Do Individuals With Obsessive-Compulsive Disorder and Obsessive-Compulsive Personality Disorder Share Similar Neural Mechanisms of Decision-Making Under Ambiguous Circumstances?

Abstract

Impaired decision-making is well documented in obsessive-compulsive disorder (OCD) and a range of electrophysiological and functional neuroimaging measures have begun to reveal the pathological mechanisms that underlie the decision-making process. Obsessive-compulsive personality disorder (OCPD) has core symptoms that often overlap with OCD, but similarities between these disorders at the behavioral and neurological levels are often unclear, including whether OCPD exhibits similar decisionmaking deficits and shared neurological dysfunction. To address these issues, we examined 24 cases of OCD, 19 cases of OCPD, and 26 matched normal control (NC) subjects during the revised Iowa Gambling Task (IGT) using event-related potentials (ERPs). The net IGT scores were lower for OCD subjects than for OCPD or NC subjects, thus indicating that OCD subjects chose more disadvantageous options and were "short-sighted" with regards to information. The feedback-related negativity (FRN) waveform (lose-win) was larger in both OCD and OCPD subjects, which suggested that obstacles exist in the feedback process. Consequently, these subjects might share similar neural mechanisms under ambiguous decision-making circumstances. Furthermore, IGT net scores were significantly and negatively correlated with Hamilton Anxiety Rating Scale (HAMA) and Hamilton Depression Rating Scale (HAMD) scales. This implies that more severe obsessive-compulsive symptoms inspired more negative emotions that led to worse decision-making ability. Therefore, although similar neural mechanisms might exist, this led to different behaviors in which OCPD is associated with better behavioral performance compared to OCD patients.

Identifying mechanistic pathways to rigidity associated with Obsessive-Compulsive Personality Disorder traits using a novel decision-making paradigm

“…Historically regarded as highly similar or even overlapping disorders, some recent literature questions the relationship between the two (Starcevic & Brakoulias, 2014;Taylor et al, 2011). Our results build on previous literature indicating important mechanistic differences between OCD and OCPD despite many similarities in clinical characteristics (Luo et al, 2020;Marincowitz et al, 2021;Pinto et al, 2014). Second, we identified several mechanistic overlaps between OCPD traits and AN, such that these presentations may share a pathway to inflexible behavior characterized by heightened choice decisiveness and selectivity related to reward.…”

“…Despite these commonalities, research remains inconclusive regarding the degree to which there is a mechanistic overlap between the disorders. Several studies have found appreciable differences when comparing OCD, OCPD, and AN on a number of indices, including decision making under uncertainty (Luo et al, 2020), planning ability (Paast et al, 2016), capacity to delay reward (Pinto et al, 2014;Steinglass et al, 2017) and setshifting (Bohon et al, 2020). Similar to the way in which a medical symptom like shortness of breath can result from multiple causes, each requiring distinct interventions, inflexible behavior may be caused by a number of different cognitive processes (Ionescu, 2012;Serpell et al, 2002;Treadway & Zald, 2013).…”

“…Adaptation of behavior over time is also impaired in OCD. Individuals with OCD will continue to rigidly prioritize certain choices, such as performing a ritual, despite experiencing negative outcomes (Luo et al, 2020;Nielen et al, 2009) and struggle to integrate new contextual information in order to "override" outdated associations between actions and outcomes (O'Brien et al, 2019;Rotge et al, 2015).…”

Functional MRI findings in personality disorders: A review

“…Both of these publications utilized rs‐fMRI in their study design (Table 7). While obsessive‐compulsive disorder and OCPD share very similar symptomatology, it is unclear whether the two disorders also share similar neurobiology 16,17 . For this reason, we only included studies with diagnosed OCPD patients.…”

Differences in Psychiatric Comorbidities and Gender Distribution among Three Clusters of Personality Disorders: A Nationwide Population-Based Study

“…Furthermore, among the three PDs, we found that individuals with cluster B PDs had a significantly higher proportion of trauma and stressor disorders, feeding and eating disorders, and substance and addictive disorders; those with cluster C PDs demonstrated a higher comorbidity with somatic symptom disorders and sleep–wake disorders; and those with cluster A PDs highly co-occurred with neurodevelopmental disorders, schizophrenia, and neurocognitive disorders. The aforementioned phenomena may be explained as follows: First, they reflect the diagnostic characteristics of the subgroup of the three PDs, such as affective instability and emotional liability in borderline PD (cluster B) and bipolar disorder [ 21 , 22 ], sharing the same symptoms of alexithymia in patients with borderline PD (cluster B) or feeding and eating disorders [ 23 ], and there is an overlap of the core symptoms between obsessive–compulsive PD (cluster C) and obsessive–compulsive disorder [ 24 ]. Second, they result from some poor social interaction due to the trait of specified cluster PD, such as the intimate connection between antisocial PD (cluster B) and illegal drug abuse [ 25 ] and the status of depression and anxiety because of extreme sensitivity to negative evaluation in individuals with avoidant PD (cluster C).…”