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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.
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“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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“These three hypotheses were derived from Gillan and colleagues’ previous work (Gillan et al., 2015), although no evidence was obtained in that study supporting the equivalent of Hypothesis 2.”
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“While a previous study using the outcome devaluation paradigm determined a key role of the caudate in failures to avoid habits in OCD, 39 we did not observe aberrations in this region.”
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“Functional studies have indicated that hyperactivation in themOFC and caudatemaybe related to goal-directed dysfunction in OCD (Gillan et al., 2014).”
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“Excessive habit formation was not related to differences in activation in the putamen (Gillan et al., 2015).”
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“Finally, avoidance habits have been shown to exist in humans and are disrupted in OCD (Gillan et al., 2015; Gillan, MoreinZamir, Urcelay, et al., 2014).”
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“…Kringelbach & Rolls, 2004; Milad & Rauch, 2012; Noonan, Chau, Rushworth, & Fellows, 2017; O’Doherty et al., 2001; Zald et al., 2014), including OCD patients (Apergis-Schoute et al., 2017; Gillan et al., 2015), and other primates (Noonan et al., 2010; Walton, Behrens, Noonan, & Rushworth, 2011).”
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“This was a behavioural study, and no neural data were collected, which would have been helpful in providing further comparisons with OCD in the neural domain [12].”
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“The fact that repetition of compulsions leads to habit learning, involving different brain mechanisms that may not respond to standard OCD treatments (Gillan et al., 2015, 2017), makes this disorder perfectly suitable for early interventions.”
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“According to a neuroimaging study, when facing a fear-evoking situation, stronger coupling between the caudate and right ventrolateral prefrontal cortex (vlPFC) resulted in less urge and no unrealistic reactions, but stronger coupling between the caudate and sgACC resulted in greater urge and unrealistic reactions [69…”
BackgroundInfluentialIt Just Doesn’t Feel Right: OCD and the ‘Scaling Up’ Problem
Downey, A. (2019) · Phenomenology and the Cognitive Sciences · doi:10.1007/s11097-019-09644-3 · Cited by 12
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“Dysfunc-tional goal-directed control in OCD has been strongly supported both behaviorally (Gillan et al., 2011; Vaghi et al., 2018) and from a neurobiological perspective (Gillan et al., 2015a).”
Self-citationValence processing alterations in SAPAP3 knockout mice and human OCD
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“While avoidance is an adaptive response to danger, exaggerated or pathological avoidance is a core symptom in many clinical disorders, including posttraumatic stress disorder (PTSD) [1, 2], obsessive-compulsive disorder [3], and addiction [4].”
BackgroundParkes, 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. (2018) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/389320 · Cited by 9
Cognitive inflexibility, obsessive-compulsive symptoms and traits and poor post-pandemic adjustment
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“An example of this phenomenon can be seen with safety signalling learning, as individuals with OCD have been shown to persevere at performing learnt behaviours aimed at avoiding threat even after the threat is known to be no longer present (Apergis-Schoute et al., 2017; Gillan et al., 2015).”
Self-citationIntersect between brain mechanisms of conditioned threat, active avoidance, and reward
Badarnee, M., Wen, Z., Hammoud, M. Z., Glimcher, P. W., Cain, C. K., & Milad, M. R. (2025) · Communications Psychology · doi:10.1038/s44271-025-00197-7 · Cited by 8
“The emotional “ relief ” that patients feel in the absence of the aversive event after repeated avoidance responses does not appear to decrease over time in patients, and the omission of harm appears to continue to “ surprise the patients ” 75,87 (see Fig.”
