This chapter will examine ongoing research and the potential role this may have in the future. The chapter will first discuss physical methods of treatment. Then it will examine the role of infection and inflammation in the development of OCD. Finally, it examines potential gene modification by some hormones and how these may be harnessed to improve the outcome in OCD in the future.

First, there will be an examination of the role that neurosurgery has played for a very small number of people with OCD who have failed to respond to all other treatment approaches. This will dispel the myth that neurosurgery is the same as the ‘lobotomy’ performed during the early twentieth century. The reported outcomes of more specific surgery performed today will also be examined.

The chapter then discusses recent research into deep brain stimulation for people who may previously have been recommended for neurosurgery. This technique still involves wires being placed in the brain, but it does not permanently destroy brain tissue in the way neurosurgery does.

Next, the chapter will examine the more experimental transcranial magnetic stimulation as a potential alternative to more invasive procedures and possibly a technique which may be used in more routine practice in the future. This technique involves the application of powerful magnets to the outside of the head. By targeting these to act on specific areas of the brain, they can temporarily reduce OCD symptomatology. It is hoped that these may be useful in combination with exposure and response prevention (ERP) for some people unable to tolerate ERP alone.

In another area of research, it has been suggested that the glial cells in the brains of people with autism and OCD may be inflamed and unable to act typically. These cells produce glutamate, and this may tie in with recent work examining the potential use of glutamate modifiers. This theory has been taken further by some, who theorise that the normal healthy bacteria which make up an important part of our bodies may have become altered in modern life, resulting in an increase in autoimmune conditions. It has been suggested that childhood autism may also be ‘autoimmune’. People with autism often have marked OCD symptoms, and so this link is also being examined.

Finally, the chapter will discuss how certain hormones may modify our genes. We know that OCD is a condition with a complex causation. Although there seems to be a genetic link, there is no clear pattern of inheritance, suggesting that other factors may be acting in a ‘preventative’ way to stop OCD from always appearing in its full-blown form. One theory is that oxytocin, a hormone produced when one is being nurtured or is nurturing, may bind to the gene and make it more likely to be dormant. Thus, it might be possible that good nurturing experiences in early childhood may modify or reduce OCD symptoms for some, but not all, people with OCD.