Abstract
Doubt is subjective uncertainty about one’s perceptions and recall. It can impair decision-making and is a prominent feature of obsessive-compulsive disorder (OCD). We propose that evaluation of doubt during decision-making provides a useful endophenotype with which to study the underlying pathophysiology of OCD and potentially other psychopathologies. For the current study, we developed a new instrument, the Doubt Questionnaire, to clinically assess doubt. The random dot motion task was used to measure reaction time and subjective certainty, at varying levels of perceptual difficulty, in individuals who scored high and low on doubt, and in individuals with and without OCD. We found that doubt scores were significantly higher in OCD cases than controls. Drift diffusion modeling revealed that high doubt scores predicted slower evidence accumulation than did low doubt scores; and OCD diagnosis lower than controls. At higher levels of dot coherence, OCD participants exhibited significantly slower drift rates than did controls (q<0.05 for 30%, and 45% coherence; q<0.01 for 70% coherence). In addition, at higher levels of coherence, high doubt subjects exhibited even slower drift rates and reaction times than low doubt subjects (q<0.01 for 70% coherence). Moreover, under high coherence conditions, individuals with high doubt scores reported lower certainty in their decisions than did those with low doubt scores. We conclude that the Doubt Questionnaire is a useful instrument for measuring doubt. Compared to those with low doubt, those with high doubt accumulate evidence more slowly and report lower certainty when making decisions under conditions of low uncertainty. High doubt may affect the decision-making process in individuals with OCD. The dimensional doubt measure is a useful endophenotype for OCD research and could enable computationally rigorous and neurally valid understanding of decision-making and its pathological expression in OCD and other disorders.
Highlights
Making decisions promptly and accurately is fundamental to adaptive functioning
Doubt is a prominent feature in many patients with obsessive-compulsive disorder (OCD), in whom doubt has been described as an inability to “experience a sense of conviction”, to put closure on experience, or to generate the normal “feeling of knowing” [2,3]
The studies presented in this paper describe the development of a measure of doubt and address the hypotheses that a) individuals vary along a cognitive dimension, doubt; b) this dimension is relatable to the computational parameters that describe how external evidence is accumulated for decision-making under uncertainty; and c) extremes on this dimension are observed in patients with OCD
Summary
Making decisions promptly and accurately is fundamental to adaptive functioning. Individual differences in this ability may reflect differences in underlying physiological processes and related cognitive traits, and in extreme cases may give rise to specific psychopathology. Doubt has been described as a lack of subjective certainty about, and confidence in, one’s perceptions and internal states [1]. Several studies have found that OCD is associated with lack of confidence in one’s own memory, attention, and perception [4,5,6], and studies using cognitive assessment have found that individuals with OCD or high compulsivity require more time and experience more uncertainty in decision-making tasks [7, 8]. It has been proposed that the lack of certainty when assimilating information contributes to decisionmaking difficulties experienced by many individuals with OCD [12]
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