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Related Experiment Video

Updated: Feb 23, 2026

Exploring the Neural Correlates of Cognitive Reappraisal in Obsessive-Compulsive Disorder Using Task-based Functional Magnetic Resonance Imaging
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Value-based decision making under uncertainty in hoarding and obsessive- compulsive disorders.

Helen Pushkarskaya1, David Tolin2, Lital Ruderman1

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Summary

Decision-making difficulties in obsessive-compulsive disorder (OCD) involve inconsistent choices, unlike hoarding disorder (HD). This study reveals distinct cognitive underpinnings for these related conditions.

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Area of Science:

  • Cognitive Neuroscience
  • Behavioral Economics
  • Psychiatry

Background:

  • Decision-making impairments are common in various disorders, including obsessive-compulsive disorder (OCD) and hoarding disorder (HD).
  • Both OCD and HD are clinically associated with indecisiveness and intolerance to uncertainty.
  • Understanding the specific decision-making deficits in these disorders is crucial for targeted interventions.

Purpose of the Study:

  • To investigate and differentiate decision-making patterns in individuals with OCD, HD, comorbid OCD and HD, and healthy controls.
  • To determine if observed clinical similarities in indecisiveness reflect shared or distinct cognitive mechanisms.
  • To explore the fidelity of value-based decision-making in these clinical groups.

Main Methods:

  • A cohort of 19 individuals with OCD, 19 with HD, 19 with comorbid OCD and HD, and 57 healthy controls participated.
  • A validated choice task, based on behavioral economic principles, was employed to assess decision-making.
  • Decision-making patterns were analyzed to evaluate choice consistency and value-based fidelity.

Main Results:

  • Individuals with OCD (with or without comorbid HD) exhibited reduced fidelity in value-based decision-making, indicated by increased choice inconsistency.
  • Individuals with HD performed largely comparably to controls on the laboratory decision-making task.
  • The findings suggest distinct neurocognitive underpinnings for decision-making impairments in OCD and HD, despite clinical overlap.

Conclusions:

  • Decision-making deficits in OCD are linked to impaired value-based processing, leading to inconsistent choices.
  • Hoarding disorder does not appear to share these specific decision-making impairments.
  • Differentiating cognitive mechanisms underlying OCD and HD is essential for advancing our understanding of these distinct clinical syndromes.