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. 2017 Apr 30:262:15-24.
doi: 10.1016/j.pscychresns.2017.01.012. Epub 2017 Feb 9.

Altered olfactory processing and increased insula activity in patients with obsessive-compulsive disorder: An fMRI study

Heather A Berlin  1 , Emily R Stern  2 , Johnny Ng  3 , Sam Zhang  4 , David Rosenthal  4 , Rachel Turetzky  4 , Cheuk Tang  3 , Wayne Goodman  2
Affiliations

Altered olfactory processing and increased insula activity in patients with obsessive-compulsive disorder: An fMRI study

Heather A Berlin et al. Psychiatry Res Neuroimaging. .

Abstract

Obsessive-compulsive disorder (OCD) patients show increased insula activation to disgust-inducing images compared to healthy controls (HC). We explored whether this disgust reactivity was also present in the olfactory domain by conducting the first fMRI study of olfaction in OCD. Neural activation in response to pleasant and unpleasant odors (vs. unscented air) was investigated in 15 OCD and 15 HC participants using fMRI. OCD participants (vs. HC) had increased left anterior insula activation to unpleasant odors (vs. unscented air), which positively correlated with their disgust sensitivity and ratings of the unpleasantness and intensity of those odors. OCD participants (vs. HC) showed increased activation of caudate nucleus and left anterior and posterior insula to pleasant odors (vs. unscented air), which positively correlated with their OCD symptom severity, trait anxiety, frequency of feeling disgust, and odor intensity ratings. OCD participants had increased anterior insula activation to both pleasant and unpleasant odors, which correlated with their OCD symptoms, anxiety, disgust sensitivity, and frequency of feeling disgust. OCD patients might have a negative cognitive bias and experience all stimuli, regardless of valence, as being more unpleasant than healthy people. These findings further elucidate the neural underpinnings of OCD and may contribute to more effective treatments.

Keywords: Anxiety; Disgust; Emotion; OCD; Odor; Olfaction; Sensory.

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Conflict of interest statement

Conflict of interest

Dr. Heather A. Berlin, Dr. Emily R. Stern, Dr. Johnny Ng, Sam Zhang, David Rosenthal, Rachel Turetzky, and Dr. Cheuk Tang report no conflicts of interest. Dr..Wayne Goodman reports research funding from Roche, Simon Foundation and NIMH.

Figures

Figure 1
Figure 1
fMRI stimulus presentation design. Note: OLF_1 = block 1; OLF_2 = block 2; OLF_3 = block 3; OLF_4 = block 4
Figure 2
Figure 2
ROI analysis revealed greater activation of left anterior insula in OCD patients compared to HC for the comparison of unpleasant odors vs. rest. Within the OCD group, this activation was positively correlated with ratings on the Disgust Sensitivity scale and of the intensity of unpleasant odors, and negatively correlated with the valence of unpleasant odors.
Figure 3
Figure 3
(A) Greater activation in caudate nucleus for OCD patients compared to HC for pleasant odors (vs. rest), which was positively correlated with self-rated OCD symptoms on the Padua inventory (PI). (B) Greater activation in left anterior insula for OCD patients compared to HC for pleasant odors (vs. rest), which was positively correlated with self-rated OCD symptom severity (PI) and trait anxiety (STAI). C) Greater left posterior insula activation for OCD patients compared to HC for pleasant odors (vs. rest), which was positively correlated with intensity ratings of unpleasant odors.
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