Abstract
Extensive cleaning or checking of patients with obsessive-compulsive disorder (OCD) are often interpreted as strategies to avoid harm and as an expression of the widespread belief that OCD patients are more risk-averse. However, despite its clinical significance, the neural basis of risk attitude in OCD is unknown. Here, we investigated neural activity during risk processing using functional magnetic resonance imaging and simultaneously assessed risk attitude using a separate behavioral paradigm in OCD patients with different symptoms versus healthy controls (HCs). We found opposite insula responses to high versus low risk in OCD patients compared to HCs: a positive correlation between insula activity and risk-aversion in patients versus a negative correlation in controls. Although OCD patients overall were not more risk-averse than controls, there were differences between subgroups of OCD patients: patients with doubt/checking symptoms were more risk-averse than other patients. Taken together, OCD patients show a reversed pattern of risk processing by the insula compared to HCs. Moreover, the data suggest that increased activation of the insula signals an abnormal urge to avoid risks in the subpopulation of OCD patients with doubt and checking symptoms. These results indicate a role for the insula in excessive risk-avoidance relevant to OCD.
Highlights
Risk and the need to assess risk pervade our daily life
The data showed that the risk attitude measures were similar for both groups: no significant difference between obsessive-compulsive disorder (OCD) patients and healthy controls (HCs) in mean risk-aversion or mean risk premium during the risk attitude assessment prior to the scanning session (p ≥ 0.25; Table 2)
These results indicate that OCD patients are not more risk-averse than HC and that both groups are heterogeneous and vary considerably in their risk attitudes
Summary
Risk and the need to assess risk pervade our daily life. The outcome of choices is not always certain but different outcomes can occur probabilistically. If the choice can lead to either a very positive or a very negative outcome for the individual, there is a higher variance and a higher risk than if the choice can lead to a moderately positive or a moderately negative outcome. How the level of risk influences one’s choice differs between individuals. People tend to prefer safer options, at least when the stakes are high (Pratt, 1964). This tendency toward risk avoiding strategies may have evolved because they may have promoted survival in cases where negative outcomes were life-threatening (Hintze et al, 2015). Too much risk aversion may lead to suboptimal behavior and may be related to psychopathology
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