Decision-making under uncertainty in obsessive–compulsive disorder
Open accessAbstract
Obsessive compulsive disorder (OCD) produces profound morbidity. Difficulties with decision-making and intolerance of uncertainty are prominent clinical features in many patients. The nature and etiology of these deficits are poorly understood. We used a well-validated choice task, grounded in behavioral economic theory, to investigate differences in valuation and value-based choice during decision making under uncertainty in 20 unmedicated participants with OCD and 20 matched healthy controls. Participants' choices were used to assess individual decision-making characteristics. OCD participants did not differ from healthy controls in how they valued uncertain options when outcome probabilities were known (risk) but were more likely than healthy controls to avoid uncertain options when these probabilities were imprecisely specified (ambiguity). Compared to healthy controls, individuals with OCD were less consistent in their choices and less able to identify options that should be clearly preferable. These abnormalities correlated with symptom severity. These results suggest that value-based choices during decision-making are abnormal in OCD. Individuals with OCD show elevated intolerance of uncertainty, but only when outcome probabilities are themselves uncertain. Future research focused on the neural valuation network, which is implicated in value-based computations, may provide new neurocognitive insights into the pathophysiology of OCD. Deficits in decision-making processes may represent a target for therapeutic intervention.
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Previous studies reported impaired adaption of the decision strategy during a decision-making task, suggesting lower flexibility in OCD.
“Third, previous studies reported impaired adaption of the decision strategy during a decision-making task, suggesting lower flexibility in OCD [69, 70].”
From P300 and delay-discounting in obsessive–compulsive disorder (2022) · cites this paper as [70]
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- Authors
- Pushkarskaya, H., Tolin, D., Ruderman, L., Kirshenbaum, A., Kelly, J. M., Pittenger, C., & Levy, I.
- Affiliations
- Yale University (US)
- Hartford Hospital (US)
- Corresponding author
- Pushkarskaya, Helen
- Venue
- Journal of Psychiatric Research
- Publisher
- Elsevier BV
- Published
- 2015-10
- Volume
- 69
- Pages
- 166-173
- ISSN
- 0022-3956 (ISSN-L)
- PMC
- PMC4562025
- OpenAlex
- W2155549704
- Cited by
- 127
- References
- 34
- Citations by year
- 2026: 23 · 2025: 12 · 2024: 14 · 2023: 18 · 2022: 9 · 2021: 12 · 2020: 11 · 2019: 12 · 2018: 6 · 2017: 7 · 2016: 3
- FWCI
- 6.62
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Psychiatric Research (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (K01 MH101326-01, R01MH095790)
- National Institute on Aging (R01AG033406)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Decision Sciences › General Decision Sciences › Decision-Making and Behavioral Economics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- obsessive-compulsive disorder, decision making under uncertainty, intolerance of uncertainty, ambiguity, risk, value-based choice, behavioral economics, outcome valuation, decision consistency, symptom severity
- MeSH terms
- Attitude, Decision Making, Humans, Obsessive-Compulsive Disorder, Psychiatric Status Rating Scales, Psychological Tests, Risk-Taking, Severity of Illness Index, Uncertainty
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