Striatum-Mediated Deficits in Stimulus-Response Learning and Decision-Making in OCD
Hiebert, N. M., Lawrence, M. R., Ganjavi, H., Watling, M., Owen, A. M., Seergobin, K. N., & MacDonald, P. A. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00013 · Cited by 10
Multi-graph Fusion for Functional Neuroimaging Biomarker Detection
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Efficacy of nicotine administration on obsessions and compulsions in OCD: a systematic review
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Cognitive neuroscience of obsessive-compulsive disorder
Bragdon, L. B., Eng, G. K., Recchia, N., Collins, K. A., & Stern, E. R. (2023) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2022.11.001 · Cited by 7
McDonald, M., Kohls, G., Henke, N., Wahl, H., Backhausen, L. L., Roessner, V., & Buse, J. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-05808-x · Cited by 8
“In addition to harm avoidance or neutralizing anxiety, the behavior of OCD patients may also indicate that they are more sensitive to loss or punishment, which has also been linked to the (dorsal) striatum, including the caudate nucleus in studies conducted in adults with OCD [7, 8].”
BackgroundManning, E. E., & Ahmari, S. E. (2018) · Brain and Neuroscience Advances · doi:10.1177/2398212818783896 · Cited by 8
“In contrast, neuroimaging studies conducted during cognitive testing (e.g. reversal learning) consistently reveal impaired recruitment of OFC in OCD patients (Chamberlain et al., 2008; Gillan et al., 2015; Gu et al., 2008; Remijnse et al., 2006, 2009, 2013).”
BackgroundResultThe Future of Obsessive-Compulsive Spectrum Disorders: A Research Perspective
Vats, T., Fineberg, N. A., & Hollander, E. (2021) · Current topics in behavioral neurosciences · doi:10.1007/7854_2020_208 · Cited by 7
Self-citationThe relative contribution of goal-directed and habit systems to psychiatric disorders.
Woodhead, S., & Robbins, T. W. (2017) · PubMed · Cited by 7
Self-citationFailure Modes of the Will: From Goals to Habits to Compulsions?
Huys, Q. J. M., & Petzschner, F. H. (2015) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2014.14121502 · Cited by 6
“(5) add to an impressive catalog of studies on the im-balance between habitual and goal-directed decisions in OCD.”
BackgroundGhane, M., Trambaiolli, L. R., Bertocci, M. A., Martínez-Rivera, F. J., Chase, H. W., Brady, T., Skeba, A., Graur, S., Bonar, L. K., Iyengar, S., et al. (2024) · Biological Psychiatry · doi:10.1016/j.biopsych.2023.12.027 · Cited by 6
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Rewiring the OCD brain: Insights beyond cortico-striatal networks
Jijimon, F., Mehak, S. F., Mohammed, Z., Praharaj, S. K., & Gangadharan, G. (2025) · Neurobiology of Disease · doi:10.1016/j.nbd.2025.107216 · Cited by 7
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“At this stage, the interaction between motor and limbic systems leads to a more complex set of motivating forces that eventually shift from goal-directed to habitual modes of responding to both internal and external events [15,18,28].”
BackgroundElectroencephalographic Correlates of Obsessive-Compulsive Disorder
de Souza, A. M. F. L. P. (2021) · Current topics in behavioral neurosciences · doi:10.1007/7854_2020_200 · Cited by 7
There Is Much to Be Learned From Animal Models of Obsessive-Compulsive Disorder
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Gera, R., Or, M. B., Tavor, I., Roll, D., Cockburn, J., Barak, S., Tricomi, E. M., O’Doherty, J. P., & Schönberg, T. (2022) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2022.12.12.520188 · Cited by 5
Zenoni, M., Lopez, M. R., Archer, S., & Milton, A. L. (2026) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2026.152664 · Cited by 4
Brezóczki, B., Farkas, B. C., Hann, F., Pesthy, O., Tóth-Fáber, E., Farkas, K., Csigó, K., Németh, D., & Vékony, T. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-06786-4 · Cited by 3
A New Paradigm for Evaluating Avoidance/Escape Motivation
Tsutsui‐Kimura, I., Bouchekioua, Y., Mimura, M., & Tanaka, K. F. (2017) · The International Journal of Neuropsychopharmacology · doi:10.1093/ijnp/pyx031 · Cited by 4
“Recently, persistent avoidance was found to be a key feature of obsessive-compulsive disorder (Gillan et al., 2014, 2015).”
