High Obsessive-compulsive Research Articles

Whom are you mad at? Anger and revenge in obsessive-compulsive symptoms during adolescence

Previous research has extensively explored the role of anxiety, disgust, guilt, and shame in obsessive-compulsive (OC) symptoms, but few studies have investigated anger and associated vengeful motivations, especially during adolescence, when OC symptoms typically onset. This is unfortunate as anger is a key human emotion linked to various aspects of behaviour. Our aim was to explore how anger and revenge motivations were associated with the most common OC subtypes in adolescents. Participants were 1035 high school students who completed a battery of questionnaires including the Obsessive-Compulsive Inventory-Child Version, the Children's Depression Inventory, the Transgression-Related Interpersonal Motivations Inventory-18 and the State-Trait Anger Expression Inventory for children and adolescents. Even when accounting for different aspects of anger, TRIMs and depression, trait anger (i.e., a stable tendency to experience anger) was uniquely associated with all types of OC symptoms (doubting/checking, obsessing, and ordering). Unique associations were also found between revenge motivations and doubting/checking and obsessing. Our findings show that adolescents with high OC symptoms may experience not only intense anger, but also vengeful feelings and motivations. Future research should examine how anger, vengeful motivations and OC symptoms co-develop over time. Clinicians should be aware that anger and vengeful motivations can be part of the clinical presentation of OCD, which can inform assessment and treatment.

Action inhibition in individuals with high obsessive-compulsive trait of incompleteness: An ERP study

BackgroundMissing action completion signals are assumed to trigger repetitive behavior and feelings of the action “not being right”. This proposal is based mostly on individual’s self-reports. Here, we investigated the influence of experimentally manipulated action completion experience and the obsessive-compulsive (OC) trait of incompleteness on behavioral and neurophysiological measures of action inhibition. MethodsAction completion was manipulated in an adapted Go/NoGo task, and OC trait incompleteness was assessed in healthy participants. More commission errors and faster responses were expected after missing action completion, especially for individuals with high OC trait incompleteness. The inhibition-related event-related potentials (ERPs) N200 and P300 were also measured. ResultsHigh OC trait incompleteness led to more errors following omitted- and faster responses during commission errors following incongruent outcomes. Furthermore, lower N200 was associated with worse response inhibition, and high OC trait incompleteness was associated with reduced N200, but not reduced P300 amplitude. These findings provide evidence that trait-like feelings of incompleteness may underlie maladaptive action repetition and impaired inhibitory control as observed in OCD.

Obsessive-compulsive symptoms are related to reduced awareness of emotional valence

BackgroundThe Seeking Proxies for Internal States (SPIS) model of OCD asserts that obsessive-compulsive (OC) tendencies are associated with attenuated access to internal states. Here we explore the implications of this model for awareness of emotional valence. MethodsIn Study 1, participants with high and low OC tendencies (n = 30 in each group) rated how they felt while viewing different pictures with positive, neutral, or negative valence taken from the International Affective Picture System. Study 2 replicated Study 1 among non-selected participants (n = 99) that rated positive and negative pictures chosen from the recently developed Basic-Emotions Nencki Affective Picture System. In both studies, mean deviation from norm ratings (of each picture system) served as the primary outcome measure. ResultsStudy 1 showed that high OC participants’ mean deviation score was significantly higher, compared with low OC participants, across positive, neutral, and negative pictures (p=.01). Follow-up analyses revealed that while no group difference emerged for mean valence rating (p=.16), groups differed on the mean standard deviation of ratings within each valence category (p=.002). In Study 2, only OC tendencies, not depressive or anxiety symptoms, were positively correlated with mean deviation from norm ratings (p=.026). Dividing the sample to high and low OC groups based on an OC cutoff score yielded similar group differences to those observed in Study 1 (p<.001). LimitationsAnalog samples and a relative small sample size (Study 1). ConclusionsThis study suggests that OC symptoms are associated with reduced awareness of emotional valence, possibly emanating from a noisier emotional perception.

