Characterizing a psychiatric symptom dimension related to deficits in goal-directed control

Abstract

Prominent theories suggest that compulsive behaviors, characteristic of obsessive-compulsive disorder and addiction, are driven by shared deficits in goal-directed control, which confers vulnerability for developing rigid habits. However, recent studies have shown that deficient goal-directed control accompanies several disorders, including those without an obvious compulsive element. Reasoning that this lack of clinical specificity might reflect broader issues with psychiatric diagnostic categories, we investigated whether a dimensional approach would better delineate the clinical manifestations of goal-directed deficits. Using large-scale online assessment of psychiatric symptoms and neurocognitive performance in two independent general-population samples, we found that deficits in goal-directed control were most strongly associated with a symptom dimension comprising compulsive behavior and intrusive thought. This association was highly specific when compared to other non-compulsive aspects of psychopathology. These data showcase a powerful new methodology and highlight the potential of a dimensional, biologically-grounded approach to psychiatry research.

DOI: http://dx.doi.org/10.7554/eLife.11305.001

eLife digest

When an individual resists the temptation to stay out late in order to get a good night’s sleep, he or she is exercising what is known as “goal-directed control”. This kind of control allows individuals to regulate their behaviour in a deliberate manner. It is thought that a reduction in goal-directed control may be linked to compulsiveness or compulsivity, a psychological trait that involves excessive repetition of thoughts or actions. Furthermore, evidence shows that goal-directed control is reduced in people with compulsive disorders, such as obsessive-compulsive disorder (or OCD) and drug addiction. However, failures of goal-directed control have also been reported in other mental health conditions that are not linked to compulsivity, such as social anxiety disorder.

The fact that reduced goal-directed control is found across various mental health conditions highlights a core issue in modern psychiatric research and treatment. Mental health conditions are typically defined and diagnosed by their clinical symptoms, not by their underlying psychological traits or biological abnormalities. This makes it difficult to determine the cause of a specific disorder, as its symptoms are often rooted in the same psychological and biological traits seen in other mental health conditions.

To start to tackle this issue, Gillan et al. used a strategy that allowed them to look at compulsivity as a “trans-diagnostic dimension”; that is, as something that exists on a spectrum and is not specific to one disorder but involved in numerous different mental health conditions. Nearly 2,000 people completed an online task that assessed goal-directed control, and filled in questionnaires that measured symptoms of various mental health conditions. Gillan et al. showed that, as expected, people with reduced goal-directed control were generally more compulsive, and that this relationship could be seen in the context of both OCD and other compulsive disorders such as addiction.

Further, by leveraging the efficiency of online data collection to collect such a large sample, Gillan et al. were also able to examine how much different symptoms co-occurred in people. This enabled them to use a statistical technique to pick out three trans-diagnostic dimensions – compulsive behaviour and intrusive thought, anxious-depression and social withdrawal – and found that only the compulsive factor was associated with reduced goal-directed control. In fact, reduced goal-directed control was found to be more closely related to compulsivity than the symptoms of traditional mental health disorders including OCD. These findings show that research into the causes of mental health conditions and perhaps ultimately diagnosis and treatment – all of which have traditionally approached specific disorders in isolation – would benefit greatly from a trans-diagnostic approach.

DOI: http://dx.doi.org/10.7554/eLife.11305.002