Altered response to risky decisions and reward in patients with obsessive–compulsive disorder
Open accessAbstract
Background: Patients with obsessive–compulsive disorder (OCD) employ ritualistic behaviours to reduce or even neutralize the anxiety provoked by their obsessions. The presence of excessive rumination and indecision has motivated the view of OCD as a disorder of decision-making. Most studies have focused on the “cold,” cognitive aspects of decision-making. This study expands current understanding of OCD by characterizing the abnormalities associated with affective, or “hot” decision-making. Methods: We performed a functional MRI study in a sample of 34 patients with OCD and 33 sex- and age-matched healthy controls, during which participants made 2-choice gambles taking varying levels of risk. Results: During risky decisions, patients showed significantly reduced task-related activation in the posterior cingulum, lingual gyrus and anterior cingulate cortex. We identified significant group × risk interactions in the calcarine cortex, precuneus, amygdala and anterior cingulate cortex. During the outcome phase, patients with OCD showed stronger activation of the orbitofrontal cortex, anterior cingulate cortex and putamen in response to unexpected losses. Limitations: The group of patients not receiving medication was very small ( n = 5), which precluded us from assessing the effect of medication on risk-taking behaviour in these patients. Conclusion: Obsessive–compulsive disorder is associated with abnormal brain activity patterns during risky decision-making in a set of brain regions that have been consistently implicated in the processing of reward prediction errors. Alterations in affective “hot” processes implicated in decision-making may contribute to increased indecisiveness and intolerance to uncertainty in patients with OCD.
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OCD is associated with underactivation of NAcc and OFC during reward anticipation and reward-based decision-making, and with poorer reward-based decision-making and reward-learning performance.
“Several studies have also reported underactivation of the NAcc and OFC during anticipation of reward (but not during anticipation of punishment) and during reward-based decision-making [136, 143–145] as well as poorer performance on reward-based decision-making and reward-learning tasks [146–147].”
From Toward a neurocircuit-based taxonomy to guide treatment of obsessive-compulsive disorder (2021) · cites this paper as [145]
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- Authors
- Moreira, P. S., Macoveanu, J., Marques, P., Coelho, A., Magalhães, R., Siebner, H. R., Soares, J. M., Sousa, N., & Morgado, P.
- Affiliations
- University of Copenhagen (DK)
- ORCID
- Venue
- Journal of Psychiatry and Neuroscience
- Publisher
- Canadian Science Publishing
- Published
- 2020-03
- Volume
- 45
- Issue
- 2
- Pages
- 98-107
- ISSN
- 1180-4882 (ISSN-L)
- 1488-2434
- PMC
- PMC7828903
- OpenAlex
- W2988411889
- Cited by
- 26
- References
- 62
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 9 · 2023: 1 · 2022: 3 · 2021: 3 · 2020: 5
- FWCI
- 1.20
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- Journal of Psychiatry and Neuroscience (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, other-oa)
- PubMed (publishedVersion)
- Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion)
- Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, cc-by-nc-nd)
- Funders
- Lundbeckfonden (R186-2015-2138)
- Novo Nordisk Fonden (NNF14OC0011413)
- 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, risky decision making, reward prediction error, emotional decision-making, gambling, anterior cingulate cortex, orbitofrontal cortex, amygdala, posterior cingulum, precuneus, calcarine cortex, putamen, indecision, intolerance of uncertainty, brain activation
- MeSH terms
- Adult, Amygdala, Brain, Decision Making, Female, Gyrus Cinguli, Humans, Magnetic Resonance Imaging, Male, Neural Pathways, Obsessive-Compulsive Disorder, Occipital Lobe, Parietal Lobe, Reward, Risk-Taking, Young Adult, Functional Neuroimaging
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