Obsessive-compulsive tendencies predict seeking proxies for understanding

Background and objectivesThe Seeking Proxies for Internal States (SPIS) model of obsessive-compulsive disorder (OCD) postulates that obsessive-compulsive (OC) individuals have reduced access to their internal states and must therefore seek and rely on external proxies for these states. The present study extended this hypothesis to the feeling of understanding, which had not been examined previously in relation to OCD. MethodsWe presented 148 participants with a computerized task requiring them to read and understand a text on medieval architecture. Participants were randomly assigned to an ongoing feedback condition (comprehension quiz and answers provided after each text segment) or no-feedback condition (quiz and answers provided only at the end). Throughout, participants were offered proxies in the form of “learning aids,” which were unrelated to text comprehension. Participants were divided to high vs. low OC tendencies based on a median split on a measure of OCD symptoms. ResultsAs predicted, lacking feedback on understanding was associated with higher use of proxies and high OC participants used more proxies than low OC participants in the no-feedback condition. Actual understanding, as assessed by comprehension scores, was unrelated to OC tendencies. LimitationsAmong other limitations discussed in the article, our results were obtained on a non-selected sample of students varying on OC tendencies. It would be important to replicate these findings with diagnosed OCD participants as compared to both non-clinical and anxiety disorders control participants. ConclusionsThese findings extend the SPIS model to the domain of understanding and may have important clinical implications.

Attenuation of access to internal states in high obsessive-compulsive individuals might increase susceptibility to false feedback: Evidence from a visuo-motor hand-reaching task

Background and objectivesThe Seeking Proxies for Internal States (SPIS) model of obsessive-compulsive disorder (OCD) posits that obsessive-compulsive (OC) individuals have attenuated access to their internal states. Hence, they seek and rely on proxies, or discernible substitutes for these internal states. In previous studies, participants with high OC tendencies and OCD patients, compared to controls, showed increased reliance on external proxies and were more influenced by false feedback when judging their internal states. This study is the first to examine the effects of false feedback on performance of hand movements in participants with high and low OC tendencies. MethodThirty-four participants with high OC tendencies and 34 participants with low OC tendencies were asked to perform accurate hand reaches without visual feedback in two separate sessions of a computerized hand-reaching task: once after valid feedback training of their hand location and once with false-rotated feedback. We assessed the accuracy and directional adaptation of participants’ reaches. ResultsAs predicted, high OC participants evidenced a larger decrease in their hand positioning accuracy after training with false feedback compared to low OC participants. LimitationsThe generalization of our findings to OCD requires replication with a clinical sample. ConclusionsThese results suggest that in addition to self-perceptions, motor performance of OC individuals is prone to be overly influenced by false feedback, possibly due to attenuated access to proprioceptive cues. These findings may be particularly relevant to understanding the distorted sense of agency in OCD.

High obsessive-compulsive individuals may have attenuated access to internal cues associated with active movement: Evidence from a head repositioning study

Background and objectivesThe Seeking Proxies for Internal States model of OCD posits that obsessive-compulsive (OC) individuals have attenuated access to their internal states. Consequently, they seek and rely on discernible substitutes for these internal states. Previous research has supported these conjectures. Other studies, using a variety of measures, reported a reduced sense of agency (SoA) in OCD. The current study aimed to connect these two bodies of research by focusing on internal signals associated with active movement, which are related to the SoA. We hypothesized that the performance accuracy of high OC participants would be similar for active and passive movements, while that of low OC participants would be higher when the movement is acquired actively. MethodParticipants with high vs. low OC tendencies were asked to reposition their head to a target angle that was acquired actively or passively. This was repeated with eyes blindfolded to evaluate reliance on visual information. Accuracy of repositioning was measured with a cervical range-of-motion device. ResultsAs predicted, while low OC participants presented a significant decrease in their accuracy after passive (compared to active) acquisition, high OC participants' accuracy did not differ between acquisition types. Contrary to our predictions, reliance on vision was similar across groups. LimitationsThe generalization of our findings to OCD requires replication with a clinical sample. ConclusionsThis study implies that high OC individuals have a deficient access to internal cues involved in active movement. This might contribute to their doubt regarding their actions and to their reduced SoA.

