Functional neuroimaging of avoidance habits in obsessive-compulsive disorder
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OBJECTIVE: The purpose of this study was to determine the neural correlates of excessive habit formation in obsessive-compulsive disorder (OCD). The authors aimed to test for neurobiological convergence with the known pathophysiology of OCD and to infer, based on abnormalities in brain activation, whether these habits arise from dysfunction in the goal-directed or habit system. METHOD: Thirty-seven OCD patients and 33 healthy comparison subjects learned to avoid shocks while undergoing a functional MRI scan. Following four blocks of training, the authors tested whether the avoidance response had become a habit by removing the threat of shock and measuring continued avoidance. Task-related differences in brain activity in three regions of interest (the caudate, the putamen, and the medial orbitofrontal cortex) were tested at a statistical threshold set at <0.05 (family-wise-error corrected). RESULTS: Excessive habit formation in OCD patients, which was associated with hyperactivation in the caudate, was observed. Activation in this region was also associated with subjective ratings of increased urge to perform habits. The OCD group, as a whole, showed hyperactivation in the medial orbitofrontal cortex during the acquisition of avoidance; however, this did not relate directly to habit formation. CONCLUSIONS: OCD patients exhibited excessive habits that were associated with hyperactivation in a key region implicated in the pathophysiology of OCD, the caudate nucleus. Previous studies indicate that this region is important for goal-directed behavior, suggesting that habit-forming biases in OCD may be a result of impairments in this system, rather than differences in the buildup of stimulus-response habits themselves.
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Impaired functional connectivity between these regions disrupts the balance between goal-directed and habitual systems, causing excessive habitual responding and a struggle to shift to goal-directed actions.
“Moreover, impaired functional connectivity between these regions disrupts the balance between goal-directed and habitual systems, causing excessive habitual responding and a struggle to shift to goal-directed actions (16, 198, 199).”
From Neural mechanisms underlying cognitive inflexibility in obsessive-compulsive disorder: a review (2026) · cites this paper as [199]
The Results (fMRI; page unavailable) report connectivity differences between OCD patients who formed habits and those who did not, but no overall connectivity difference between patients and controls. The Discussion suggests that excessive caudate–subgenual ACC connectivity may compromise goal-directed control. It does not establish that impaired connectivity causes a disrupted balance or difficulty shifting to goal-directed actions. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe functional/causal relationship between obsessions and compulsions is not always clear; despite a traditional view that obsessions lead to compulsions, this may not always be the case.
“The functional/causal relationship between obsessions and compulsions is not always clear—despite a traditional view that obsessions lead to compulsions, this may not always be the case (Abramowitz & Jacoby, 2014; Gillan et al., 2015; Gillan et al., 2016; Robbins et al., 2019).”
From Obsessive-compulsive disorder: Etiology, neuropathology, and cognitive dysfunction (2023) · cites this paper as Gillan et al., 2015
The Introduction describes compulsions as habit-like actions that can persist despite being unwanted, and the Discussion says the interaction between fear learning and habits in OCD is likely complex. This supports questioning a simple account of what drives compulsions, but our copy does not directly examine whether obsessions cause compulsions or describe the traditional obsessions-first view. No page numbers are available in our copy. (LLM, conf=0.79)
Experimental — accuracy not yet measuredDysfunction in these areas disrupts the balance between goal-directed and habitual behaviors, contributing to the characteristic symptoms of OCD.
“Dysfunction in these areas disrupts the balance between goal-directed and habitual behaviors, contributing to the characteristic symptoms of OCD (193, 199).”
From Neural mechanisms underlying cognitive inflexibility in obsessive-compulsive disorder: a review (2026) · cites this paper as [199]
The Introduction describes OCD as involving dysfunction in systems supporting habits and goal-directed control. The Discussion links excessive habits to failures in goal-directed control associated with caudate and possibly mOFC hyperactivity. But the paper presents this as support for a model of OCD, not as proof that dysfunction in these areas causes its characteristic symptoms. (LLM, conf=0.83)
Experimental — accuracy not yet measuredAnxiety is not always causal in triggering compulsive-like behaviors.
“and that anxiety is not always causal in triggering compulsive‐like behaviors (Gillan & Robbins, 2014; Gillan et al., 2015; Gillan et al., 2014).”
From Obsessive-compulsive disorder: Etiology, neuropathology, and cognitive dysfunction (2023) · cites this paper as Gillan et al., 2015
The bias towards increased habit formation in OCD extends to avoidant habits that may be more relevant to clinical symptoms.
“this bias towards increased habit formation in OCD not only applies to appetitive habits, it also extends to avoidant habits that may be more relevant to the clinical symptoms seen in patients76,77.”
From DISSECTING OCD CIRCUITS: FROM ANIMAL MODELS TO TARGETED TREATMENTS: Review: Dissecting OCD Circuits: Animals to Treatments (2015) · cites this paper as [77]
Using fMRI, researchers found that increased avoidance habits in OCD patients were associated with hyper-activation in the caudate nucleus, a key region in the pathophysiology of OCD and goal-directed system.
“Using fMRI, the authors further found that these increased avoidance habits in OCD patients were associated with hyper-activation in the caudate nucleus, a key region in the pathophysiology of OCD and goal-directed system (Gillan et al., 2015).”
