Increased Loss Aversion in Unmedicated Patients with Obsessive–Compulsive Disorder

Abstract

IntroductionObsessive–compulsive disorder (OCD) patients show abnormalities in decision-making and, clinically, appear to show heightened sensitivity to potential negative outcomes. Despite the importance of these cognitive processes in OCD, few studies have examined the disorder within an economic decision-making framework. Here, we investigated loss aversion, a key construct in the prospect theory that describes the tendency for individuals to be more sensitive to potential losses than gains when making decisions.MethodsAcross two study sites, groups of unmedicated OCD patients (n = 14), medicated OCD patients (n = 29), and healthy controls (n = 34) accepted or rejected a series of 50/50 gambles containing varying loss/gain values. Loss aversion was calculated as the ratio of the likelihood of rejecting a gamble with increasing potential losses to the likelihood of accepting a gamble with increasing potential gains. Decision times to accept or reject were also examined and correlated with loss aversion.ResultsUnmedicated OCD patients exhibited significantly more loss aversion compared to medicated OCD or controls, an effect that was replicated across both sites and remained significant even after controlling for OCD symptom severity, trait anxiety, and sex. Post hoc analyses further indicated that unmedicated patients’ increased likelihood to reject a gamble as its loss value increased could not be explained solely by greater risk aversion among patients. Unmedicated patients were also slower to accept than reject gambles, effects that were not found in the other two groups. Loss aversion was correlated with decision times in unmedicated patients but not in the other two groups.DiscussionThese data identify abnormalities of decision-making in a subgroup of OCD patients not taking psychotropic medication. The findings help elucidate the cognitive mechanisms of the disorder and suggest that future treatments could aim to target abnormalities of loss/gain processing during decision-making in this population.

Diminished Value Discrimination in Obsessive-Compulsive Disorder: A Prospect Theory Model of Decision-Making Under Risk

“…The finding of significantly lower value discrimination (termed α here) in OCD patients compared to HCs is in agreement with a recent report from Aranovich and colleagues (14) who identified less “outcome sensitivity” in these patients. It is also partially consistent with Sip et al (15) who reported a flatter increase in the likelihood of accepting a gamble with increasing gains in unmedicated OCD patients, though their study focused exclusively on loss aversion and was not optimized to model value discrimination. These findings shed light on how previously identified dysfunctional reward circuitry in OCD patients, in particular in the anticipation of reward receipt (34), might manifest behaviorally and drive altered decision-making.…”

“…Aranovich and colleagues (14) reported that OCD patients have lower sensitivity to outcome values (interpreted as “less risk aversion” by the authors), and an S-shaped probability function that contrasted with the classic inverse S-shape exhibited by controls. Further, Sip and colleagues (15) found that unmedicated OCD patients demonstrated greater loss aversion than medicated OCD patients and HCs. These findings provide the first evidence that people with anxiety disorders and OCD might exhibit differences in how they integrate value and probability information, but there are also important limitations to these studies.…”

“…These findings provide the first evidence that people with anxiety disorders and OCD might exhibit differences in how they integrate value and probability information, but there are also important limitations to these studies. Charpentier et al (13) and Sip et al (15) tested only the value function of cumulative prospect theory, without manipulating the probability of the different outcomes. Conversely, Aranovich et al (14) modeled the probability function, but did not manipulate the values of the different outcomes and did not include a gain–loss (“mixed”) condition to test loss aversion.…”

“…Conversely, Aranovich et al (14) modeled the probability function, but did not manipulate the values of the different outcomes and did not include a gain–loss (“mixed”) condition to test loss aversion. In addition, none of the studies examined decisions within the loss domain (“loss-only” trials), and Sip et al (15) did not include trials within the gain domain (“gain-only” trials). Inclusion of single domain trials in study design is required to examine the shape of the value function across all possible outcomes.…”

Impaired generalization of reward but not loss in obsessive-compulsive disorder

“…OCD has, however, been associated with differential learning from gains and losses. Specifically, individuals with OCD have been shown to have increased avoidance learning and loss aversion (Gillan et al, 2014(Gillan et al, , 2015Sip, Gonzalez, Taylor, & Stern, 2018) but decreased reward learning in reinforcement learning tasks (Endrass, Kloft, Kaufmann, & Kathmann, 2011). Moreover, another study found that subjects with OCD deploy a goal-directed, "model-based" system when learning about losses, whereas they rely on a habitual, "model-free" system when learning about gains (Voon et al, 2015).…”