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Functional Neuroimaging of Avoidance Habits in Obsessive-Compulsive Disorder
Open accessAbstract
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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“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“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
In the citing paper
“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]
In the citing paper
“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
In the citing paper
“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
In the citing paper
“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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BackgroundSelf-citationModel-based learning protects against forming habits
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“7 (b), our method finds the brain regions, such as orbital-frontal cortex, caudate, thalamus, which are included in the cortical-striato-thalamic circuits, and is considered as the theoretical neuroanatomical network of OCD ( Gillan et al., 2015; 2011 ).”
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“However, it is possible to observe persistent avoidance in the absence of elevated fear in animals (30), healthy humans (31), and OCD patients (32), suggesting that factors other than elevated fear can elicit persistent avoidance.”
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“Second, our method finds the brain regions, such as orbital-frontal cortex, caudate, thalamus, which are included in the cortical-striato-thalamic circuits, and is considered as the theoretical neuro-anatomical network of OCD ([45], [46]).”
MethodWhich 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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“…valuation, which is reflected in impairments in a variety of tasks (Haber and Heilbronner, 2013) Hyperconnectivity with the caudate and its relation to compulsivity In OCD, the maintenance of habits has been shown to be associated with hyperactivity of the caudate nucleus (Gillan et al., 2015).”
BackgroundInfluentialSelf-citationDoes compulsive behavior in Anorexia Nervosa resemble an addiction? A qualitative investigation
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“…balance away from goaldirected control and toward excessive habit learning has been shown in substance dependence, and other compulsive disorders such as obsessive compulsive disorder (OCD) and binge eating disorder (BED) (Gillan et al., 2011, 2014, 2015; Sjoerds et al., 2013; Voon et al., 2015).”
BackgroundAn investigation of habit learning in Anorexia Nervosa
Godier-McBard, L. R., de Wit, S., Pinto, A., STEINGLASS, J. E., Greene, A. L., Scaife, J. C., Gillan, C. M., Walsh, B. T., Simpson, H. B., & Park, R. J. (2016) · Psychiatry Research · doi:10.1016/j.psychres.2016.07.051 · Cited by 52
“Our findings in this population differ from studies involving individuals with OCD and addictive disorders, in which excessive habitual responding has been found using these tasks (Gillan et al., 2015; Gillan et al., 2013; Gillan et al., 2011; Sjoerds et al., 2013).”
BackgroundMethodResultInfluentialSelf-citationAnnual Research Review: Developmental computational psychiatry
Hauser, T. U., Will, G., Dubois, M., & Dolan, R. J. (2018) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12964 · Cited by 55
Parkes, L., Tiego, J., Aquino, K. M., Braganza, L., Chamberlain, S. R., Fontenelle, L. F., Harrison, B. J., Lorenzetti, V., Paton, B. K., Razi, A., et al. (2019) · NeuroImage · doi:10.1016/j.neuroimage.2019.116070 · Cited by 54
Goal-Directed and Habitual Control in Smokers
Luijten, M., Gillan, C. M., de Wit, S., Franken, I. H. A., Robbins, T. W., & Ersche, K. D. (2019) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntz001 · Cited by 51
Self-citationInterfacing behavioral and neural circuit models for habit formation
Lerner, T. N. (2020) · Journal of Neuroscience Research · doi:10.1002/jnr.24581 · Cited by 50
“…activity in the caudate (analogous to rodent DMS), an area for goal-directed control, but not changes in the putamen (analogous to rodent DLS), suggesting that avoidance habits in OCD may be the result of impaired goal-directed systems rather than strengthened habit learning (Gillan et al., 2015).”
BackgroundPrice, R. B., Gillan, C. M., Hanlon, C., Ferrarelli, F., Kim, T., Karim, H. T., Renard, M., Kaskie, R., Degutis, M., Wears, A., et al. (2021) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2020.20060821 · Cited by 48
Self-citationLaing, P. A. F., & Harrison, B. J. (2021) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2021.05.014 · Cited by 68
Deficient Goal-Directed Control in a Population Characterized by Extreme Goal Pursuit
Foerde, K., Daw, N. D., Rufin, T., Walsh, B. T., Shohamy, D., & STEINGLASS, J. E. (2020) · Journal of Cognitive Neuroscience · doi:10.1162/jocn_a_01655 · Cited by 48
Norman, L. J., Mannella, K. A., Yang, H., Angstadt, M., Abelson, J. L., Himle, J. A., Fitzgerald, K. D., & Taylor, S. F. (2020) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2020.19080886 · Cited by 45
Restrictive eating across a spectrum from healthy to unhealthy: behavioral and neural mechanisms
Foerde, K., Schebendach, J., Davis, L., Daw, N. D., Walsh, B. T., Daphna Shohamy, A., & STEINGLASS, J. E. (2020) · Psychological Medicine · doi:10.1017/s0033291720003542 · Cited by 45
“goal-directed control of behavior (Gillan et al., 2015).”
