Obsessive-Compulsive Disorder Is Associated With Broad Impairments in Executive Function

Abstract

Obsessive-compulsive disorder (OCD) is a serious and often chronically disabling condition. The current dominant model of OCD focuses on abnormalities in prefrontal-striatal circuits that support executive function (EF). While there is growing evidence for EF impairments associated with OCD, results have been inconsistent, making the nature and magnitude of these impairments controversial. The current meta-analysis uses random-effects models to synthesize 110 previous studies that compared participants with OCD to healthy control participants on at least one neuropsychological measure of EF. The results indicate that individuals with OCD are impaired on tasks measuring most aspects of EF, consistent with broad impairment in EF. EF deficits were not explained by general motor slowness or depression. Effect sizes were largely stable across variation in demographic and clinical characteristics of samples, although medication use, age, and gender moderated some effects.

Perseveration causes automatization of checking behavior in obsessive-compulsive disorder

“…A more likely explanation of the slower RTs for OCD patients on the RIR pre-and post-test seems to be that the checking/RT dual task places higher demands on executive functioning (e.g., visuospatial working memory, general motor speed, and divided attention). Three recent meta-analyses showed that OCD is associated with broad impairments in cognitive functioning (i.e., verbal fluency, processing speed, attention, and executive function: inhibition, shifting, verbal and visuospatial working memory, and planning), although the magnitude of the effects is generally moderate (Abramovitch et al, 2013;Shin, Lee, Kim, & Kwon, 2014;Snyder, Kaiser, Warren, & Heller, 2014). We did not find evidence for general slower motor or processing speed in OCD patients.…”

Transdiagnostic dimensions of anxiety: Neural mechanisms, executive functions, and new directions

“…Broadly speaking, anxious apprehension and anxious arousal have been associated with poorer behavioral performance and less efficiency (Eysenck et al, 2007;Silton et al, 2011;Warren et al, 2013) on tasks requiring attentional control. More specifically, anxious apprehension tends to correlate more with shifting impairments (Snyder et al, 2014) and anxious arousal more with dysfunctions in updating and inhibition (Warren, Heller, and Miller in prep). Additionally, these anxiety constructs correlate with distinct neural mechanisms that may disrupt specific executive functions e.g., for anxious apprehension, there is a negative correlation between neural activity in Broca's area, which putatively implements aspects of worry, and activity in DLPFC, which putatively implements top-down control of attention Spielberg et al, 2013).…”

“…As evidence from clinical neuroscience and psychology has accumulated regarding the interactions among executive functions and dimensions of anxiety (e.g., Crocker et al, 2013;Levin et al, 2007;Snyder et al, 2014), it has become clear that deficits in executive function capacities can be predisposing risk factors, maintaining components, and/or negative consequences of anxiety disorders. Executive function is a broad term encompassing many cognitive processes, which in general coordinate behavior adaptively toward a goal (Banich, 2009).…”

“…Anxious apprehension could be operationalized solely as an extreme and stable pattern of worry (as indicated by self-reported answers on a selection of questionnaires: Ruscio et al, 2001). However, it might be hypothesized that additional constructs, such as executive inflexibility (e.g., impairment in shifting, for review see Snyder et al, 2014), are important components of anxious apprehension. Such a conceptualization might posit that a breakdown in executive flexibility interacting with a rise in negatively-valenced/high-arousal affect sustains a pattern of negative, repetitive thinking (see Crocker et al, 2013;Gotlib and Joormann, 2010) leading to a persistent pattern that constitutes anxious apprehension.…”

“…Executive function is a broad term encompassing many cognitive processes, which in general coordinate behavior adaptively toward a goal (Banich, 2009). These processes allow individuals to successfully "break out of habits, make decisions and evaluate risks, plan for the future, prioritize and sequence our actions, and cope with novel situations" (Snyder et al, 2014).…”