Background
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.
Methods
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.
Results
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.
Conclusions
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
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Article info
Publication history
Published online: January 28, 2011
Accepted:
December 8,
2010
Received in revised form:
December 8,
2010
Received:
June 8,
2010
Footnotes
Authors MF and MV contributed equally to this work.
Identification
Copyright
© 2011 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
