Dysfunctional Reward Circuitry in Obsessive-Compulsive Disorder


      Obsessive-compulsive disorder (OCD) is primarily conceived as an anxiety disorder but has features resembling addictive behavior. Patients with OCD may develop dependency upon compulsive behaviors because of the rewarding effects following reduction of obsession-induced anxiety. Reward processing is critically dependent on ventral striatal-orbitofrontal circuitry and brain imaging studies in OCD have consistently shown abnormal activation within this circuitry. This is the first functional imaging study to investigate explicitly reward circuitry in OCD.


      Brain activity during reward anticipation and receipt was compared between 18 OCD patients and 19 healthy control subjects, using a monetary incentive delay task and functional magnetic resonance imaging. Reward processing was compared between OCD patients with predominantly contamination fear and patients with predominantly high-risk assessment.


      Obsessive-compulsive disorder patients showed attenuated reward anticipation activity in the nucleus accumbens compared with healthy control subjects. Reduced activity of the nucleus accumbens was more pronounced in OCD patients with contamination fear than in patients with high-risk assessment. Brain activity during reward receipt was similar between patients and control subjects. A hint toward more dysfunctional reward processing was found in treatment-resistant OCD patients who subsequently were successfully treated with deep brain stimulation of the nucleus accumbens.


      Obsessive-compulsive disorder patients may be less able to make beneficial choices because of altered nucleus accumbens activation when anticipating rewards. This finding supports the conceptualization of OCD as a disorder of reward processing and behavioral addiction.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Biological Psychiatry
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Ruscio A.M.
        • Stein D.J.
        • Chiu W.T.
        • Kessler R.C.
        The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication.
        Mol Psychiatry. 2010; 15: 53-63
        • Fullana M.A.
        • Mataix-Cols D.
        • Caspi A.
        • Harrington H.
        • Grisham J.R.
        • Moffitt T.E.
        • Poulton R.
        Obsessions and compulsions in the community: Prevalence, interference, help-seeking, developmental stability, and co-occurring psychiatric conditions.
        Am J Psychiatry. 2009; 166: 329-336
        • van den Heuvel O.A.
        • Veltman D.J.
        • Groenewegen H.J.
        • Dolan R.J.
        • Cath D.C.
        • Boellaard R.
        • et al.
        Amygdala activity in obsessive-compulsive disorder with contamination fear: A study with oxygen-15 water positron emission tomography.
        Psychiatry Res. 2004; 132: 225-237
        • Chamberlain S.R.
        • Blackwell A.D.
        • Fineberg N.A.
        • Robbins T.W.
        • Sahakian B.J.
        The neuropsychology of obsessive compulsive disorder: The importance of failures in cognitive and behavioural inhibition as candidate endophenotypic markers.
        Neurosci Biobehav Rev. 2005; 29: 399-419
        • Chamberlain S.R.
        • Menzies L.
        • Hampshire A.
        • Suckling J.
        • Fineberg N.A.
        • del Campo N.
        • et al.
        Orbitofrontal dysfunction in patients with obsessive-compulsive disorder and their unaffected relatives.
        Science. 2008; 321: 421-422
        • Page L.A.
        • Rubia K.
        • Deeley Q.
        • Daly E.
        • Toal F.
        • Mataix-Cols D.
        • et al.
        A functional magnetic resonance imaging study of inhibitory control in obsessive-compulsive disorder.
        Psychiatry Res. 2009; 174: 202-209
        • Denys D.
        • Zohar J.
        • Westenberg H.G.
        The role of dopamine in obsessive-compulsive disorder: Preclinical and clinical evidence.
        J Clin Psychiatry. 2004; 65: 11-17
        • Holden C.
        “Behavioral” addictions: Do they exist?.
        Science. 2001; 294: 980-982
        • Denys D.A.
        On Certainty: Studies in Obsessive Compulsive Disorder.
        ([dissertation]) Utrecht University, Amsterdam2004
        • Nielen M.M.
        • den Boer J.A.
        • Smid H.G.
        Patients with obsessive-compulsive disorder are impaired in associative learning based on external feedback.
        Psychol Med. 2009; 39: 1519-1526
        • Tobler P.N.
        • Christopoulos G.I.
        • O'Doherty J.P.
        • Dolan R.J.
        • Schultz W.
        Risk-dependent reward value signal in human prefrontal cortex.
        Proc Natl Acad Sci U S A. 2009; 106: 7185-7190
        • Whiteside S.P.