To Do or Not to Do? Task Control Deficit in Obsessive-Compulsive Disorder
Kalanthroff, E., Henik, A., Simpson, H. B., Todder, D., & Anholt, G. E. (2017) · Behavior Therapy · doi:10.1016/j.beth.2017.01.004 · Cited by 43
Habitual Behavior Is Mediated by a Shift in Response-Outcome Encoding by Infralimbic Cortex
Barker, J. M., Glen, W. B., Linsenbardt, D. N., Lapish, C. C., & Chandler, L. J. (2017) · eNeuro · doi:10.1523/eneuro.0337-17.2017 · Cited by 45
“…behaviors, including overeating, drug abuse, and perseverative obsessive-compulsive rituals, are characterized by the inability to update actions when goals change (Balleine and O’Doherty, 2010; Sjoerds et al., 2013; Barker and Taylor, 2014; Gillan et al., 2014, 2015; Everitt and Robbins, 2015).”
BackgroundDong, C., Yang, Q., Liang, J., Seger, C. A., Han, H., Ning, Y., Chen, Q., & Peng, Z. (2020) · Psychological Medicine · doi:10.1017/s0033291719001429 · Cited by 43
“Studies using an avoidance paradigm found that OCD patients exhibited hyperactivations in the caudate nucleus, which suggested that a bias towards behavioral control by the habit system may result from impairment of the goal-directed system (Gillan et al., 2015).”
MethodSimmler, L. D., & Ozawa, T. (2019) · Neurochemistry International · doi:10.1016/j.neuint.2019.104464 · Cited by 40
Yu, J., Zhou, P., Yuan, S., Wu, Y., Wang, C., Zhang, N., Li, C. R., & Liu, N. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2021.12.029 · Cited by 43
Habit strength is predicted by activity dynamics in goal-directed brain systems during training
Zwosta, K., Ruge, H., Goschke, T., & Wolfensteller, U. (2017) · NeuroImage · doi:10.1016/j.neuroimage.2017.09.062 · Cited by 44
“Furthermore, patients with obsessive compulsive disorder, who displayed increased habitual behavior, showed changes in the goal-directed system (Gillan et al., 2015).”
Vaghi, M. M. S., Moutoussis, M., Váša, F., Kievit, R., Hauser, T. U., Vértes, P. E., Shahar, N., Romero-García, R., Kitzbichler, M. G., Bullmore, E. T., et al. (2020) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1922273117 · Cited by 43
Vicente, A. M., Martins, G. J., & Costa, R. M. (2020) · Current Opinion in Genetics & Development · doi:10.1016/j.gde.2020.05.042 · Cited by 41
Lee, M. T., Mpavaenda, D. N., & Fineberg, N. A. (2019) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2019.00079 · Cited by 40
Self-citationNeuromodulation of OCD: a review of invasive and non-invasive methods
Kammen, A., Cavaleri, J., Lam, J., Frank, A. C., Mason, X., Choi, W., Penn, M., Brasfield, K., Van Noppen, B., Murray, S. B., et al. (2022) · Frontiers in Neurology · doi:10.3389/fneur.2022.909264 · Cited by 38
“Similarly, the caudate is known to be involved in learning and goal-directed behavior, including a critical role in habit formation, and is thought to be hyperactive in OCD (11).”
BackgroundAre nonclinical obsessive-compulsive symptoms associated with bias toward habits?
Snorrason, Í., Lee, H. J., de Wit, S., & Woods, D. W. (2016) · Psychiatry Research · doi:10.1016/j.psychres.2016.04.067 · Cited by 39
Lloyd, E. C., Frampton, I. J., Verplanken, B., & Haase, A. M. (2017) · Medical Hypotheses · doi:10.1016/j.mehy.2017.09.001 · Cited by 43
Corticostriatal foundations of habits
Seger, C. A. (2018) · Current Opinion in Behavioral Sciences · doi:10.1016/j.cobeha.2018.01.006 · Cited by 38
Berman, N. C., Shaw, A. M., & Wilhelm, S. (2018) · Cognitive Therapy and Research · doi:10.1007/s10608-018-9911-z · Cited by 38
Ehmer, I., Feenstra, M., Willuhn, I., & Denys, D. (2020) · Neurobiology of Learning and Memory · doi:10.1016/j.nlm.2020.107162 · Cited by 37
Functional disruption in prefrontal-striatal network in obsessive-compulsive disorder
Sha, Z., Versace, A., Edmiston, E. K., Fournier, J. C. J., Graur, S., Greenberg, T., Santos, J. P. L., Chase, H. W., Stiffler, R. S., Bonar, L. K., et al. (2020) · Psychiatry Research Neuroimaging · doi:10.1016/j.pscychresns.2020.111081 · Cited by 41
“Given the findings above highlighting the rACC as a hub region connecting other prefrontal cortical and subcortical regions in this network, the critical role of the caudate in the balance between goal-directed versus habitual behaviors, and the important role of the vlPFC in set shifting during reversal learning, the…”
BackgroundFineberg, N. A., Pellegrini, L., Wellsted, D. M., Hall, N., Corazza, O., Giorgetti, V., Cicconcelli, D., Theofanous, E., Sireau, N., Adam, D., et al. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2021.07.001 · Cited by 36
Self-citationLeveraging cognitive neuroscience for making and breaking real-world habits
Buabang, E. K., Donegan, K. R., Rafei, P., & Gillan, C. M. (2025) · Trends in Cognitive Sciences · doi:10.1016/j.tics.2024.10.006 · Cited by 34
“O relationships [107] and aberrant activity in the caudate [108].”
