qui mettent en évidence des déficits cognitifs mais la diversité des méthodologies et la mixité des sous-types cliniques empêchent de dégager des constantes en termes de profil neurocognitif. Les études qui se sont attachées à l’examen des fonctions exécutives accordent toutefois une importance au rôle exercé par l’inhibition et la flexibilité cognitive dans l’expression symptomatique du trouble obsessionnel et compulsif (TOC). La plupart d’entre elles mettent en évidence un défaut d’inhibition et une altération de la flexibilité cognitive qui pourraient rendre compte du caractère inflexible et répétitif des pensées et des actes commun à toutes les formes du TOC. L’objectif de cet article est de réunir des arguments de la littérature qui plaident en faveur de l’hypothèse d’un déficit d’inhibition et de flexibilité cognitive. La première partie est consacrée à l’approche théorique neuropsychologique plaçant l’inhibition et la flexibilité comme médiateur prometteur pour la compréhension du TOC. En seconde partie, nous passerons en revue des études utilisant différentes mesures de l’inhibition et la flexibilité, dont les résultats vont dans le sens de cette hypothèse.

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Summary
Introduction

The nature of neuropsychological mechanisms underlying the clinical picture of obsessions and compulsions has not been clearly determined. A number of studies has emphasized the role of cognitive deficits, but diversity of methodology and overlapping of clinical sub-groups have not established a specific cognitive functioning of these patients. The studies carried out on executive functions have, however, helped to identify the important role that both inhibition and cognitive flexibility play in obsessive-compulsive (OC) symptoms. Most of them have found that a deficit of inhibition and alteration of cognitive flexibility could explain inflexibility and repetitive thoughts and actions typical of all types of OC disorders. The aim of the paper is to present the published data supporting the hypothesis of a specific role played by a deficit of inhibition and cognitive inflexibility. In the first, theoretical part, we present the neuropsychological approach emphasizing inhibition and lack of flexibility as a promising explanation of the functioning of OC disorders. In the second part, we will present studies using various measurements of inhibition and the results of which, therefore, support this hypothesis.

Arguments and discussion

On the theoretical level, it is the model of attention that was used in explaining the OCD hypothesis. In the model of attention control of action, described by Norman, Shallice and Burgess, three systems were emphasized: one that takes care of routine actions, and the second that takes over the first in situations where automatic activities must stop in order to establish an attention control and therefore inhibit automatic responses. When selection of everyday and automatic activities is not sufficient to accomplish a task, it is the third system, that of cognitive control, which takes over. This supervisory attentional system operates in non-routine and ambiguous activities. The cognitive control is charged with detecting potential or emitted cognitive errors and resolving ambiguous situations. Neurocognitive studies show that cingular anterior cortex and prefrontal lateral cortex are engaged in ambiguous and conflicting situations. These two regions are considered essential for inhibition of routine actions, adjustment to change and, more generally, for an efficient and flexible behaviour. Repetitive nature of verification rituals in OCD could be explained in terms of lack of relationship between two systems, leaving in action the one that regulates automatic activities. Therefore, the rituals are considered to be under particular influence of the system which, being in charge of automatic actions, has a deficit in disengagement. Another model of attention, described by Posner, gives a further explanation of OCD. Mental inhibition has the capacity to treat information, either by applying strategies to control it (i.e. trying not to remember an unpleasant event) or leaving it to automatic control (i.e. incapacity to experience an emotion in relation to a particular event). In this way, the effort to suppress an intrusive thought is considered as controlled and deliberate cognitive treatment of emotionally charged information. In OCD, in the context of heightened anxiety, the assumed negative valence of information would influence habitual suppression of thought during controlled treatment. As a result, controlled efforts to suppress obsessions in emotionally stressful situations, would lead to the production of repetitive thoughts, as controlled treatment of information has failed in this action. On a clinical and experimental level, these studies have led to a better understanding and conceptualization of OCD. In spite of some conflicting results, there are concordant data in favour of hypotheses of the role of sub-cortical and frontal regions and their function in inhibition/desinhibition implied in the onset and maintenance of OCD. Functional neuroimagery anomalies are also in favour of the role of sub-cortical-frontal region in clinical manifestations of OCD. They are often associated with low performance in cognitive tasks, especially those implying frontal functions, which are, in turn, dependent on a necessary level of attention in order to guide or inhibit motor and cognitive programs.

The full text of this article is available in PDF format.

Mots clés : Trouble obsessionnel-compulsif, Inhibition, Modèles neurocognitifs

Keywords : Obsessive-compulsive disorders, Inhibition, Neurocognitive models




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