Increased Loss Aversion in Unmedicated Patients with Obsessive-Compulsive Disorder.

Kamila E Sip,Emily R Stern,Stephan F Taylor,Richard Gonzalez

doi:10.3389/fpsyt.2017.00309

Abstract

Obsessive-compulsive disorder (OCD) patients show abnormalities in decision-making and, clinically, appear to show heightened sensitivity to potential negative outcomes. Despite the importance of these cognitive processes in OCD, few studies have examined the disorder within an economic decision-making framework. Here, we investigated loss aversion, a key construct in the prospect theory that describes the tendency for individuals to be more sensitive to potential losses than gains when making decisions. Across two study sites, groups of unmedicated OCD patients (n = 14), medicated OCD patients (n = 29), and healthy controls (n = 34) accepted or rejected a series of 50/50 gambles containing varying loss/gain values. Loss aversion was calculated as the ratio of the likelihood of rejecting a gamble with increasing potential losses to the likelihood of accepting a gamble with increasing potential gains. Decision times to accept or reject were also examined and correlated with loss aversion. Unmedicated OCD patients exhibited significantly more loss aversion compared to medicated OCD or controls, an effect that was replicated across both sites and remained significant even after controlling for OCD symptom severity, trait anxiety, and sex. Post hoc analyses further indicated that unmedicated patients' increased likelihood to reject a gamble as its loss value increased could not be explained solely by greater risk aversion among patients. Unmedicated patients were also slower to accept than reject gambles, effects that were not found in the other two groups. Loss aversion was correlated with decision times in unmedicated patients but not in the other two groups. These data identify abnormalities of decision-making in a subgroup of OCD patients not taking psychotropic medication. The findings help elucidate the cognitive mechanisms of the disorder and suggest that future treatments could aim to target abnormalities of loss/gain processing during decision-making in this population.

Highlights

Obsessive–compulsive disorder (OCD) patients show abnormalities in decision-making and, clinically, appear to show heightened sensitivity to potential negative outcomes
This study found increased loss aversion among unmedicated OCD patients compared to medicated patients and healthy controls, an effect that was replicated across two study sites
Our follow-up analysis of those gambles where gain = |loss| indicated that a risk aversion model alone could not explain Unmedicated OCD (uOCD) patients’ behavior, which was characterized by a greater tendency to reject gambles with higher gain/|loss| values even when expected value was held equal on gain = |loss| trials

Summary

Introduction

Obsessive–compulsive disorder (OCD) patients show abnormalities in decision-making and, clinically, appear to show heightened sensitivity to potential negative outcomes. We investigated loss aversion, a key construct in the prospect theory that describes the tendency for individuals to be more sensitive to potential losses than gains when making decisions. Sensitivity to potential negative and positive outcomes (i.e., losses and gains) when making decisions is characterized by a value function that describes the subjective (or experienced) value assigned to monetary losses and gains [15,16,17]. Loss aversion is succinctly described by the phrase “losses loom larger” than gains and is measured by the coefficient λ (lambda), which reflects the greater steepness of the value function for losses compared to gains.

Methods

Results

Conclusion