        • Port J.D.
        • Abramowitz J.S.
        A meta-analysis of functional neuroimaging in obsessive-compulsive disorder.
        Psychiatry Res. 2004; 132: 69-79
        • Denys D.
        • Mantione M.
        • Figee M.
        • van den Munckhof P.
        • Koerselman F.
        • Westenberg H.
        • et al.
        Deep brain stimulation of the nucleus accumbens for treatment-refractory obsessive-compulsive disorder.
        Arch Gen Psychiatry. 2010; 67: 1061-1068
        • Huff W.
        • Lenartz D.
        • Schormann M.
        • Lee S.H.
        • Kuhn J.
        • Koulousakis A.
        • et al.
        Unilateral deep brain stimulation of the nucleus accumbens in patients with treatment-resistant obsessive-compulsive disorder: Outcomes after one year.
        Clin Neurol Neurosurg. 2010; 112: 137-143
        • Sturm V.
        • Lenartz D.
        • Koulousakis A.
        • Treuer H.
        • Herholz K.
        • Klein J.C.
        • Klosterkotter J.
        The nucleus accumbens: A target for deep brain stimulation in obsessive-compulsive- and anxiety-disorders.
        J Chem Neuroanat. 2003; 26: 293-299
        • Knutson B.
        • Fong G.W.
        • Adams C.M.
        • Varner J.L.
        • Hommer D.
        Dissociation of reward anticipation and outcome with event-related fMRI.
        Neuroreport. 2001; 12: 3683-3687
        • Schultz W.
        • Tremblay L.
        • Hollerman J.R.
        Reward processing in primate orbitofrontal cortex and basal ganglia.
        Cereb Cortex. 2000; 10: 272-284
        • Menzies L.
        • Chamberlain S.R.
        • Laird A.R.
        • Thelen S.M.
        • Sahakian B.J.
        • Bullmore E.T.
        Integrating evidence from neuroimaging and neuropsychological studies of obsessive-compulsive disorder: The orbitofronto-striatal model revisited.
        Neurosci Biobehav Rev. 2008; 32: 525-549
        • Mataix-Cols D.
        • Wooderson S.
        • Lawrence N.
        • Brammer M.J.
        • Speckens A.
        • Phillips M.L.
        Distinct neural correlates of washing, checking, and hoarding symptom dimensions in obsessive-compulsive disorder.
        Arch Gen Psychiatry. 2004; 61: 564-576
        • Phillips M.L.
        • Marks I.M.
        • Senior C.
        • Lythgoe D.
        • O’Dwyer A.M.
        • Meehan O.
        • et al.
        A differential neural response in obsessive-compulsive disorder patients with washing compared with checking symptoms to disgust.
        Psychol Med. 2000; 30: 1037-1050
        • Enzi B.
        • de Greck M.
        • Prosch U.
        • Tempelmann C.
        • Northoff G.
        Is our self nothing but reward? Neuronal overlap and distinction between reward and personal relevance and its relation to human personality.
        PLoS One. 2009; 4: e8429
        • Sheehan D.V.
        • Lecrubier Y.
        • Sheehan K.H.
        • Amorim P.
        • Janavs J.
        • Weiller E.
        • et al.
        The Mini-International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10.
        J Clin Psychiatry. 1998; 59: 22-33
        • van Vliet I.M.
        • de Beurs E.
        The mini-international Neuropsychiatric Interview.
        Tijdschr Psychiatr. 2007; 49: 393-397
        • Goodman W.K.
        • Price L.H.
        • Rasmussen S.A.
        • Mazure C.
        • Fleischmann R.L.
        • Hill C.L.
        • et al.
        The Yale-Brown Obsessive Compulsive Scale.
        Arch Gen Psychiatry. 1989; 46: 1006-1011
        • Goodman W.K.
        • Price L.H.
        • Rasmussen S.A.
        • Mazure C.
        • Delgado P.
        • Heninger G.R.
        • Charney D.S.
        The Yale-Brown Obsessive Compulsive Scale.
        Arch Gen Psychiatry. 1989; 46: 1012-1016
        • Hamilton M.
        A rating scale for depression.
        J Neurol Neurosurg Psychiatry. 1960; 23: 56-62
        • van Hell H.H.
        • Vink M.
        • Ossewaarde L.
        • Jager G.
        • Kahn R.S.
        • Ramsey N.F.
        Chronic effects of cannabis use on the human reward system: An fMRI study.