A computerized neuropsychological evaluation of cognitive functions in a subclinical obsessive-compulsive sample

Background and objectivesAmple research in obsessive-compulsive disorder (OCD) reveals a moderate degree of underperformance on various neuropsychological tasks. Less is known about neuropsychological function in subclinical obsessive-compulsive (OC) samples. Most analogue OCD studies did not use a comprehensive neuropsychological battery and none utilized a fully computerized battery. To fill this gap in the literature, the present study aimed at assessing cognitive functions in a subclinical OC sample using a validated computerized neuropsychological battery. MethodsInitially, a sample of 165 students completed the Obsessive-Compulsive Inventory-Revised (OCI-R). Using a psychometrically valid methodology, a high OC (HOC, n = 29) and low OC (LOC, n = 29) groups were selected based on scores in the upper and lower quartiles on the OCI-R. The two groups completed the NeuroTrax computerized neuropsychological battery and clinical questionnaires. ResultsAlthough the HOC group underperformed on most outcome measures, controlling for state-anxiety and depression symptoms, no significant differences were found on major domains (i.e., memory, attention, executive functions, processing speed, visuospatial functions, verbal functions, and motor skills), and subdomains. Normalized scores, produced using population norms, indicated that both groups performed within the normative range. LimitationsNot all neuropsychological subdomains were assessed. ConclusionsResults are consistent with the general picture in analogue OC samples, and may be more reliable than paper-pencil testing, given that a full computerized neuropsychological battery minimizes examiner-examinee interactions, and increases timing accuracy. In sum, analogue OC samples, characterized by equivalent symptom severity but high functioning compared to OCD samples, do not present with cognitive deficits.

Can Thought-Action Fusion Be Induced and Alleviated?

This study aims to examine the effects of the induction of thought-action fusion (TAF) on appraisal process, by using an enhanced paradigm which integrates the favourable aspects of Sentence Completion Task (SCT) with Obsessive-Compulsive (OC)-like perseverative reasoning (PR) task. The study also aims to evaluate the effect of psychoeducation (PE) on alleviating the level of TAF-Induction experience. A total of three groups were formed. The first group with high OC traits (47 participants), a second with low OC traits (70 participants) were the two analogue groups; and a third group composed of patients with obsessive compulsive disorder (OCD) (52 participants) were used. For induction of TAF, all participants were asked to construct a causal link between two OC-like feared situations in a perseverative fashion. Later, for alleviation, while half of the participants read psychoeducational information about TAF, the remaining half read information about stress. Appraisal processes regarding TAF-Likelihood and TAF-Morality components were assessed before and after enhanced paradigm, and after PE. With the current methodology, the likelihood component of TAF could be obtained by the induction of experience. PE about TAF appeared to be effective only on TAF-likelihood component when compared to TAF-morality component. Contrary to the expectations, there was no difference between OCD group and the two analogue groups on TAF-Likelihood scores. In addition, also unexpectedly, participants in the analogue group having high OC traits had significantly higher scores on TAF-Morality compared to OCD group. Clinical implications are discussed in the light of literature.

Intentional binding and obsessive-compulsive tendencies: A dissociation between indirect and direct measures of the sense of agency

This study examined whether obsessive-compulsive (OC) tendencies are related to an impaired sense of agency (SoA). We examined agency using both indirect (“implicit”) and direct (“explicit”) measures, aiming to tap into different aspects of the sense of agency. We measured the SoA of participants with high vs. low scores on a measure of OC symptoms indirectly using a task that assesses the intentional binding effect, i.e., the subjective compression of the temporal interval between a voluntary action and its external sensory consequence. We also measured participants' "illusory" SoA using a direct question about their SoA in conditions in which control was objectively absent. As predicted, high OC individuals’ levels of intentional binding were lower, whereas their levels of illusory control were higher than those of low OC individuals. We discuss the contributions of these findings to the understanding of obsessive-compulsive disorder (OCD), stressing the importance of distinguishing between direct and indirect indices of the SoA when studying and/or treating OC individuals.

Individuals with high obsessive-compulsive tendencies or undermined confidence rely more on external proxies to access their internal states

