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

Yudan Luo,Yudan Luo,Linlin Qiu,Yi Dong,Chunyan Zhu,Chunyan Zhu,Hongchen Li,Kai Wang,Kai Wang,Kai Wang,Lei Zhang,Lei Zhang,Lu Chen,Lu Chen,Yaxiang Gao,Xiaoqin Zhou,Fengqiong Yu

doi:10.3389/fnhum.2020.585086

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 decision-making 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.

Highlights

Obsessive-compulsive disorder (OCD) and obsessivecompulsive personality disorder (OCPD) are two distinct disease entities according to the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013)
The obsessive-compulsive disorder (OCD) group performed worse than the normal control (NC) (p = 0.015) and Obsessive-compulsive personality disorder (OCPD) groups (p = 0.059), while there was no significant difference in performance between the OCPD and NC groups
OCPD subjects showed medium performance when compared with the OCD and NC groups, indicating some preservation of an ability to learn from feedback in the OCPD group

Summary

Introduction

Obsessive-compulsive disorder (OCD) and obsessivecompulsive personality disorder (OCPD) are two distinct disease entities according to the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013). Due to the overlap in clinical symptoms and difficulties in diagnosis, the distinction between OCD and OCPD is often unclear. 47.3% of subjects with OCD meet the criteria for OCPD. Subjects with OCD and comorbid OCPD show an earlier onset, a greater severity, and a poorer treatment outcome (Starcevic et al, 2013). People with OCD often suffer from their symptoms and actively seek treatment as they consider these symptoms at odds with personal self-image (i.e., ego-dystonic). Subjects with OCPD consider symptoms as being consistent with their self-image (i.e., ego-syntonic) and rarely seek medical advice. Clarification of the relationship between OCD and OCPD would be highly advantageous if we are to understand these diseases better

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