BackgroundSelf-citationBtbd3 expression regulates compulsive-like and exploratory behaviors in mice
Thompson, S. L., Welch, A. C., Ho, E. V., Bessa, J. M., Portugal‐Nunes, C., Morais, M., Young, J. W., Knowles, J. A., & Dulawa, S. C. (2019) · Translational Psychiatry · doi:10.1038/s41398-019-0558-7 · Cited by 35
Zhao, Q., Xu, T., Wang, Y., Chen, D., Liu, Q., Yang, Z., & Wang, Z. (2019) · Psychological Medicine · doi:10.1017/s0033291719002988 · Cited by 36
“, 2011), which has been related to goaldirected dysfunction in OCD (Gillan et al., 2015).”
BackgroundGoal-Directed and Habitual Control in Human Substance Use: State of the Art and Future Directions
Doñamayor, N., Ebrahimi, C., Arndt, V. A., Weiß, F., Schlagenhauf, F., & Endraß, T. (2022) · Neuropsychobiology · doi:10.1159/000527663 · Cited by 40
Understanding the balance between goal-directed and habitual behavioral control
Corbit, L. H. (2018) · Current Opinion in Behavioral Sciences · doi:10.1016/j.cobeha.2018.01.010 · Cited by 37
Linnebank, F. E., Kindt, M., & de Wit, S. (2018) · Learning & Behavior · doi:10.3758/s13420-018-0313-6 · Cited by 34
Ramakrishnan, S., Robbins, T. W., & Zmigrod, L. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.865896 · Cited by 29
“(43) found that excessive habits in OCD patients were associated with hyperactivation in the caudate nucleus, an important region for goal-directed behavior that is implicated in the pathophysiology of OCD.”
BackgroundSelf-citationHabits and goals: a motivational perspective on action control
Ceceli, A. O., & Tricomi, E. M. (2017) · Current Opinion in Behavioral Sciences · doi:10.1016/j.cobeha.2017.12.005 · Cited by 34
“For instance, disorders of compulsion, such as Obsessive-Compulsive Disorder (OCD) [49], alcohol abuse [40,50–52], cocaine dependence [53,54], various other stimulants and opioid addictions [55], Tourette’s Syndrome [56], and even non-clinical symptoms of compulsive tendencies [23] predict cue-reactive habitual contro…”
BackgroundMerchán, A., Mora, S., Gago, B., Rodríguez‐Ortega, E., Fernández‐Teruel, A., Puga, J. L., Sánchez-Santed, F., Moreno, M., & Flores, P. (2018) · Genes Brain & Behavior · doi:10.1111/gbb.12489 · Cited by 35
Weidt, S., Lutz, J., Rufer, M., Delsignore, A., Jakob, N. J., Herwig, U., & Bruehl, A. B. (2016) · Psychological Medicine · doi:10.1017/s0033291715002998 · Cited by 30
“Such fronto-striatal abnormalities are hypothesized to underlie executive deficits in OCD patients (de Wit et al. 2012; Gillan et al. 2015).”
BackgroundMethodCigarette smoking and cerebral blood flow in a cohort of middle-aged adults
Elbejjani, M., Auer, R., Dolui, S., Jacobs, D. R., Haight, T. J., Goff, D. C., Detre, J. A., Davatzikos, C. A., Bryan, R. N., & Launer, L. J. (2018) · Journal of Cerebral Blood Flow & Metabolism · doi:10.1177/0271678x18754973 · Cited by 31
Tricklebank, M. D., Robbins, T. W., Simmons, C., & Wong, E. H. F. (2021) · Psychopharmacology · doi:10.1007/s00213-021-05787-x · Cited by 30
Self-citationGera, R., Or, M. B., Tavor, I., Roll, D., Cockburn, J., Barak, S., Tricomi, E. M., O’Doherty, J. P., & Schönberg, T. (2023) · NeuroImage · doi:10.1016/j.neuroimage.2023.120002 · Cited by 36
Enhanced Avoidance Habits in Relation to History of Early-Life Stress
Patterson, T. K., Craske, M. G., & Knowlton, B. J. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.01876 · Cited by 30
Recent developments in the habit hypothesis of OCD and compulsive disorders
Gillan, C. M. (2021) · Current Topics in Behavioral Neurosciences · doi:10.1007/7854_2020_199 · Cited by 27
Self-citationLee, I. B., Lee, E., Han, N.-E., Slavuj, M., Hwang, J. W., Lee, A., Sun, T., Jeong, Y., Baik, J., Park, J., et al. (2024) · Nature Communications · doi:10.1038/s41467-023-44322-8 · Cited by 33
“Only male mice were used in all other experiments to avoid possible complications due to gender differences in OCD 79 .”
Influential
Metadata
- 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
- 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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