Background and ObjectivesThe Seeking Proxies for Internal States (SPIS) hypothesis predicts that obsessive-compulsive disorder (OCD) is associated with a deficit in subjective convictions, which may lead to a reliance on external substitutes for the perceptions of an individual's internal states. Two well-designed studies were performed for the present work that adopted a false bio-feedback procedure in a muscle tension task to examine the SPIS hypothesis. MethodsThe false bio-feedback paradigm was used to investigate our hypothesis. NeXus-10 Mark II hardware and V2011 BioTrace + software (Mind Media B.V., Herten, Netherlands) were utilized to measure the muscle tension of the flexor carpiulnaris muscle, which characterized the target's internal state. In addition, false EMG changes were recorded and displayed on a computer monitor and were considered external proxies. ResultsStudy 1 demonstrated that the participants with high obsessive-compulsive (OC) tendencies were more affected by the false bio-feedback and exhibited lower confidence in their judgments regarding their muscle tension compared with the participants with low OC tendencies. These findings indicate that subjects with high OC tendencies were more influenced by self-perception effects. In contrast, the subjects in the undermined confidence group in Study 2 were more easily influenced by the false bio-feedback compared with the control group, which suggests that the subjects in the undermined confidence group were more affected by self-perception effects. LimitationsWe did not combine the undermined confidence with OC tendencies or OCD symptoms in our paradigm to investigate their joint effects on self-perception. ConclusionsOur findings provide further evidence that supports the SPIS hypothesis, which indicates that OC tendencies and the confidence in an individual's recognition of internal states appear to have similar effects on the assessment of internal states and reliance on proxies.

How can I know what I'm feeling? Obsessive-compulsive tendencies and induced doubt are related to reduced access to emotional states

Background and objectivePeople's feelings are not always accessible to them, and this might be especially the case for some individuals and in some situations. Based on our model of obsessive-compulsive disorder, we predicted that obsessive-compulsive (OC) tendencies and situationally induced doubt would be associated with decreased access to one's own emotions. MethodsIn the first two studies we examined the relationships between OC tendencies and performance on the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT). In Study 3 we undermined participants' confidence in their ability to accurately assess their own emotions and assessed the effect of this manipulation on MSCEIT performance. ResultsAs predicted, OC tendencies were associated with lower scores on the Experiential area of the MSCEIT, which relies on access to experienced emotions, but not on the Strategic area, which relies on semantic knowledge about emotions. Similarly, undermining participants' confidence in their own emotions reduced their scores on the Experiential, but not on the Strategic area of the MSCEIT. LimitationsThe findings should be replicated with a clinical OCD population and with other measures of emotional experience. ConclusionThese studies suggest that impaired access to emotional states may be caused by doubting those states, that it characterizes people with high OC tendencies, and that it might be a manifestation of a more general difficulty in accessing internal states.

Things happen: Individuals with high obsessive-compulsive tendencies omit agency in their spoken language.

The study examined the prediction that obsessive-compulsive tendencies are related to an attenuated sense of agency (SoA). As most explicit agency judgments are likely to reflect also motivation for and expectation of control, we examined agency in sentence production. Reduced agency can be expressed linguistically by omitting the agent or by using grammatical framings that detach the event from the entity that caused it. We examined the use of agentic language of participants with high vs. low scores on a measure of obsessive-compulsive (OC) symptoms, using structured linguistic tasks in which sentences are elicited in a conversation-like setting. As predicted, high OC individuals produced significantly more non-agentic sentences than low OC individuals, using various linguistic strategies. The results suggest that OC tendencies are related to attenuated SoA. We discuss the implications of these findings for explicating the SoA in OCD and the potential contribution of language analysis for understanding psychopathology.

Clinical Correlates of Hoarding With and Without Comorbid Obsessive-Compulsive Symptoms in a Community Pediatric Sample

We assessed the prevalence and clinical correlates of hoarding, with and without obsessive-compulsive (OC) symptoms, in a community-based pediatric sample. We measured hoarding and OC symptoms using the Toronto Obsessive-Compulsive Scale (TOCS) in 16,718 youth aged 6 to 17 years in the community. We classified participants with high and low symptom counts for hoarding and OC into 4 groups: hoarding+OC; hoarding-only; OC-only; and control (no OC or hoarding symptoms). We compared these 4 groups on parent- or self-reported medical and psychiatric conditions, anxiety symptoms measured with the Child Behavior Checklist (CBCL), and attention-deficit/hyperactivity disorder (ADHD) symptoms measured with the Strengths and Weaknesses of Attention-Deficit/Hyperactivity Disorder Symptoms and Normal Behavior Scale (SWAN). Almost 10% of participants were in the high hoarding group. Of these participants, 40% did not fall into the high OC group. The prevalence of reported psychiatric disorders (e.g., ADHD, autism spectrum disorder, obsessive-compulsive disorder) was greater in the hoarding (hoarding+OC and hoarding-only) and OC groups (hoarding+OC and OC-only) than in the nonhoarding (OC-only and control) and non-OC groups (hoarding-only and control), respectively. ADHD, specifically inattentive, symptoms were more common in the hoarding-only than in the OC-only group while anxiety symptoms were more common in the OC-only than in the hoarding-only group. In a community pediatric sample, hoarding symptoms occurred in both the presence and absence of obsessive-compulsive symptoms. Hoarding symptoms alone had some unique clinical correlates, in particular, more inattentive ADHD symptoms and fewer anxiety symptoms. These findings suggest that hoarding is distinct from OC traits in youth.

