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      Think twice: Impulsivity and decision making in obsessive–compulsive disorder

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          Abstract

          Background and Aims

          Recent studies have challenged the anxiety-avoidance model of obsessive–compulsive disorder (OCD), linking OCD to impulsivity, risky-decision-making and reward-system dysfunction, which can also be found in addiction and might support the conceptualization of OCD as a behavioral addiction. Here, we conducted an exploratory investigation of the behavioral addiction model of OCD by assessing whether OCD patients are more impulsive, have impaired decision-making, and biased probabilistic reasoning, three core dimensions of addiction, in a sample of OCD patients and healthy controls.

          Methods

          We assessed these dimensions on 38 OCD patients and 39 healthy controls with the Barratt Impulsiveness Scale (BIS-11), the Iowa Gambling Task (IGT) and the Beads Task.

          Results

          OCD patients had significantly higher BIS-11 scores than controls, in particular on the cognitive subscales. They performed significantly worse than controls on the IGT preferring immediate reward despite negative future consequences, and did not learn from losses. Finally, OCD patients demonstrated biased probabilistic reasoning as reflected by significantly fewer draws to decision than controls on the Beads Task.

          Conclusions

          OCD patients are more impulsive than controls and demonstrate risky decision-making and biased probabilistic reasoning. These results might suggest that other conceptualizations of OCD, such as the behavioral addiction model, may be more suitable than the anxiety-avoidance one. However, further studies directly comparing OCD and behavioral addiction patients are needed in order to scrutinize this model.

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          Most cited references79

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          Prospect Theory: An Analysis of Decision under Risk

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            Factor structure of the barratt impulsiveness scale

            The purpose of the present study was to revise the Barratt Impulsiveness Scale Version 10 (BIS-10), identify the factor structure of the items among normals, and compare their scores on the revised form (BIS-11) with psychiatric inpatients and prison inmates. The scale was administered to 412 college undergraduates, 248 psychiatric inpatients, and 73 male prison inmates. Exploratory principal components analysis of the items identified six primary factors and three second-order factors. The three second-order factors were labeled Attentional Impulsiveness, Motor Impulsiveness, and Nonplanning Impulsiveness. Two of the three second-order factors identified in the BIS-11 were consistent with those proposed by Barratt (1985), but no cognitive impulsiveness component was identified per se. The results of the present study suggest that the total score of the BIS-11 is an internally consistent measure of impulsiveness and has potential clinical utility for measuring impulsiveness among selected patient and inmate populations.
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              Insensitivity to future consequences following damage to human prefrontal cortex

              Following damage to the ventromedial prefrontal cortex, humans develop a defect in real-life decision-making, which contrasts with otherwise normal intellectual functions. Currently, there is no neuropsychological probe to detect in the laboratory, and the cognitive and neural mechanisms responsible for this defect have resisted explanation. Here, using a novel task which simulates real-life decision-making in the way it factors uncertainty of premises and outcomes, as well as reward and punishment, we find that prefrontal patients, unlike controls, are oblivious to the future consequences of their actions, and seem to be guided by immediate prospects only. This finding offers, for the first time, the possibility of detecting these patients' elusive impairment in the laboratory, measuring it, and investigating its possible causes.
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                Author and article information

                Journal
                jba
                2006
                Journal of Behavioral Addictions
                J Behav Addict
                Akadémiai Kiadó (Budapest )
                2062-5871
                2063-5303
                December 2015
                21 December 2015
                : 4
                : 4
                : 263-272
                Affiliations
                [ 1 ]Department of Neurofarba, University of Florence , Florence, Italy
                [ 2 ]Department of Molecular and Developmental Medicine, University of Siena , Siena, Italy
                [ 3 ]Department of Psychiatry, Academic Medical Center, University of Amsterdam , Amsterdam, the Netherlands
                [ 4 ]Department of Mental Health, University of L’Aquila , L’Aquila, Italy
                Author notes
                [* ]Corresponding author: Giacomo Grassi, MD; Department of Neurofarba, University of Florence, via delle Gore 2H, 50141 Florence, Italy; Phone: 00390557949707; Fax: 0039055794707; E-mail: giacomograssimd@ 123456gmail.com
                Article
                10.1556/2006.4.2015.039
                4712760
                26690621
                3e97bc70-a140-4b4d-accd-958d4ae350dd
                © 2015 Akadémiai Kiadó, Budapest

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and source are credited.

                History
                : 01 July 2015
                : 13 August 2015
                : 12 September 2015
                Page count
                Figures: 2, Tables: 3, Equations: 0, References: 74, Pages: 28
                Funding
                Funding sources: No financial support was received for this study.
                Categories
                Full-Length Report

                Medicine,Psychology,Social & Behavioral Sciences,Clinical Psychology & Psychiatry
                OCD,impulsivity,behavioral addiction,neuroeconomics,decision making,probabilistic reasoning

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