        Eur Neuropsychopharmacol. 2010; 20: 153-163
        • Fiorillo C.D.
        • Tobler P.N.
        • Schultz W.
        Discrete coding of reward probability and uncertainty by dopamine neurons.
        Science. 2003; 299: 1898-1902
        • Knutson B.
        • Adams C.M.
        • Fong G.W.
        • Hommer D.
        Anticipation of increasing monetary reward selectively recruits nucleus accumbens.
        J Neurosci. 2001; 21: RC159
        • van Gelderen P.
        • Ramsey N.F.
        • Liu G.
        • Duyn J.H.
        • Frank J.A.
        • Weinberger D.R.
        • Moonen C.T.
        Three-dimensional functional magnetic resonance imaging of human brain on a clinical 1.5-T scanner.
        Proc Natl Acad Sci U S A. 1995; 92: 6906-6910
        • Worsley K.J.
        • Liao C.H.
        • Aston J.
        • Petre V.
        • Duncan G.H.
        • Morales F.
        • Evans A.C.
        A general statistical analysis for fMRI data.
        Neuroimage. 2002; 15: 1-15
        • Kiebel S.J.
        • Poline J.B.
        • Friston K.J.
        • Holmes A.P.
        • Worsley K.J.
        Robust smoothness estimation in statistical parametric maps using standardized residuals from the general linear model.
        Neuroimage. 1999; 10: 756-766
        • Remijnse P.L.
        • Nielen M.M.
        • van Balkom A.J.
        • Cath D.C.
        • van Oppen P.
        • Uylings H.B.
        • Veltman D.J.
        Reduced orbitofrontal-striatal activity on a reversal learning task in obsessive-compulsive disorder.
        Arch Gen Psychiatry. 2006; 63: 1225-1236
        • Rauch S.L.
        • Wedig M.M.
        • Wright C.I.
        • Martis B.
        • McMullin K.G.
        • Shin L.M.
        • et al.
        Functional magnetic resonance imaging study of regional brain activation during implicit sequence learning in obsessive-compulsive disorder.
        Biol Psychiatry. 2007; 61: 330-336
        • Schienle A.
        • Schafer A.
        • Stark R.
        • Walter B.
        • Vaitl D.
        Neural responses of OCD patients towards disorder-relevant, generally disgust-inducing and fear-inducing pictures.
        Int J Psychophysiol. 2005; 57: 69-77
        • Wrase J.
        • Schlagenhauf F.
        • Kienast T.
        • Wustenberg T.
        • Bermpohl F.
        • Kahnt T.
        • et al.
        Dysfunction of reward processing correlates with alcohol craving in detoxified alcoholics.
        Neuroimage. 2007; 35: 787-794
        • Buhler M.
        • Vollstadt-Klein S.
        • Kobiella A.
        • Budde H.
        • Reed L.J.
        • Braus D.F.
        • et al.
        Nicotine dependence is characterized by disordered reward processing in a network driving motivation.
        Biol Psychiatry. 2009; 67: 745-752
        • Martin-Soelch C.
        • Missimer J.
        • Leenders K.L.
        • Schultz W.
        Neural activity related to the processing of increasing monetary reward in smokers and nonsmokers.
        Eur J Neurosci. 2003; 18: 680-688
        • Diekhof E.K.
        • Falkai P.
        • Gruber O.
        Functional neuroimaging of reward processing and decision-making: A review of aberrant motivational and affective processing in addiction and mood disorders.
        Brain Res Rev. 2008; 59: 164-184
        • Mantione M.
        • van de Brink W.
        • Schuurman P.R.
        • Denys D.
        Smoking cessation and weight loss after chronic deep brain stimulation of the nucleus accumbens: Therapeutic and research implications: Case report.
        Neurosurgery. 2010; 66: E218
        • Pizzagalli D.A.
        • Holmes A.J.
        • Dillon D.G.
        • Goetz E.L.
        • Birk J.L.
        • Bogdan R.
        • et al.
        Reduced caudate and nucleus accumbens response to rewards in unmedicated individuals with major depressive disorder.
        Am J Psychiatry. 2009; 166: 702-710
        • Spreckelmeyer K.N.
        • Krach S.
        • Kohls G.
        • Rademacher L.
        • Irmak A.
        • Konrad K.
        • et al.
        Anticipation of monetary and social reward differently activates mesolimbic brain structures in men and women.
        Soc Cogn Affect Neurosci. 2009; 4: 158-165