The Role of Stress in the Pathogenesis and Maintenance of Obsessive-Compulsive Disorder

Thomas G. Adams, Benjamin Kelmendi, C. Alex Brake, Patricia Gruner, Christal L. Badour, Christopher Pittenger

Research output: Contribution to journalReview articlepeer-review

74 Scopus citations


Individuals with obsessive-compulsive disorder often identify psychosocial stress as a factor that exacerbates their symptoms, and many trace the onset of symptoms to a stressful period of life or a discrete traumatic incident. However, the pathophysiological relationship between stress and obsessive-compulsive disorder remains poorly characterized: it is unclear whether trauma or stress is an independent cause of obsessive-compulsive disorder symptoms, a triggering factor that interacts with a preexisting diathesis, or simply a nonspecific factor that can exacerbate obsessive-compulsive disorder along with other aspects of psychiatric symptomatology. Nonetheless, preclinical research has demonstrated that stress has conspicuous effects on corticostriatal and limbic circuitry. Specifically, stress can lead to neuronal atrophy in frontal cortices (particularly the medial prefrontal cortex), the dorsomedial striatum (caudate), and the hippocampus. Stress can also result in neuronal hypertrophy in the dorsolateral striatum (putamen) and amygdala. These neurobiological effects mirror reported neural abnormalities in obsessive-compulsive disorder and may contribute to an imbalance between goal-directed and habitual behavior, an imbalance that is implicated in the pathogenesis and expression of obsessive-compulsive disorder symptomatology. The modulation of corticostriatal and limbic circuits by stress and the resultant imbalance between habit and goal-directed learning and behavior offers a framework for investigating how stress may exacerbate or trigger obsessive-compulsive disorder symptomatology.

Original languageEnglish
JournalChronic Stress
StatePublished - 2018

Bibliographical note

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The primary author was supported by NIMH awards 1K23MH111977 and 1L30MH111037.

Publisher Copyright:
© The Author(s) 2018.


  • OCD
  • corticostriatal-limbic circuitry
  • goal-directed
  • habit
  • stress

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health
  • Biological Psychiatry
  • Behavioral Neuroscience


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