People with OCD do not overestimate immediate rewards

People with obsessive-compulsive disorder (OCD) suffer from intrusive, obsessive thoughts. To relieve distress, they often feel compelled to perform repetitive actions or rituals in response to these thoughts. For people diagnosed with OCD, performing these complex rituals interferes with daily life. Rituals bring relief in the short term, but lead to negative consequences in the long term (for example, loss of performance). Thus, people with OCD are often characterized as impulsive or lacking initiative. self-control.

But how do they cope with a typical impulsive task? One of the hallmarks of impulsivity is delay discounting: The extent to which people prefer smaller and earlier rewards to larger and later rewards. Delay discounting is measured by people making a series of choices between smaller amounts of money they can receive today (e.g., $10 now) and larger amounts they can receive after a delay (e.g., $20 in seven days).

Delay discounting is increased in people with conditions such as substance use disorder and borderline personality disorder, where impulsivity is a key symptom. But most previous studies on delay discounting in OCD have been inconclusive, and some studies have found that people with OCD normal discount for delay and others showing what they have above average delay discounting. These previous studies had small sample sizes and often included people with OCD who were treated with medicine (eg, selective serotonin reuptake inhibitors), making it difficult to determine whether OCD truly does not affect discounting or whether the effect is simply small and perhaps masked by medication.

To address these limitations, I recently collaborated with global team of OCD researchers from sites in Brazil, India, the Netherlands, South Africa, and the United States to examine whether people with OCD differ from healthy participants in their delay discounting. About 50 people with OCD (unmedicated) and about 50 healthy controls were recruited from each site, resulting in a total sample size of 268 people with OCD and 256 healthy controls. Much attention was paid to coordinating the tasks of providing discounts on all sites. The results were conclusive: people with OCD did not differ from healthy participants in their delay discounting.

How can we reconcile this null finding with the reality that people with OCD cannot resist the desire for immediate relief that their rituals provide them? Well, despite how the results of this task are often interpreted, the delay discounting task may not actually measure the ability to resist immediate gratification. Instead, it may measure negative expectations about the future. Indeed, in our study, in the OCD group, delay neglect was not associated with either impulsive (e.g., drug use) or compulsive (e.g., hand-washing) behavior. On the contrary, it was people with OCD who were more depressive And alarming who were less willing to wait for delayed rewards. People who are depressed and anxious tend to prefer immediate rewards over delayed ones, probably because they have a pessimistic view of future outcomes.

Taken together, this recent study has two main implications. First, the tendency to prioritize immediate rewards is more likely to be explained by a negative outlook on the future than by an inability to resist temptation. Second, people with OCD may be compulsive, but not necessarily impulsive. They may find it difficult to resist the urge to perform rituals, but that doesn’t mean they can’t find meaning in pursuing long-term rewards and planning for the future. (Actually, one study in people with obsessive-compulsive disorder personality disorder discovered that they were more more future-oriented than healthy participants.)

The findings of this study are strengthened not only by the large and diverse sample, but also by the fact that we controlled for other factors that may influence delay discounting, such as age, floor, educationsocio-economic status and general intelligence. Large-scale collaborative research, such as the Global OCD Study, is accelerating our ability to generate psychological knowledge that will help us better understand decision making processes and develop more effective treatments for disorders such as OCD.