How gambling revealed an OCD breakthrough

Key points:

• Popular depictions of people with OCD in popular culture may mistake OCD-associated behaviours for OCPD or Asperger’s syndrome tendencies

• OCD is commonly associated with a negative stigma about ‘fussy’ or orderly people

• A new study that involved participants ‘betting’ may have revealed that the condition is likely related to a fear of uncertainty rather than a need for order

A new study uncovered a significant breakthrough that is tipped to change the general understanding of what it means to live with obsessive-compulsive disorder — commonly referred to as, simply, ‘OCD.’

The recent findings, published in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, suggest that people with OCD may live with a fear of uncertainty, rather than an obsession with order.

OCD is an anxiety disorder characterised by the need to act on intrusive thoughts, known as compulsions, which may present in the form of repetitive behaviours, such as hand-washing or checking for symmetry — others with the condition may live with mental compulsions, such as counting, praying or repeating thoughts.

If you or someone you love may live with OCD, visit the Disability Support Guide on ‘OCD vs OCPD.’

A team of researchers led by Valerie Voon, PhD, from the University of Cambridge, studied a group of patients with OCD and a group with severe OCD who had undergone a procedure known as ‘capsulotomy,’ which is thought to decrease OCD-related brain activity.

Dr Voon explained that the group of participants with OCD, the group with severe OCD who had the surgical procedure, along with a control group, were tasked with completing a card game.

“We used a simple card gambling task like that commonly used in drinking games,” Dr Voon said.

“Participants faced with an open card simply bet whether they thought the next card would be higher or lower than the open card. At the extremes, with high or low open cards, certainty is high, but uncertainty was much higher with cards near the middle of the deck.”

Researchers used magnetic resonance imaging, or MRI scans, during the card gambling task in which participants made decisions whether to bet that the next card would be greater than the card presented to them.

The study looked at the response time of participants to determine whether people who live with OCD faced a greater degree of difficulty when processing uncertainty. Throughout the trials, researchers noticed a significant difference in the brain activity of those with OCD in the brain’s decision-making areas — the dorsal anterior cingulate cortex and anterior insula.

“Critically, patients with OCD showed slower decision-making, but only when the outcomes were more certain,” Dr Voon explained.

“These impairments appeared in both the OCD patients and those who had improved after capsulotomy surgery — that suggests this cognitive mechanism might be a core feature underlying why OCD develops, irrespective of how severe the symptoms might be.

“The imaging data may provide a representation of how OCD patients might struggle with their symptoms. Whereas healthy individuals might be able to say, ‘this is clean’ and stop cleaning, people with OCD might struggle with that sense of certainty and perhaps spend more time wondering ‘is this still a bit dirty, or is this clean enough,’ and clean further.”

People with OCD are aware of these compulsions and despite feeling the need to act, do not wish to have these thoughts or act on them. OCD can also be a psychosocial disorder and may be eligible for National Disability Insurance Scheme support based on the time-consuming impairment.

Treatment for OCD includes cognitive behavioural therapy and potentially exposure therapy if the onset of the condition is related to a life event that induces anxiety.

Editor of the publication, Cameron Carter, said the work provided an important new perspective on the mechanism underlying the disabling symptoms of OCD.

“[The study] suggests that developing new therapies targeting uncertainty processing in the disorder, as well as the neural systems underlying these processes — such as the dACC and AI — may offer new hope to those suffering from this difficult-to-treat and disabling disorder.”

Do you find it easy to make uncertain decisions? Is your anxiety disorder eligible for NDIS support? Let the team at Talking Disability know your thoughts on psychosocial disability and your lived experience. To read the full study, please visit Elsevier to read in its entirety.