Performance monitoring in obsessive–compulsive undergraduates: Effects of task difficulty

Both obsessive–compulsive disorder and subclinical obsessive–compulsive (OC) symptoms seem to be associated with hyperactive error-related brain activity. The current study examined performance monitoring in subjects with subclinical OC symptoms using a new task with different levels of difficulty. Nineteen subjects with high and 18 subjects with low OC characteristics performed a random dot cinematogram (RDC) task with three levels of difficulty. The high and low OC groups did not differ in error-related negativity (ERN), correct-related negativity (CRN) and performance irrespective of task difficulty. The amplitude of the ERN decreased with increasing difficulty whereas the magnitude of CRN did not vary. ERN and CRN approached in size and topography with increasing difficulty, which suggests that errors and correct responses are processed more similarly. These results add to a growing number of studies that fail to replicate hyperactive performance monitoring in individuals with OC symptoms in task with higher difficulty or requiring learning. Together with these findings our results suggest that the relationship between OC symptoms and performance monitoring may be sensitive to type of task and task characteristics and cannot be observed in a RDC that differs from typically used tasks in difficulty and the amount of response-conflict.

Enhanced action tendencies in high versus low obsessive-compulsive symptoms: An event-related potential study

Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by repeated thoughts and behaviors. Inhibitory deficits are presumably related to the onset and maintenance of this disorder. The present study investigated whether obsessive-compulsive (OC) symptoms are related to enhanced response tendencies in reaction to external stimuli. Our goal was to search for direct evidence of an early response preparation process by examining the event-related potential (ERP) component of the readiness potential (RP). An enhanced response tendency might underlie inhibitory deficits in OCD. Response to novel stimuli was studied using a dishabituation paradigm in which a small number of schematic faces (angry or neutral) were presented. An analog sample of healthy subjects was divided into groups of high and low OC levels and high and low trait anxiety levels. The high OC group presented with a greater RP slope gradient that was enhanced under negative valence, compared to the low OC group. No such effect was found in the high versus low trait anxiety groups or in behavioral reaction times (ms). Results support the hypothesis that a stronger readiness for action might characterize subjects with OC symptoms, especially in the presence of threatening stimuli. This finding, specific to OC symptoms and not to anxiety symptoms, may underlie habitual and embodiment tendencies in OCD. This study suggests that early stages of motor preparation might be important to the etiology and maintenance of OC symptoms.

The effect of manipulating task difficulty on error-related negativity in individuals with obsessive-compulsive symptoms

Previous research has found that individuals with obsessive-compulsive (OC) symptoms show larger error-related negativity (ERN) and correct-response negativity (CRN) amplitudes than controls. Task difficulty was manipulated during a flanker task and a probabilistic learning task to determine the effect of difficulty on ERN and CRN amplitudes in those with high or low levels of OC symptoms. Increasing task difficulty during a flanker task attenuated ERN amplitudes and enhanced CRN amplitudes. Although larger ERN amplitudes were found in the high OC group compared to the low OC group during the easy flanker task, this group difference was no longer apparent during the difficult version of the flanker task. Increasing difficulty during the probabilistic learning task had no effect on group differences in ERN or CRN amplitudes. The results of this study suggest that the hyperactive error-monitoring activity associated with OC symptoms depends on the difficulty and type of task performed.

