The OCD Mind: How Anxiety and Reward-Seeking Influence Choices

While obsessive-compulsive disorder (OCD) is treatable, research indicates that individuals with the disorder often experience a lower quality of life compared to neurotypical individuals (Remmerswaal et al., 2016). Many face challenges in reaching the same educational and financial milestones as those without OCD. In a study published in Clinical Psychological Science, researchers proposed that a specific cognitive process may contribute to these challenges: decision making. In their November 2024 study, Karolina Lempert and colleagues investigated decision making in people with OCD, focusing on two key measures: delay discounting and risk tolerance.

Link to Impulsivity and Problematic Behaviors

The researchers first looked at delay discounting, which is the tendency to prefer instant rewards to those you have to wait for, even when the delayed reward is greater. Researchers sometimes describe delay discounting as a measure of impulsiveness. In previous studies, people with higher delay discounting scores were more likely to have problems with addiction, overspending, and sedentary behavior (Amlung et al., 2017; Bartels et al., 2023; MacKillop et al., 2011; McClelland et al., 2016).

Previous studies have also shown that people with OCD tend to have low risk tolerance—a measure of someone’s willingness to gamble on a decision with uncertain outcomes—making it difficult for the person to make a decision when the outcome is unknown, Lempert said.

Lempert and her team hypothesized people with OCD would have high delay discounting and low risk tolerance—making decision making even harder. This is comparable to the strain that a neurotypical person feels when they are presented with many choices and feel unable to decide, also known as decision paralysis.

They examined this theory by studying 268 people with OCD and 256 people without OCD from Brazil, India, Netherlands, South Africa, and the United States. None of the participants were medicated during the study.

The researchers ran 51 trials of a test designed to measure delay discounting. Participants were asked to choose between receiving a smaller amount of money immediately or a larger amount of money later. For example, a person would be asked whether they preferred receiving $10 dollars immediately or $25 in 100 days.

After controlling for factors like sex, age, and education, Lempert and colleagues found people with OCD had similar delay discounting to participants without OCD. There were, however, some differences within the OCD group itself.

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“It was pretty clear that there was no difference between people with OCD and healthy controls on that task and in that preference, which to me, was actually not that surprising,” Lempert said in an interview.

She said these results challenge the notion that in most psychiatric disorders, people struggle with high levels of delay discounting. If it holds true that delay discounting is only altered in certain conditions, then psychiatrists may be able to use its presence to diagnose those disorders.

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“The more that we discover what symptoms exactly are linked to what decision tendencies, we might have a better way of predicting specifically for individuals what we might expect from their decision making,” Lempert said.

The researchers then ran 60 trials of a test designed to measure risk aversion, where participants presented with a hypothetical had to decide whether they would rather be guaranteed to earn a smaller amount of money or whether they would gamble to receive a larger amount of money. For example, a person would be asked whether they wanted $1 for certain or take a gamble with 50 percent odds for earning $10.

They found no significant difference between the participants with OCD and the control subjects, even in those with anxiety. Lempert said previous studies also found this result. Lempert’s study featured a bigger, more diverse sample size than previous research.

“Just knowing those specifics will really help in the future for developing more individualized interventions,” Lempert said.

Source-Eurekalert