Error Processing and Inhibitory Control in Obsessive-Compulsive Disorder: A Meta-analysis Using Statistical Parametric Maps
Open accessAbstract
Background Error processing and inhibitory control enable the adjustment of behaviors to meet task demands. Functional magnetic resonance imaging studies report brain activation abnormalities in patients with obsessive-compulsive disorder (OCD) during both processes. However, conclusions are limited by inconsistencies in the literature and small sample sizes. Therefore, the aim here was to perform a meta-analysis of the existing literature using unthresholded statistical maps from previous studies.Methods A voxelwise seed-based d mapping meta-analysis was performed using t-maps from studies comparing patients with OCD and healthy control subjects (HCs) during error processing and inhibitory control. For the error processing analysis, 239 patients with OCD (120 male; 79 medicated) and 229 HCs (129 male) were included, while the inhibitory control analysis included 245 patients with OCD (120 male; 91 medicated) and 239 HCs (135 male).Results Patients with OCD, relative to HCs, showed longer inhibitory control reaction time (standardized mean difference = 0.20, p = .03, 95% confidence interval = 0.016, 0.393) and more inhibitory control errors (standardized mean difference = 0.22, p = .02, 95% confidence interval = 0.039, 0.399). In the brain, patients showed hyperactivation in the bilateral dorsal anterior cingulate cortex, supplementary motor area, and pre-supplementary motor area as well as right anterior insula/frontal operculum and anterior lateral prefrontal cortex during error processing but showed hypoactivation during inhibitory control in the rostral and ventral anterior cingulate cortices and bilateral thalamus/caudate, as well as the right anterior insula/frontal operculum, supramarginal gyrus, and medial orbitofrontal cortex (all seed-based d mapping z value >2, p < .001).Conclusions A hyperactive error processing mechanism in conjunction with impairments in implementing inhibitory control may underlie deficits in stopping unwanted compulsive behaviors in the disorder.
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An increase in P3 amplitude in the CBT group can be interpreted as improved efficiency or recruitment of inhibitory neural circuits following therapy.
“Therefore, an increase in P3 amplitude in the CBT group can be interpreted as improved efficiency or recruitment of these inhibitory neural circuits following therapy [34].”
From Neural correlates of response inhibition following cognitive behavioral therapy in obsessive–compulsive disorder: a randomized controlled EEG study (2026) · cites this paper as [34]
The Results and Discussion (pages unavailable) identify altered activation in inhibitory-control networks in OCD, and the Discussion notes that CBT can modulate activity in one prefrontal region. The paper does not connect increased P3 amplitude after CBT to improved efficiency or recruitment of those circuits. (LLM, conf=0.82)
Experimental — accuracy not yet measuredACC dysfunction may contribute to exacerbating obsessive thoughts by amplifying perceived discrepancies between intended and actual outcomes, potentially contributing to repeated checking or rumination.
“This pattern of dysfunction may contribute to exacerbating obsessive thoughts by amplifying perceived discrepancies between intended and actual outcomes, potentially contributing to repeated checking or rumination (166, 167).”
From Neural mechanisms underlying cognitive inflexibility in obsessive-compulsive disorder: a review (2026) · cites this paper as [166]
The Discussion (page unavailable) proposes that heightened error-processing and detection of actions misaligned with goals may worsen obsessions, and gives repeated stove-checking as an example. It does not link this proposed mechanism to rumination, so that alternative outcome is unsupported. (LLM, conf=0.82)
Experimental — accuracy not yet measuredOCD and schizophrenia patients may exhibit abnormal neural activities in frontostriatal and frontoparietal networks while performing tasks related to inhibition and shifting, suggesting disrupted inhibition-related and shifting-related circuitries as shared deficits across these two disorders.
“Obsessive-compulsive disorder patients and SCZ patients may exhibit abnormal neural activities in the frontostriatal (eg, cingulate cortex, dorsolateral prefrontal cortex) and frontoparietal (eg, parietal cortex) networks while performing tasks related to inhibition 26 ,29-31 and shifting, 14 ,32-35 suggesting disrupted inhibition-related and shifting-related circuitries as shared deficits across”
From Cognitive Inflexibility Shares Across Schizophrenia and Obsessive-Compulsive Disorder: A Task-Based Functional MRI Study (2025) · cites this paper as [30]
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Experimental — accuracy not yet measuredPrevious meta-analyses of OCD fMRI data sets indicate abnormal activation of the rostral and dorsal anterior cingulate cortex, the medial prefrontal cortex, and the striatum during inhibitory control.
“Evidence from existing meta-analyses suggests aberrant activation of regions in fronto-striatal circuits during inhibitory control.”
From Inhibitory control in obsessive compulsive disorder: a systematic review and activation likelihood estimation meta-analysis of functional magnetic resonance imaging studies (2022) · cites this paper as Norman et al., 2019
Carlisi et al. (2017), Norman et al. (2016) and Norman et al. (2019) used the anisotropic effect size version of seed-based d mapping (AES-SDM) to combine peak coordinates and non-thresholded t-maps.
