Obsessive-Compulsive Disorder and Decision Making under Ambiguity: A Systematic Review with Meta-Analysis

Abstract

In the last decade, decision-making has been proposed to have a central role in obsessive-compulsive disorder (OCD) aetiology, since patients show pathological doubt and an apparent inability to make decisions. Here, we aimed to comprehensively review decision making under ambiguity, as measured by the Iowa Gambling Task (IGT), in OCD, using a meta-analytic approach. According to PRISMA Guidelines, we selected 26 studies for a systematic review and, amongst them, 16 studies were included in a meta-analysis, comprising a total of 846 OCD patients and 763 healthy controls (HC). Our results show that OCD patients perform significantly lower than HC at the IGT, pointing towards the direction of a decision making impairment. In particular, this deficit seems to emerge mainly in the last three blocks of the IGT. IGT scores in OCD patients under the age of 18 were still significantly lower than in HC. Finally, no difference emerged between medicated and unmedicated patients, since they both scored significantly lower at the IGT compared to HC. In conclusion, our results are in line with the hypothesis according to which decision making impairment might represent a potential endophenotype lying between the clinical manifestation of OCD and its neurobiological aetiology.

The orbitofrontal cortex represents advantageous choice in the Iowa gambling task

“…The inability to make choices in a complex decision‐making situation, for example, Iowa gambling task (IGT), is a symptom of several brain disorders, including borderline personality disorder (Linhartová et al, 2020 ), attention‐deficit/hyperactivity disorder (Linhartová et al, 2020 ), anorexia nervosa (Verharen et al, 2019 ), addiction (Kluwe‐Schiavon et al, 2020 ), obsessive‐compulsive disorder (Nisticò et al, 2021 ), and schizophrenia (Betz et al, 2019 ). In the IGT, reward value is a key decision‐making parameter (Bechara et al, 1997 ).…”

A comparison of ‘not just right experiences’ in obsessive–compulsive disorder, anxiety and depressive disorders and non‐clinical controls in China

“…Like NJREs, pathological doubt or uncertainty also seems to be present across multiple symptom dimensions of OCD. Pathological doubt impairs decision-making ability (Nistico et al, 2021), and NJREs may underlie maladaptive action repetition and impaired inhibitory control in OCD (Dominke et al, 2021), reflecting neurocognitive deficits in OCD.…”

“…Like NJREs, pathological doubt or uncertainty also seems to be present across multiple symptom dimensions of OCD. Pathological doubt impairs decision‐making ability (Nistico et al, 2021), and NJREs may underlie maladaptive action repetition and impaired inhibitory control in OCD (Dominke et al, 2021), reflecting neurocognitive deficits in OCD. Several studies have shown that NJREs may play a mediating role between other psychological constructs (e.g., maladaptive perfectionism, intolerance of uncertainty and guilt) and OC symptoms (Bottesi et al, 2017; Mancini et al, 2008; Moretz & McKay, 2009).…”

Development of a scale to assess obsessive-compulsive tendencies among Japanese university students

“…Therefore, as indecisiveness is not a symptom specific to OCD, it is not considered as a diagnostic criterion for OCD in the DSM-5. However, Nisticò et al. (2021) conducted a systematic review regarding decision making in OCD and used a meta-analytic approach to show that the impairment of decision making in OCD might constitute a trait feature of the disorder itself.…”