Planning functioning and impulsiveness in obsessive–compulsive disorder

  • Riccardo Maria Martoni
  • Roberta de FilippisEmail author
  • Stefania Cammino
  • Mattia Giuliani
  • Gaia Risso
  • Maria Cristina Cavallini
  • Laura Bellodi
Original Paper


Planning ability (PA) is a key aspect of cognitive functioning and requires subjects to identify and organise the necessary steps to achieve a goal. Despite the central role of executive dysfunction in patients with obsessive–compulsive disorder (OCD), deficits in PA have been investigated leading to contrasting results. Given these inconsistencies, the main aim of our work is to give a deeper and clearer understanding of PA in OCD patients. Moreover, we are interested in investigating the relationship between PAs and impulsivity traits and other clinical variables. Sixty-eight OCD patients and 68 healthy controls (HCs) matched for sex and age were assessed through the Stocking of Cambridge (SoC), a computerised version of the Tower of London. We examined planning sub-components for each difficulty levels (from 2 to 5 minimum moves). Our results showed that OCD patients needed longer initial thinking time than HCs during the execution of low demanding tasks (i.e. 2 and 3 moves), while the accuracy level between the two groups did not significantly differ. OCD patients required longer initial thinking time also during high demanding tasks (i.e., 4 and 5 moves), but in this case their accuracy was significantly worse than HCs’ one. We did not find any association between impulsivity and PAs. Our results supported the hypothesis that OCD patients were not able to retain in memory the planned sequence and they had to reschedule their movements during the execution. Thus, future studies should deepen the interrelation between working memory and PA to better understand the influence between these two cognitive functions and their interaction with clinical variables in OCD patients.


Planning Obsessive–compulsive disorder (OCD) Cognition Neuropsychology Stocking of Cambridge 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interest.


  1. 1.
    Osterrieth PA (1944) Le test de copie d’une figure complex: contribution a l’etude de la perception et de la memoire. Arch Psychol 30:286–356Google Scholar
  2. 2.
    Delis DC, Kramer JH, Kaplan E, Ober BA (1987) CVLT, california verbal learning test: adult version: manual. Psychological Corporation, New YorkGoogle Scholar
  3. 3.
    Rogers MA, Kasai K, Koji M, Fukuda R, Iwanami A, Nakagome K, Fukuda M, Kato N (2004) Executive and prefrontal dysfunction in unipolar depression: a review of neuropsychological and imaging evidence. Neurosci Res 50(1):1–11CrossRefPubMedGoogle Scholar
  4. 4.
    van Beilen M, Leenders KL (2006) Putamen FDOPA uptake and its relationship tot cognitive functioning in PD. J Neurol Sci 248(1):68–71CrossRefPubMedGoogle Scholar
  5. 5.
    Ressler KJ, Mayberg HS (2007) Targeting abnormal neural circuits in mood and anxiety disorders: from the laboratory to the clinic. Nat Neurosci 10(9):1116–1124CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Bustamante ML, Villarroel J, Francesetti V, Ríos M, Arcos-Burgos M, Jerez S, Iturra P, Solari A, Silva H (2009) Planning in borderline personality disorder: evidence for distinct subpopulations. World J Biol Psychiatry 10(4–2):512–517CrossRefPubMedGoogle Scholar
  7. 7.
    Gvirts HZ, Braw Y, Harari H, Lozin M, Bloch Y, Fefer K, Levkovitz Y (2015) Executive dysfunction in bipolar disorder and borderline personality disorder. Eur Psychiatry 30(8):959–964CrossRefPubMedGoogle Scholar
  8. 8.
    Salcedo-Marin MD, Moreno-Granados JM, Ruiz-Veguilla M, Ferrin M (2013) Evaluation of planning dysfunction in attention deficit hyperactivity disorder and autistic spectrum disorders using the zoo map task. Child Psychiatry Hum Dev 44(1):166–185CrossRefPubMedGoogle Scholar
  9. 9.
    Abramovitch A, Abramowitz JS, Mittelman A (2013) The neuropsychology of adult obsessive-compulsive disorder: a meta-analysis. Clin Psychol Rev 33(8):1163–1171CrossRefPubMedGoogle Scholar
  10. 10.
    Unterrainer JM, Owen AM (2006) Planning and problem solving: from neuropsychology to functional neuroimaging. J Physiol Paris 99(4–6):308–317 (Review) CrossRefPubMedGoogle Scholar
  11. 11.
