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Understanding Obsessive–Compulsive Disorder: Focus on Decision Making

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Current approaches to obsessive-compulsive disorder (OCD) have suggested that neurobiological abnormalities play a crucial role in the etiology and course of this psychiatric illness. In particular, a fronto-subcortical circuit, including the orbitofrontal cortex, basal ganglia and thalamus appears to be involved in the expression of OCD symptoms. Neuropsychological studies have also shown that patients with OCD show deficits in cognitive abilities that are strictly linked to the functioning of the frontal lobe and its related fronto-subcortical structures, such as executive functioning deficits and insufficient cognitive-behavioral flexibility. This article focuses on decision making, an executive ability that plays a crucial role in many real-life situations, whereby individuals choose between pursuing strategies of action that involve only immediate reward and others based on long-term reward. Although the role of decision-making deficits in the evolution of OCD requires further research, the collected findings have significant implications for understanding the clinical and behavioral heterogeneity that characterizes individuals with OCD.

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Acknowledgments

The authors wish to thank Clementina Baraldi, PsyD, Tommaso Bassi, MD, Monica Piccinni PsyD and Claudia Zorzi, MD, at our University, for their hard work on decision-making studies of obsessive–compulsive spectrum disorders and for their invaluable cooperation in discussing this review.

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Authors and Affiliations

  1. San Raffaele Scientific Institute, Department of Neuropsychiatric Sciences, Universitá Vita-Salute San Raffaele, Faculty of Psychology, Milan, Italy

    Paolo Cavedini, Alessandra Gorini & Laura Bellodi

  2. Maastricht University, Department of Psychiatry and Neuropsychology, Maastricht, The Netherlands

    Alessandra Gorini

  3. San Raffaele Hospital Scientific Institute, Department of Neuropsychiatric Sciences, Universitá Vita-Salute San Raffaele, Faculty of Psychology, 20, Via Stamira D’Aneona, 20127, Milan, Italy

    Paolo Cavedini

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  1. Paolo Cavedini
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  2. Alessandra Gorini
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  3. Laura Bellodi
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Correspondence to Paolo Cavedini.

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Cavedini, P., Gorini, A. & Bellodi, L. Understanding Obsessive–Compulsive Disorder: Focus on Decision Making. Neuropsychol Rev 16, 3–15 (2006). https://doi.org/10.1007/s11065-006-9001-y

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