Neurochemically informed network control theory reveals energetic dysregulation of altered brain state dynamics in obsessive‐compulsive disorder

AIM: Previous studies assessed dynamic functional connectivity in obsessive-compulsive disorder (OCD) by the sliding-window approach, limiting sensitivity to rapid neural fluctuations. Moreover, the mechanisms underlying dynamic transitions between brain states also remain unknown. Therefore, the study aimed to explore the dynamic neural mechanisms of OCD by characterizing state dynamic patterns and the underlying energy basis. METHODS: The study recruited 198 OCD patients and 109 healthy controls, characterizing altered state dynamic patterns and underlying control energy in OCD by integrating co-activation pattern (CAP) analysis with network control theory (NCT). RESULTS: were intrinsically energy-demanding, modulated by dopaminergic and serotonergic systems, constituting an "inefficient pathological transition" consistent with repetitive behavior observed clinically. CONCLUSIONS: state via virtual perturbation partially improved the dysregulated cycle in OCD. Within this cycle, two distinct pathological transition modes emerged: a "low-cost shortcut" from DMN to VAN/SMN modulated by GABAergic and an "inefficient transition" from SMN to VAN linked to dopaminergic and serotonergic. These reveal neurochemically grounded alterations in the energy control of abnormal brain-state transitions, offering mechanistic insights into the disrupted neural dynamics of OCD.