    Veale DM, Sahakian BJ, Owen AM, Marks IM (1996) Specific cognitive deficits in tests sensitive to frontal lobe dysfunction in obsessive-compulsive disorder. Psychol Med 26(06):1261–1269CrossRefPubMedGoogle Scholar
  12. 12.
    Purcell R, Maruff P, Kyrios M, Pantelis C (1998) Neuropsychological deficits in obsessive-compulsive disorder: a comparison with unipolar depression, panic disorder, and normal controls. Arch Gen Psychiatry 55(5):415–423CrossRefPubMedGoogle Scholar
  13. 13.
    Purcell R, Maruff P, Kyrios M, Pantelis C (1998) Cognitive deficits in obsessive-compulsive disorder on tests of frontal–striatal function. Biol Psychiat 43(5):348–357CrossRefPubMedGoogle Scholar
  14. 14.
    Nedeljkovic M, Kyrios M, Moulding R, Doron G, Wainwright K, Pantelis C, Purcell R, Maruff P (2009) Differences in neuropsychological performance between subtypes of obsessive-compulsive disorder. Aust N Z J Psychiatry 43(3):216–226CrossRefPubMedGoogle Scholar
  15. 15.
    Rajender G, Bhatia MS, Kanwal K, Malhotra S, Singh TB, Chaudhary D (2011) Study of neurocognitive endophenotypes in drug-naïve obsessive-compulsive disorder patients, their first-degree relatives and healthy controls. Acta Psychiatr Scand 124(2):152–161CrossRefPubMedGoogle Scholar
  16. 16.
    Tükel R, Gürvit H, Ertekin BA, Oflaz S, Ertekin E, Baran B, Kalem SA, Kandemir PE, Ozdemiroğlu FA, Atalay F (2012) Neuropsychological function in obsessive-compulsive disorder. Compr Psychiatry 53(2):167–175CrossRefPubMedGoogle Scholar
  17. 17.
    Benzina N, Mallet L, Burguière E, N’Diaye K, Pelissolo A (2016) Cognitive dysfunction in obsessive-compulsive disorder. Curr Psychiatry Rep 18(9):80. doi: 10.1007/s11920-016-0720-3 (Review) CrossRefPubMedGoogle Scholar
  18. 18.
    Mataix-Cols D, Junqué C, Sànchez-Turet M, Vallejo J, Verger K, Barrios M (1999) Neuropsychological functioning in a subclinical obsessive-compulsive sample. Biol Psychiat 45(7):898–904CrossRefPubMedGoogle Scholar
  19. 19.
    Cavedini P, Cisima M, Riboldi G, D’Annucci A, Bellodi L (2001) A neuropsychological study of dissociation in cortical and subcortical functioning in obsessive-compulsive disorder by Tower of Hanoi task. Brain Cogn 46(3):357–363CrossRefPubMedGoogle Scholar
  20. 20.
    Roth RM, Milovan D, Baribeau J, O’Connor K (2005) Neuropsychological functioning in early-and late-onset obsessive-compulsive disorder. J Neuropsychiatr Clin Neurosci 17(2):208–213CrossRefGoogle Scholar
  21. 21.
    Nielen MMA, Den Boer JA (2003) Neuropsychological performance of OCD patients before and after treatment with fluoxetine: evidence for persistent cognitive deficits. Psychol Med 33(05):917–925CrossRefPubMedGoogle Scholar
  22. 22.
    Benatti B, Dell’Osso B, Arici C, Hollander E, Altamura AC (2014) Characterizing impulsivity profile in patients with obsessive-compulsive disorder. Int J Psychiatr Clin Pract 18(3):156–160CrossRefGoogle Scholar
  23. 23.
    Patton JH, Stanford MS (1995) Factor structure of the Barratt impulsiveness scale. J Clin Psychol 51(6):768–774CrossRefPubMedGoogle Scholar
  24. 24.
    Grassi G, Pallanti S, Righi L, Figee M, Mantione M, Denys D, Piccagliani D, Rossi A, Stratta P (2015) Think twice: impulsivity and decision making in obsessive-compulsive disorder. J Behav Addict 4(4):263–272CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Cavedini P, Gorini A, Bellodi L (2006) Understanding obsessive-compulsive disorder: focus on decision making. Neuropsychol Rev 16(1):3–14CrossRefPubMedGoogle Scholar
  26. 26.
