Understanding Obsessive–Compulsive Disorder: Focus on Decision Making

Abstract

Current approaches to obsessive-compulsive disorder (OCD) have suggested that neurobiological abnormalities play a crucial role in the etiology and course of this psychiatric illness. In particular, a fronto-subcortical circuit, including the orbitofrontal cortex, basal ganglia and thalamus appears to be involved in the expression of OCD symptoms. Neuropsychological studies have also shown that patients with OCD show deficits in cognitive abilities that are strictly linked to the functioning of the frontal lobe and its related fronto-subcortical structures, such as executive functioning deficits and insufficient cognitive-behavioral flexibility. This article focuses on decision making, an executive ability that plays a crucial role in many real-life situations, whereby individuals choose between pursuing strategies of action that involve only immediate reward and others based on long-term reward. Although the role of decision-making deficits in the evolution of OCD requires further research, the collected findings have significant implications for understanding the clinical and behavioral heterogeneity that characterizes individuals with OCD.

Reward circuitry dysfunction in psychiatric and neurodevelopmental disorders and genetic syndromes: animal models and clinical findings

“…OCD has an estimated prevalence of 1 to 3% [501], and is characterized by recurrent anxiety-provoking thoughts or impulses (obsessions), typically followed by repetitive ritualistic behaviors to relieve anxiety (compulsions) [502]. Although OCD is formally classified as an anxiety disorder, it has many phenotypic features resembling addictive behaviors, including tolerance and withdrawal-like behaviors, suggesting linkages between core symptoms and reward-circuitry processes.…”

Deep brain stimulation for obsessive-compulsive disorder: past, present, and future

“…Current research is guided by the premise that the coupling of a thorough understanding of the brain circuitry underlying a psychiatric disease such as OCD with a deconstruction of the illness into clusters of pathological components will yield more effective and targeted interventions. 12,13 If patients are selected according to their unique clusters of symptoms (which presumably correspond to homogeneous pathophysiological patterns), then stimulation perhaps could be tailored for specific disease manifestations, thereby improving the probability of achieving meaningful clinical benefit.…”

“…12 Looped CSTC circuits subserve a diversity of physiological functions, 3 and pathological activity in these loops might form the basis for OCD. 53 Frontal lobe and basal ganglia abnormalities have been observed among OCD patients, 25,66 and the fibers linking these regions traverse the ALIC, which is the site of anterior capsulotomy lesions.…”

“…Primates could then be trained to perform similar tasks, while physiological recordings interrogate the role of various regions in the circuit implicated in OCD. 12 In our current research, we are exploring the abnormally high sensitivity to potentially aversive outcomes in OCD by training animals to perform a task in which they must weigh combined aversive and rewarding stimuli. Knowledge of the neural circuitry of OCD suggests that the OFC, basal ganglia, and thalamic targets might mediate this decision-conflict paradigm, because patients with OCD perform this task abnormally.…”

Weakness of will, akrasia, and the neuropsychiatry of decision making: An interdisciplinary perspective

“…Moreover, serotonin depletion appears to be a common neurobiological correlate of both impulsivity and compulsivity (Grant & Potenza, 2006). The performance of subjects with obsessive-compulsive disorder (OCD) on gambling tasks has also been a matter of controversy (Cavedini, Gorini, & Bellodi, 2006;Chamberlain et al, 2007;Lawrence et al, 2006). Recent evidence suggests that decision-making performance is differentially associated with specific OCD symptom clusters (Lawrence et al, 2006).…”