Jacoby Ryan J, Szkutak Abigail, Shin Jin, Lerner Jennifer, Wilhelm Sabine
Massachusetts General Hospital/Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA.
Teachers College, Columbia University, 422F Thompson Hall, 525 W 120th Street, New York, NY, 10027, USA.
J Obsessive Compuls Relat Disord. 2023 Oct;39. doi: 10.1016/j.jocrd.2023.100842. Epub 2023 Sep 18.
Patients with obsessive compulsive disorder (OCD) present as risk-averse and avoidant of feared stimuli, yet the literature examining risk aversion in OCD is conflicting. One possible explanation is that patients may exhibit aversion only on ambiguous tasks where the likelihood of possible outcomes is unknown. To test this idea, the current study assigned 30 patients with OCD versus 30 non-psychiatric controls (NPC) to conditions of known versus unknown risk (i.e., probabilities) on the Beads Task. Importantly, the task involved real financial stakes. We also examined self-reported intolerance of uncertainty (IU) as a mechanism. Results revealed a significant risk information x group interaction for certainty about the decision. Specifically, while NPCs felt significantly less certain on the unknown risk (versus known risk) task, the OCD group felt uncertain regardless of risk information. Results also revealed a significant main effect of group for distress after deciding, such that the OCD group was more distressed across all task versions compared to NPCs. Elevated trait IU was associated with higher task-related distress. Results indicate that even when patients with OCD are given information about likelihoods, they still feel uncertain and experience distress. Findings have clinical implications for addressing risk aversion and ambiguity/uncertainty in treatment.
强迫症（OCD）患者表现出规避风险并回避恐惧刺激，但研究强迫症中风险规避的文献存在矛盾之处。一种可能的解释是，患者可能仅在可能结果的可能性未知的模糊任务中表现出厌恶。为了验证这一想法，当前研究将30名强迫症患者与30名非精神科对照者（NPC）分配到珠子任务中已知风险与未知风险（即概率）的条件下。重要的是，该任务涉及实际金钱利益。我们还将自我报告的不确定性不耐受（IU）作为一种机制进行了研究。结果显示，在决策的确定性方面，风险信息×组存在显著交互作用。具体而言，虽然NPC在未知风险（与已知风险相比）任务上的确定性显著更低，但强迫症组无论风险信息如何都感到不确定。结果还显示，决策后痛苦程度的组间主效应显著，即与NPC相比，强迫症组在所有任务版本中的痛苦程度都更高。特质IU升高与更高的任务相关痛苦有关。结果表明，即使给强迫症患者提供了关于可能性的信息，他们仍然感到不确定并体验到痛苦。这些发现对于在治疗中解决风险规避和模糊性/不确定性具有临床意义。
