Cognitive inflexibility in Obsessive-Compulsive Disorder
Open accessAbstract
Obsessive-Compulsive Disorder (OCD) is characterized by maladaptive patterns of repetitive, inflexible cognition and behavior that suggest a lack of cognitive flexibility. Consistent with this clinical observation, many neurocognitive studies suggest behavioral and neurobiological abnormalities in cognitive flexibility in individuals with OCD. Meta-analytic reviews support a pattern of cognitive inflexibility, with effect sizes generally in the medium range. Heterogeneity in assessments and the way underlying constructs have been operationalized point to the need for better standardization across studies, as well as more refined overarching models of cognitive flexibility and executive function (EF). Neuropsychological assessments of cognitive flexibility include measures of attentional set shifting, reversal and alternation, cued task-switching paradigms, cognitive control measures such as the Trail-Making and Stroop tasks, and several measures of motor inhibition. Differences in the cognitive constructs and neural substrates associated with these measures suggest that performance within these different domains should be examined separately. Additional factors, such as the number of consistent trials prior to a shift and whether a shift is explicitly signaled or must be inferred from a change in reward contingencies, may influence performance, and thus mask or accentuate deficits. Several studies have described abnormalities in neural activation in the absence of differences in behavioral performance, suggesting that our behavioral probes may not be adequately sensitive, but also offering important insights into potential compensatory processes. The fact that deficits of moderate effect size are seen across a broad range of classic neuropsychological tests in OCD presents a conceptual challenge, as clinical symptomatology suggests greater specificity. Traditional cognitive probes may not be sufficient to delineate specific domains of deficit in this and other neuropsychiatric disorders; a new generation of behavioral tasks that test more specific underlying constructs, supplemented by neuroimaging to provide insight into the underlying processes, may be needed.
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Lack of psychological flexibility is closely related to obsessive-compulsive symptoms in children and adults.
“Lack of psychological flexibility is closely related to the OCS in children and adults (3).”
From Effects of Acceptance and Commitment Therapy and Repetitive Transcranial Magnetic Stimulation on Obsessive–Compulsive Disorder (2022) · cites this paper as [3]
The Conclusions and the section on face validity and conceptual challenges link cognitive inflexibility with OCD symptoms. The paper does not establish the stated close relationship between psychological flexibility and obsessive-compulsive symptoms across both children and adults; its child-specific passage concerns cognitive-task performance in children and adolescents with OCD. Page numbers are unavailable in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredOur results are in keeping with deficits in the ability to flexibly update behaviour observed in neurological and psychiatric disorders such as Parkinson's Disease, schizophrenia and autism.
“Moreover, our results are in keeping with deficits in the ability to flexibly update behaviour observed in neurological and psychiatric disorders such as Parkinson’s Disease, schizophrenia and autism [23–31].”
From Linking haploinsufficiency of the autism- and schizophrenia-associated gene Cyfip1 with striatal-limbic-cortical network dysfunction and cognitive inflexibility (2024) · cites this paper as [27]
The sections “Cognitive flexibility in OCD: Updating” and “The paradox of broad executive function deficits in OCD” describe impaired updating in OCD and broad executive-function deficits in schizophrenia, respectively. They support the general point that flexibility-related deficits occur in psychiatric disorders, but our copy does not establish the claimed deficits in Parkinson’s disease or autism. The passages have no page numbers. (LLM, conf=0.82)
Experimental — accuracy not yet measuredCognitive inflexibility is associated with OCD-specific symptomatology.
“This finding provides preliminary evidence for the association between cognitive inflexibility and OCD-specific symptomatology.55”
From Cognitive Inflexibility Shares Across Schizophrenia and Obsessive-Compulsive Disorder: A Task-Based Functional MRI Study (2025) · cites this paper as [55]
Deficits in the ability to flexibly update behaviour are manifest in a wide range of neurological and psychiatric disorders, including autism, obsessive-compulsive disorder, major depressive disorder and schizophrenia.
“Deficits in the ability to flexibly update behaviour are manifest in a wide range of neurological and psychiatric disorders, including autism, obsessive–compulsive disorder, major depressive disorder and schizophrenia [23–30]”
In OCD, reduced activation of the OFC and frontostriatal regions during cognitive flexibility tasks is regularly reported.
“In OCD, reduced activation of the OFC and frontostriatal regions during cognitive flexibility task performance is regularly reported92,93.”
From Cognitive and behavioural flexibility: Neural mechanisms and clinical considerations (2021) · cites this paper as [93]
The persistence of maladaptive patterns of inflexible thoughts and behaviors in OCD suggests a lack of cognitive flexibility.
“The persistence of maladaptive patterns of inflexible thoughts and behaviors suggest a lack of cognitive flexibility,4 the ability to adapt behavior in response to changing situational requirements.”
From Behavioral flexibility in a mouse model for obsessive‐compulsive disorder: Impaired Pavlovian reversal learning in SAPAP3 mutants (2019) · cites this paper as [4]
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- Gruner P McKay D Differences in performance on the Wisconsin card sorting test (WCST) between patients with tic related OCD and non-tic related OCD: A preliminary investigation Journal of obsessive-compulsive and related disorders 2013 2 444 447
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- Authors
- Gruner, P., & Pittenger, C.
- Affiliations
- Yale University (US)
- Corresponding author
- Pittenger, Christopher
- Venue
- Neuroscience
- Publisher
- Elsevier BV
- Published
- 2017-03
- Volume
- 345
- Pages
- 243-255
- ISSN
- 0306-4522 (ISSN-L)
- PMC
- PMC5288350
- OpenAlex
- W2486004373
- Cited by
- 261
- References
- 49
- Citations by year
- 2026: 31 · 2025: 32 · 2024: 41 · 2023: 31 · 2022: 26 · 2021: 37 · 2020: 22 · 2019: 23 · 2018: 12 · 2017: 5 · 2016: 1
- FWCI
- 2.02
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Neuroscience (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Department of Veterans Affairs (IK6 RX002458)
- National Institutes of Health (UL1TR001863)
- National Institute of Mental Health (T32MH062994)
- National Center for Advancing Translational Sciences
- 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, cognitive flexibility, executive function, set-shifting, task switching, cognitive control, motor inhibition, neuropsychological assessment, neural correlates, compensatory mechanisms
- MeSH terms
- Attention, Cognition, Humans, Inhibition, Psychological, Obsessive-Compulsive Disorder, Reversal Learning, Executive Function
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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