    Cavedini P, Zorzi C, Piccini M, Cavallini MC, Bellodi L (2010) Executive dysfunctions in obsessive-compulsive patients and unaffected relatives: searching for a new intermediate phenotype. Biol Psychiat 67(12):1178–1184CrossRefPubMedGoogle Scholar
  27. 27.
    Chamberlain SR, Fineberg NA, Blackwell AD, Clark L, Robbins TW, Sahakian BJ (2007) A neuropsychological comparison of obsessive-compulsive disorder and trichotillomania. Neuropsychologia 45(4):654–662CrossRefPubMedGoogle Scholar
  28. 28.
    Sohn SY, Kang JI, Namkoong K, Kim SJ (2014) Multidimensional measures of impulsivity in obsessive-compulsive disorder: cannot wait and stop. PLoS One 9(11):e111739CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Bickel WK, Jarmolowicz DP, Mueller ET, Gatchalian KM, McClure SM (2012) Are executive function and impulsivity antipodes? A conceptual reconstruction with special reference to addiction. Psychopharmacology 221(3):361–387CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Abramovitch A, McKay D (2016) Behavioral impulsivity in obsessive-compulsive disorder. J Behav Addict 5(3):395–397CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edn-TR. American Psychiatric Publishing, ArlingtonGoogle Scholar
  32. 32.
    Rosario-Campos MC, Miguel EC, Quatrano S, Chacon P, Ferrao Y, Findley D, Katsovich L, Scahill L, King RA, Woody SR, Tolin D, Hollander E, Kano Y, Leckman JF (2006) The dimensional yale-brown obsessive-compulsive scale (DY-BOCS): an instrument for assessing obsessive-compulsive symptom dimensions. Mol Psychiatry 11(5):495–504CrossRefPubMedGoogle Scholar
  33. 33.
    Fossati A, Di Ceglie A, Acquarini E, Barratt ES (2001) Psychometric properties of an Italian version of the Barratt impulsiveness scale-11 (BIS-11) in nonclinical subjects. J Clin Psychol 57(6):815–828CrossRefPubMedGoogle Scholar
  34. 34.
    Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC (1998) The mini-international neuropsychiatric interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59(Suppl 20):22–33PubMedGoogle Scholar
  35. 35.
    Robbins TW, James M, Owen AM, Sahakian BJ, McInnes L, Rabbitt P (1994) Cambridge neuropsychological test automated battery (CANTAB): a factor analytic study of a large sample of normal elderly volunteers. Dement Geriatr Cogn Disord 5(5):266–281CrossRefGoogle Scholar
  36. 36.
    Owen AM, Downes JJ, Sahakian BJ, Polkey CE, Robbins TW (1990) Planning and spatial working memory following frontal lobe lesions in man. Neuropsychologia 28(10):1021–1034CrossRefPubMedGoogle Scholar
  37. 37.
    StatSoft Inc. (2007) STATISTICA (data analysis software system), version 8.0.
  38. 38.
    Welsh MC, Satterlee-Cartmell T, Stine M (1999) Towers of Hanoi and London: contribution of working memory and inhibition to performance. Brain Cogn 41(2):231–242CrossRefPubMedGoogle Scholar
  39. 39.
    Gilhooly KJ, Wynn V, Phillips LH, Della Sala S (2002) Visuo-spatial and verbal working memory in the five-disc Tower of London task: an individual differences approach. Think Reason 8(3):165–178CrossRefGoogle Scholar
  40. 40.
    Cheetham JM, Rahm B, Kaller CP, Unterrainer JM (2012) Visuospatial over verbal demands in predicting Tower of London planning tasks. Br J Psychol 103(1):98–116CrossRefPubMedGoogle Scholar
  41. 41.
    Martoni RM, Salgari G, Galimberti E, Cavallini MC, O’Neill J (2015) Effects of gender and executive function on visuospatial working memory in adult obsessive-compulsive disorder. Eur Arch Psychiatry Clin Neurosci 265(8):707–718CrossRefPubMedGoogle Scholar
  42. 42.
