Nice review on neurocircuitry of OCD: Neuroscientifically Informed Formulation and Treatment Planning for Patients With Obsessive-Compulsive Disorder: A Review - PubMed pubmed.ncbi.nlm.nih.gov/30140845/
Some people with disabling OCD that doesn’t respond to other treatments will get surgery, like a cingulotomy or gamma knife capsulotomy, but since 2018 deep TMS targeting the anterior cingulate/ dorsal-medial prefrontal cortex had been FDA approved for OCD.
Severe non-responsive OCD is pretty much the only thing in psychiatry surgery is used for anymore.
Deep brain stimulation (kinda like a pacemaker for the brain) is also tried for some of these cases.
Ime a lot of people don’t understand their own intrusive thoughts. In OCD it’s often your worst nightmare or as we say in the biz: ego-dystonic. For example a young man who is fearful he will become a sexual predator or a mother who has recurrent thoughts killing her children.
You can see how these thoughts would be disabling (some can’t leave the house or function at all) which if the standard treatments and secondary and tertiary don’t work you might consider these other options.
While OCD intrusive thoughts respond well to exposure therapy, classic insight oriented psychotherapy is often not useful for those particular symptoms (or in some cases worsen it)
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