“Carlisi et al. (Carlisi et al., 2017); Norman et al. (Norman et al., 2016) and Norman et al. (Norman et al., 2019) used the anisotropic effect size version of seed-based d mapping (AES-SDM) to combine peak coordinates and non-thresholded t-maps”
From Inhibitory control in obsessive compulsive disorder: a systematic review and activation likelihood estimation meta-analysis of functional magnetic resonance imaging studies (2022) · cites this paper as Norman et al., 2019
A recent meta-analysis of 10 inhibitory control tasks that concurrently included both an error and an inhibition contrast found error-related hyperactivation of the dACC, but inhibition-related hypoactivation of the same region.
“Interestingly, a recent meta-analysis of 10 inhibitory control tasks that concurrently included both an error and an inhibition contrast found error-related hyperactivation of the dACC, but inhibition-related hypoactivation of the same region (Norman et al., 2019).”
From Inhibitory control in obsessive compulsive disorder: a systematic review and activation likelihood estimation meta-analysis of functional magnetic resonance imaging studies (2022) · cites this paper as Norman et al., 2019
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Development of Posterior Medial Frontal Cortex Function in Pediatric Obsessive-Compulsive Disorder
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Self-citationNetwork failures: When incentives trigger impulsive responses
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Pathological Changes in Performance Monitoring
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Self-citationTask-based fMRI predicts response and remission to exposure therapy in obsessive-compulsive disorder
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Self-citationAltered response to risky decisions and reward in patients with obsessive–compulsive disorder
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Exploring response inhibition and error monitoring in obsessive-compulsive disorder
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“, 2019) and increased activity in cortical regions involved in EM, including the anterior cingulate cortex (Norman et al., 2019).”
BackgroundResultInfluentialEvidence accumulation and neural correlates of uncertainty in obsessive-compulsive disorder
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Cognitive neuroscience of obsessive-compulsive disorder
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Response Inhibition in Youth Undergoing Intensive Treatment for Obsessive Compulsive Disorder
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Error-related brain activity associated with obsessive-compulsive symptoms in youth
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“Therefore, an increase in P3 amplitude in the CBT group can be interpreted as improved efficiency or recruitment of these inhibitory neural circuits following therapy [34].”
Neural mechanisms underlying cognitive inflexibility in obsessive-compulsive disorder: a review
Guo, W., Neo, P. S.-H., & McNaughton, N. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1795436
“This pattern of dysfunction may contribute to exacerbating obsessive thoughts by amplifying perceived discrepancies between intended and actual outcomes, potentially contributing to repeated checking or rumination (166, 167).”
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Dissociating executive prefrontal substrates following capsulotomy in obsessive-compulsive disorder
Zhao, Y.-J., Cui, H., Zhang, Y., Chen, R., Manssuer, L., Li, H., Zhang, J., Liu, W., Sun, B., & Voon, V. (2026) · Brain · doi:10.1093/brain/awag132
- Authors
- Norman, L. J., Taylor, S. F., Liu, Y., Radua, J., Chye, Y., De Wit, S. J., Huyser, C., Karahanoglu, F. I., Luks, T., Manoach, D., Mathews, C., Rubia, K., Suo, C., van den Heuvel, O. A., Yücel, M., & Fitzgerald, K.
- Affiliations
- King's College London (GB)
- University of Michigan (US)
- Monash University (AU)
- University of California, San Francisco (US)
- Harvard University (US)
- University of Florida (US)
- The University of Melbourne (AU)
- Corresponding author
- Norman, Luke J.
- ORCID
- Venue
- Biological Psychiatry
- Publisher
- Elsevier BV
- Published
- 2019-05
- Volume
- 85
- Issue
- 9
- Pages
- 713-725
- ISSN
- 0006-3223 (ISSN-L)
- PMC
- PMC6474799
- OpenAlex
- W2902990194
- Cited by
- 189
- References
- 109
- Citations by year
- 2026: 25 · 2025: 23 · 2024: 18 · 2023: 29 · 2022: 28 · 2021: 26 · 2020: 33 · 2019: 7
- FWCI
- 2.78
- Type
- journal article
- Language
- en
- Open access
- green
- kclpure.kcl.ac.uk
- Licence
- Locations
- Biological Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (publishedVersion, cc-by-nc-nd)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- PubMed Central (acceptedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- eScholarship (California Digital Library) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- Abbott Laboratories
- Otsuka Pharmaceutical
- National Institute of Mental Health (R01 MH102242)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- obsessive-compulsive disorder, error processing, inhibitory control, dorsal anterior cingulate cortex, supplementary motor area, pre-supplementary motor area, anterior insula, frontal operculum, rostral anterior cingulate cortex, thalamus, caudate nucleus, reaction time, compulsive behavior
- MeSH terms
- Adolescent, Adult, Brain, Brain Mapping, Female, Humans, Inhibition, Psychological, Magnetic Resonance Imaging, Male, Neural Pathways, Obsessive-Compulsive Disorder, Young Adult
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