    Henseler I, Gruber O, Reith W, Falkai P (2008) Compensatory hyperactivations as markers of latent working memory dysfunctions in patients with obsessive-compulsive disorder: an fMRI study. J Psychiatry Neurosci 33(3):209–215PubMedPubMedCentralGoogle Scholar
  43. 43.
    de Vries FE, de Wit SJ, Cath DC, van der Werf YD, van der Borden V, van Rossum TB, van Balkom AJ, van der Wee NJ, Veltman DJ, van den Heuvel OA (2014) Compensatory frontoparietal activity during working memory: an endophenotype of obsessive-compulsive disorder. Biol Psychiat 76(11):878–887CrossRefPubMedGoogle Scholar
  44. 44.
    van den Heuvel OA, Veltman DJ, Groenewegen HJ, Cath DC, van Balkom AJ, van Hartskamp J, Barkhof F, van Dyck R (2005) Frontal-striatal dysfunction during planning in obsessive-compulsive disorder. Arch Gen Psychiatry 62(3):301–309CrossRefPubMedGoogle Scholar
  45. 45.
    den Braber A, van’t Ent D, Cath DC, Wagner J, Boomsma DI, de Geus EJC (2010) Brain activation during cognitive planning in twins discordant or concordant for obsessive-compulsive symptoms. Brain 133:3123–3140CrossRefGoogle Scholar
  46. 46.
    Newman SD, Greco JA, Lee D (2009) An fMRI study on the Tower of London: a look at problem structure differences. Brain Res 1286:123–132CrossRefPubMedGoogle Scholar
  47. 47.
    Insel T, Cuthbert B, Garvey M, Heinssen R, Pine DS, Quinn K, Sanislow C, Wang P (2010) Research domain criteria (RDoC): toward a new classification framework for research on mental disorders. Am J Psychiatry 167(7):748–751CrossRefPubMedGoogle Scholar
  48. 48.
    Parker JDA, Bagby RM (1997) Impulsivity in adults: a critical review of measurement approaches. In: Webster CD, Jackson MA (eds) Impulsivity: theory, assessment, and treatment. The Guilford Press, New York, pp 142–157Google Scholar
  49. 49.
    Enticott PG, Ogloff JRP, Bradshaw JI (2006) Associations between laboratory measures of executive inhibitory control and self-reported impulsivity. Personal Individ Differ 41(2):285–294CrossRefGoogle Scholar
  50. 50.
    Cloninger CR (1999) Temperament and character inventory-revised. Center for Psychology of Personality, Washington University, St. LouisGoogle Scholar
  51. 51.
    Grisham JR, Brown TA, Savage CR, Steketee G, Barlow DH (2007) Neuropsychological impairment associated with compulsive hoarding. Behav Res Ther 45:1471–1483CrossRefPubMedGoogle Scholar
  52. 52.
    Grisham JR, Norberg MM, Williamsn AD, Certoma SP, Kadib R (2010) Categorization and cognitive deficits in compulsive hoarding. Behav Res Ther 48:866–887CrossRefPubMedGoogle Scholar
  53. 53.
    Tolin DF, Villavicencio A, Umbach A, Kurtz MM (2011) Neuropsychological functioning in hoarding disorder. Psychiatry Res 189:413–418CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Savage CR, Baer L, Keuthen NJ, Brown HD, Rauch SL, Jenike MA (1999) Organizational strategies mediate nonverbal memory impairment in obsessive-compulsive disorder. Biol Psychiatr 45(7):905–916CrossRefGoogle Scholar
  55. 55.
    Savage CR, Deckersbach T, Wilhelm S, Rauch SL, Baer L, Reid T, Jenike MA (2000) Strategic processing and episodic memory impairment in obsessive compulsive disorder. Neuropsychology 14(1):141–151CrossRefPubMedGoogle Scholar
  56. 56.
    Pinto PS, Iego S, Nunes S, Menezes H, Mastrorosa RS, Oliveira IR, Rosário MC (2011) Influence of specific obsessive-compulsive symptom dimensions on strategic planning in patients with obsessive-compulsive disorder. Rev Bras Psiquiatr 33(1):40–46CrossRefPubMedGoogle Scholar
  57. 57.
    Harkin B, Kessler K (2011) The role of working memory in compulsive checking and OCD: a systematic classification of 58 experimental findings. Clin Psychol Rev 31(6):1004–1021CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Riccardo Maria Martoni
    • 1
  • Roberta de Filippis
    • 1
    Email author
  • Stefania Cammino
    • 1
  • Mattia Giuliani
    • 1
  • Gaia Risso
    • 1
  • Maria Cristina Cavallini
    • 1
  • Laura Bellodi
    • 1
    • 2
  1. 1.Department of Clinical NeurosciencesSan Raffaele Scientific InstituteMilanItaly
  2. 2.Faculty of PsychologyUniversity Vita-Salute San RaffaeleMilanItaly

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