From Imbalance between the caudate and putamen connectivity in obsessive–compulsive disorder (2022) · cites this paper as Gillan et al., 2015
Compulsion is associated with an imbalance between the goal-directed and habit-based system, caused by an impairment of the former system.
“Together, these findings provide evidence that compulsion is associated with an imbalance between the goal-directed and habit-based system, caused by an impairment of the former system (Gillan et al., 2015).”
From Imbalance between the caudate and putamen connectivity in obsessive–compulsive disorder (2022) · cites this paper as Gillan et al., 2015
Experimental studies report excessive habit formation or over-reliance on habitual behavior at the expense of flexible goal-directed behavior in OCD and in other disorders characterized by compulsive behavior including Tourette syndrome.
“Further support for this hypothesis comes from experimental studies, which report excessive habit formation and/or an over-reliance on habitual behavior at the expense of flexible goal-directed behavior on experimental tasks in OCD [90–91], as well as in other disorders characterized by compulsive behavior including TS [92–93].”
From Toward a neurocircuit-based taxonomy to guide treatment of obsessive-compulsive disorder (2021) · cites this paper as [91]
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“The functional/causal relationship between obsessions and compulsions is not always clear— despite a traditional view that obsessions lead to compulsions, thismay not always be the case (Abramowitz & Jacoby, 2014; Gillan et al., 2015; Gillan et al., 2016; Robbins et al., 2019).”
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Using mice to model Obsessive Compulsive Disorder: From genes to circuits
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Self-citationBrain functional connectivity analysis based on multi-graph fusion
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Habit Formation and the Striatum.
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Multi-Band Brain Network Analysis for Functional Neuroimaging Biomarker Identification
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Which Is the Driver, the Obsessions or the Compulsions, in OCD?
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Self-citationHyperconnectivity of the ventromedial prefrontal cortex in obsessive-compulsive disorder
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Self-citationDoes compulsive behavior in Anorexia Nervosa resemble an addiction? A qualitative investigation
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An investigation of habit learning in Anorexia Nervosa
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Self-citationAnnual Research Review: Developmental computational psychiatry
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Goal-Directed and Habitual Control in Smokers
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Self-citationInterfacing behavioral and neural circuit models for habit formation
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Deficient Goal-Directed Control in a Population Characterized by Extreme Goal Pursuit
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Restrictive eating across a spectrum from healthy to unhealthy: behavioral and neural mechanisms
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To Do or Not to Do? Task Control Deficit in Obsessive-Compulsive Disorder
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Habitual Behavior Is Mediated by a Shift in Response-Outcome Encoding by Infralimbic Cortex
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Habit strength is predicted by activity dynamics in goal-directed brain systems during training
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Self-citationNeuromodulation of OCD: a review of invasive and non-invasive methods
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Are nonclinical obsessive-compulsive symptoms associated with bias toward habits?
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Corticostriatal foundations of habits
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Functional disruption in prefrontal-striatal network in obsessive-compulsive disorder
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Self-citationLeveraging cognitive neuroscience for making and breaking real-world habits
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Self-citationBtbd3 expression regulates compulsive-like and exploratory behaviors in mice
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Goal-Directed and Habitual Control in Human Substance Use: State of the Art and Future Directions
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Enhanced Avoidance Habits in Relation to History of Early-Life Stress
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Recent developments in the habit hypothesis of OCD and compulsive disorders
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- Authors
- Gillan, C. M., Apergis-Schoute, A. M., Morein-Zamir, S., Urcelay, G. P., Sule, A., Fineberg, N. A., Sahakian, B. J., & Robbins, T. W.
- Affiliations
- University of Hertfordshire (GB)
- New York University (US)
- Queen Elizabeth II Hospital (GB)
- Corresponding author
- Gillan, Claire M.
- ORCID
- Venue
- American Journal of Psychiatry
- Published
- 2015-03
- Volume
- 172
- Issue
- 3
- Pages
- 284-293
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- PMC
- PMC4910868
- OpenAlex
- W2132598305
- Cited by
- 265
- References
- 49
- Citations by year
- 2026: 15 · 2025: 17 · 2024: 22 · 2023: 16 · 2022: 18 · 2021: 41 · 2020: 30 · 2019: 24 · 2018: 27 · 2017: 21 · 2016: 20 · 2015: 13 · 2014: 1
- FWCI
- 21.70
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Anglia Ruskin Research Online (Anglia Ruskin University) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Leicester Research Archive (University of Leicester) (submittedVersion, other-oa)
- Apollo (University of Cambridge) (submittedVersion)
- Funders
- Wellcome Trust (089589/Z/09/Z, 101521, 104631/Z/14/Z, 089589, G00001354, 104631)
- Medical Research Council (MR/J012084/1)
- 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, avoidance behavior, habit formation, caudate nucleus, putamen, medial orbitofrontal cortex, goal-directed behavior
- MeSH terms
- Adult, Avoidance Learning, Caudate Nucleus, Female, Habits, Humans, Male, Obsessive-Compulsive Disorder, Psychopathology, Putamen, Research Design, Prefrontal Cortex, Functional Neuroimaging
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