<p class="first" id="P1">Difficulties in decision making are a core impairment in
a range of disease states.
For instance, both obsessive-compulsive disorder (OCD) and hoarding disorder (HD)
are associated with indecisiveness, inefficient planning, and enhanced uncertainty
intolerance, even in contexts unrelated to their core symptomology. We examined decision-making
patterns in 19 individuals with OCD, 19 individuals with HD, 19 individuals with comorbid
OCD and HD, and 57 individuals from the general population, using a well-validated
choice task grounded in behavioral economic theory. Our results suggest that difficulties
in decision making in individuals with OCD (with or without comorbid HD) are linked
to reduced fidelity of value-based decision making (i.e. increase in inconsistent
choices). In contrast, we find that performance of individuals with HD on our laboratory
task is largely intact. Overall, these results support our hypothesis that decision-making
impairments in OCD and HD, which can appear quite similar clinically, have importantly
different underpinnings. Systematic investigation of different aspects of decision
making, under varying conditions, may shed new light on commonalities between and
distinctions among clinical syndromes.
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