BackgroundKasal, M. I., Beşiroğlu, L., Zorlu, N., Dikmeer, N., Bektaş, A. B., Durmaz, E., Polat, S., Gelal, F. M., Rapp, M. A., Heinz, A., et al. (2021) · Scientific Reports · doi:10.1038/s41598-021-91179-2 · Cited by 3
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Dissecting compulsive eating behavior into three elements
Moore, C. F., Sabino, V., Koob, G. F., & Cottone, P. (2019) · Compulsive Eating Behavior and Food Addiction · doi:10.1016/b978-0-12-816207-1.00003-2 · Cited by 4
Obsessive-Compulsive and Related Disorders
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Control of Behaviour by Competing Learning Systems
de Wit, S. (2017) · Wiley eBooks · doi:10.1002/9781118920497.ch11 · Cited by 5
Model-based learning deficits in compulsivity are linked to faulty representations of task structurePreprint
Seow, T. X. F., O’Connell, R. G., & Gillan, C. M. (2020) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2020.06.11.147447 · Cited by 4
“…shown that behavioural insensitivity to rapid changes in outcome value (“outcome devaluation”) and habitual urges in OCD are associated with the hyperactivation of a brain area linked to goal-directed associative learning, the caudate nucleus, but not habit-related regions (Gillan et al., 2015).”
BackgroundSelf-citationDevelopmental Computational PsychiatryPreprint
Hauser, T. U., Will, G., Dubois, M., & Dolan, R. J. (2018) · PsyArXiv (OSF Preprints) · doi:10.31234/osf.io/85prq · Cited by 4
Extinction of Avoidance by Response Prevention: Translation From an Animal Model to the Clinic
Lange, I. (2016) · Biological Psychiatry · doi:10.1016/j.biopsych.2016.08.004 · Cited by 3
Cognitive, Emotional, and Behavioral Inflexibility and Perseveration in Neuropsychiatric Illness
Weisholtz, D. S., Sullivan, J. F., Nelson, A. P., Daffner, K. R., & Silbersweig, D. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-803676-1.00010-6 · Cited by 3
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The Role of the Orbitofrontal Cortex in the Regulation of Fear Coping Strategies
Kuan, H.-Y., & Chang, C. (2024) · Journal of physiological investigation. · doi:10.4103/ejpi.ejpi-d-24-00072 · Cited by 3
Exploring Habits in Anorexia Nervosa: Promise, Pitfalls, and Progress
Foerde, K. (2025) · Current Psychiatry Reports · doi:10.1007/s11920-025-01588-7 · Cited by 19
“Indeed, this pattern has been found across other clinical populations [ 83, 94] and, in a large, online, non-clinical sample, reduced goal-directed control was associated with eating disorder-related symptomatology [ 95].”
Examining the effect of stress on the flexible updating of avoidance responses
Lemmens, A., Quaedflieg, C. W. E. M., Dibbets, P., Rijkeboer, M. M., & Smeets, T. (2021) · European Journal of Neuroscience · doi:10.1111/ejn.15155 · Cited by 2
The Habitual Tendencies Questionnaire: A Tool for Psychometric Individual Differences ResearchPreprint
Ramakrishnan, S., Robbins, T. W., & Zmigrod, L. (2021) · PsyArXiv (OSF Preprints) · doi:10.31234/osf.io/yng4j · Cited by 3
Self-citationObsessive-Compulsive Tendencies Shift the Balance Between Competitive Neurocognitive FunctionsPreprint
Brezóczki, B., Vékony, T., Farkas, B. C., Hann, F., & Németh, D. (2025) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2025.08.13.669948 · Cited by 3
Altered Neural Activity during Negative Reinforcement in People with Obsessive-Compulsive Disorder
Panny, B., Price, R. B., Wears, A., & Ahmari, S. E. (2024) · Cognitive Therapy and Research · doi:10.1007/s10608-024-10475-z · Cited by 3
“In addition, OCD patients show more activity in the caudate than healthy controls when an experimentally devalued choice is made, and this activity is positively correlated with habit urge ratings (Gillan et al., 2015).”
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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