Generalization of Conditioned Fear and Obsessive-Compulsive Traits

Generalization of conditioned fear refers to the transfer of the conditioned fear response to stimuli that resemble the original conditioned stimulus. Overgeneralization of conditioned fear has been associated with panic disorder and generalized anxiety disorder and may be relevant to obsessive-compulsive (OC) symptoms as well. This study represents the first attempt to determine the degree to which individuals with high versus low OC traits over generalize conditioned fear. We hypothesized that the high OC individuals, particularly those characterized by overestimation of threat, would show overgeneralization of conditioned fear compared to controls as measured by behavioral and psychophysiological (fear-potentiated startle) measures. The results of this study show an interaction between the high and low Threat Estimation groups as measured by the Obsessive Beliefs Questionnaire, which suggests that those who have a tendency to overestimate threat show overgeneralization of conditioned fear. This finding suggests that the relation between OC symptoms and overgeneralization of conditioned fear may be specific to the high threat estimation component of OC symptoms.

Obsessive–compulsive tendencies may be associated with attenuated access to internal states: Evidence from a biofeedback-aided muscle tensing task

The present study was motivated by the hypothesis that inputs from internal states in obsessive-compulsive (OC) individuals are attenuated, which could be one source of the pervasive doubting and checking in OCD. Participants who were high or low in OC tendencies were asked to produce specific levels of muscle tension with and without biofeedback, and their accuracy in producing the required muscle tension levels was assessed. As predicted, high OC participants performed more poorly than low OC participants on this task when biofeedback was not available. When biofeedback was provided, the difference between the groups was eliminated, and withdrawing the monitor again reversed this effect. Finally, when given the opportunity, high OC participants were more likely than low OC participants to request biofeedback. These results suggest that doubt in OCD may be grounded in a real and general deficiency in accessing internal states.

Obsessive-compulsive tendencies and undermined confidence are related to reliance on proxies for internal states in a false feedback paradigm

Background and objectives We have previously hypothesized that obsessive-compulsive (OC) tendencies are associated with a general lack of subjective conviction regarding internal states, which leads to compensatory seeking of and reliance on more discernible substitutes (proxies) for these states (Lazarov, A., Dar, R., Oded, Y., & Liberman, N. (2010). Behaviour Research and Therapy, 48, 516–523). This article presents two studies designed to provide further support to this hypothesis by using false biofeedback as a proxy for internal states. Methods In Study 1 we presented high and low OC participants with pre-programmed false feedback showing either increasing or decreasing levels of muscle tension. In Study 2 we presented similar false feedback on level of relaxation to non-selected participants, half of which received instructions that undermined their confidence in their ability to assess their own level of relaxation. Results In Study 1, high OC participants were more affected by false biofeedback when judging their own level of muscle tension than were low OC participants. In Study 2, undermined confidence participants were more affected by false biofeedback when judging their own level of relaxation as compared to control participants. Limitations Our findings are based on a non-clinical, highly functioning, largely female student sample and their generalization to OCD requires replication with a sample of OCD patients. Conclusions These results provide converging evidence for our hypothesis by replicating and extending our previous findings. We discuss the implication of our hypothesis for the understanding and treatment of OCD and outline directions for future research.

Altered cingulate sub-region activation accounts for task-related dissociation in ERN amplitude as a function of obsessive-compulsive symptoms

Larger error-related negativities (ERNs) have been consistently found in obsessive-compulsive disorder (OCD) patients, and are thought to reflect the activities of a hyperactive cortico-striatal circuit during action monitoring. We previously observed that obsessive-compulsive (OC) symptomatic students (non-patients) have larger ERNs during errors in a response competition task, yet smaller ERNs in a reinforcement learning task. The finding of a task-specific dissociation suggests that distinct yet partially overlapping medio-frontal systems underlie the ERN in different tasks, and that OC symptoms are associated with functional differences in these systems. Here, we used EEG source localization to identify why OC symptoms are associated with hyperactive ERNs to errors yet hypoactive ERNs when selecting maladaptive actions. At rest, OC symptomatology predicted greater activity in rostral anterior cingulate cortex (rACC) and lower activity in dorsal anterior cingulate cortex (dACC). When compared to a group with low OC symptom scores, the high OC group had greater rACC reactivity during errors in the response competition task and less deactivation of dACC activity during errors in the reinforcement learning task. The degree of activation in these areas correlated with ERN amplitudes during both tasks in the high OC group, but not in the low group. Interactive anterior cingulate cortex (ACC) systems associated avoidance of maladaptive actions were intact in the high OC group, but were related to poorer performance on a third task: probabilistic reversal learning. These novel findings link both tonic and phasic activities in the ACC to action monitoring alterations, including dissociation in performance deficits, in OC symptomatic participants.