How Do People With OCD Make Risky Decisions Differently From Others?

What you need to know

• People with OCD show different patterns of brain activity when making risky decisions compared to those without OCD
• During risky choices, people with OCD show reduced activity in brain regions involved in emotion processing and risk assessment
• When receiving unexpected losses, people with OCD show stronger activation in reward-related brain regions
• These brain differences may help explain why people with OCD often struggle with indecisiveness and uncertainty

Understanding How OCD Affects Decision-Making

Obsessive-compulsive disorder (OCD) is characterized by intrusive thoughts that cause anxiety (obsessions) and repetitive behaviors performed to reduce this anxiety (compulsions). While people with OCD know their rituals are excessive, these behaviors help neutralize their anxiety, creating a cycle of reinforcement.

One key feature of OCD is difficulty making decisions, especially when faced with uncertainty. People with OCD often get stuck in excessive doubt about whether they made the right choice. To better understand this, researchers used brain imaging to study how people with OCD process risky decisions differently from others.

The Gambling Task Study

The study involved 34 people with OCD and 33 people without OCD. Participants completed a gambling task while their brain activity was measured using functional magnetic resonance imaging (fMRI). In the task, they had to choose between two options with different levels of risk.

Key Brain Differences During Decision-Making

Emotion Processing Regions

During risky decisions, people with OCD showed reduced activity in several brain regions compared to the control group:

• The amygdala (a region involved in processing emotions) showed decreased activity during high-risk choices
• The posterior cingulate cortex (involved in self-reflection and emotion) was less active overall
• The anterior cingulate cortex (important for integrating risk and reward information) showed reduced activity

These differences suggest that people with OCD process the emotional aspects of risky decisions differently.

Risk Assessment Regions

Both groups showed increased activity in the anterior insula (involved in risk assessment) during high-risk choices. However, the posterior insula was more active during low-risk choices. This suggests different parts of the insula play distinct roles in evaluating risk:

• Anterior insula: Tracks arousal and risk prediction
• Posterior insula: Processes urges and body signals

Response to Losses

When participants received unexpected losses:

• People with OCD showed stronger activation in reward-processing regions like the putamen and anterior cingulate cortex
• This heightened response was specifically seen for low-risk choices that resulted in losses
• The control group showed stronger responses to losses following high-risk choices instead

Brain Activity Links to OCD Symptoms

The researchers found several connections between brain activity patterns and OCD symptoms:

• Activity in the lingual gyrus (involved in emotional processing) correlated with OCD severity
• Posterior cingulum activity was linked to depression symptoms
• Activity in risk-processing regions was associated with anxiety levels

Conclusions

• People with OCD show distinct patterns of brain activity during risky decision-making, particularly in regions involved in emotion processing and risk assessment
• These differences may help explain why people with OCD often struggle with indecision and uncertainty
• The findings suggest that emotional (“hot”) decision-making processes are altered in OCD, not just cognitive (“cold”) ones
• Understanding these brain differences could lead to better treatments targeting decision-making difficulties in OCD