72) A mystery explained: endocrinological bases of compulsive behaviors

In addition to my son's history of food obsession and food seeking (hyperphagia), Sasha has engaged in a peculiar habit of needing to acquire and sort things for a collection. Since the early days after tumor surgery, I noticed that we had an awfully large number of pens, pencils, erasers, and other various office supplies in our house that I know we didn't purchase.  When I paid attention, I noticed that he had a way of organizing his collections in little plastic baggies which he kept hidden away in his desk.  Sometimes he would be seen sorting and organizing them (sometimes even in the middle of the night).  He was compelled to collect these office supplies (a lot of them!) and his compulsion was so strong that he even stole things from other people including classmates, teachers, and merchants.

Although we didn't need to have hundreds of pencils and pens in our house, we didn't mind that he wanted to collect office supplies.  We DID mind that he resorted to stealing these items.  It became clear to us after we admonished, lectured and disciplined him, that he was unable to control this behavior.  It was then that I decided to conduct a survey to find out if this was a common behavior pattern among his craniopharyngioma cohorts.  After conducting a survey, I received responses from 146 subjects and was astounded to learn that there was a high prevalence, 33-42%, of cranios who compulsively acquired non-food items.  The rates increased to 41-51% when I filtered for cranios who had HO (hypothalamic obesity) and decreased to only 9-12% among cranios who did NOT have HO!  Although I was investigating the specific compulsion of collecting and hoarding non-food items, I also received comments from some respondents that other compulsive behaviors including skin picking, ordering, needs for symmetry, etc. were also present.

Besides being relieved that my son wasn't the only one with a compulsive acquiring habit, I was fascinated that the prevalence was so high and that there was virtually no mention of it in the medical or psychiatric literature save for a couple of case study papers.  I was also intrigued that the rates of compulsive acquiring increased among those who had HO and decreased significantly among those who did not have HO.  What is the relationship between HO and compulsive acquiring?  Why would collecting and hoarding non-food items be so much higher among cranios with HO compared to cranios without HO?

In the last 6 years since acting as a amateur endocrine researcher/mom, I have been totally fascinated by the endocrine underpinnings of my son's behavior.  Who knew that our hormones control so much of who we are, how we feel, how we act, etc?  After observing his peculiar collecting behaviors and learning about their existence in other cranios, I began to really wonder about the biological etiology of OCD and other compulsive behaviors.  I proceeded to write a paper on it and hope to publish it in the medical/psychiatric literature to share this interesting finding.

Recently, I have felt extremely excited because I believe I have figured something out that solves a big mystery for me regarding the connection between compulsive behaviors and HO.  I bet you can guess...  in looking over the existing literature, I have found some clues that point to oxytocin as a significant player in explaining compulsive behaviors.  Not only does it show up in research pertaining to autism and PWS (disorders known for obsessive compulsive behaviors and social impairment), it has been referenced in some papers on diabetes insipidus (DI).  As you may know, DI is a disorder in which the brain no longer produces the anti-diuretic hormone, vasopressin.  Like oxytocin,  vasopressin is made in the hypothalamus and secreted by the posterior pituitary gland.  Vasopressin must be replaced in people with DI or else they would be required to drink inordinate amounts of water to stay hydrated and to keep electrolytes in balance, or they would dessicate. Unlike vasopressin (as you know), oxytocin is typically NOT replaced.

Considering that both oxytocin and vasopressin are made and secreted from the same areas of the brain, it is interesting to read about the co-morbidity of DI and obsessive-compulsive behaviors. In these cases, might certain people with central DI also suffer from oxytocin imbalances/abnormalities to help explain their compulsivity?  Here is a dated but fascinating report on nine cases examples of diabetes insipidus and "obsessional neuroses" (back in the day when psychoanalytic theory was alive and well!)
http://www.sciencedirect.com/science/article/pii/S0140673665910925

From a book chapter on childhood obsessional compulsive disorder:
https://books.google.com/books?hl=en&lr=&id=hEY0dmttheIC&oi=fnd&pg=PA208&dq=diabetes+insipidus+ocd&ots=ioSWj04uX2&sig=mls_uJV64JGoLWp7ODCHp8sjIEM#v=onepage&q=diabetes%20insipidus%20ocd&f=false

A paper on the role of central oxytocin in OCD and related normal behavior:http://www.sciencedirect.com/science/article/pii/0306453094900213

There may be other ways to show the connection between compulsive behaviors and HO hunger since oxytocin is likely to play an important role in mediating hunger and its associated stress. Using a psycho-endocrinological theory (which I just made up- finding evidence in the literature to support my theory is still a work in progress):  Without oxytocin's ability to provide satiety, this drives up anxiety.  In OCD, obsessions are the ruminative, anxious thoughts ("I will die if I touch germs") that plague the sufferer.  Compulsions are the compensatory behaviors ("therefore I have to wash my hands 25 times") to relieve the sufferer of his/her anxiety.  In the case of the HO sufferer who also compulsively acquires non-food, the obsession is hunger for food.  Although the compulsion to collect non-food items may not be a direct compensation for their hunger, compulsions to acquire things (for example) may be a way for these oxytocin-impaired people to soothe themselves from their terrible pangs of hunger.  Others may use other types of compulsive behaviors to find relief.

By the way, now that Sasha is taking oxytocin, he has stopped his compulsive acquiring of office supplies.  He still tries to sneak food and money every once in a while, but it has greatly reduced in frequency since oxytocin.

I am excited to finish writing this paper in order to expose the prevalence of these co-morbid phenomena in the medical literature.  Please feel free to comment and to share your observations especially if you believe you/your loved one also suffer from oxytocin deficiency (HO, DI without a thirst mechanism, PWS, autism) and compulsive behaviors.