Background:
Obsessive compulsive disorder (OCD) is a chronic and debilitating disorder characterized by chronic doubt and indecision; yet, decision making as a cognitive construct has received little attention in either the neuropsychological or the neuroimaging studies of OCD. Indeed, the neuropsychological profile of OCD remains poorly defined and further investigations are needed. To date, most studies have been exploratory in nature and not based on theoretical frameworks.
Methods:
A selective review of memory and executive functioning in OCD was conducted using the MEDLINE database, with particular focus on decision making. In addition, the neurobiology of both OCD and decision making was reviewed. Results: OCD, although once believed to be a disorder of memory, is now viewed primarily as a disorder of executive functioning, a view which is strongly supported by findings in neuroimaging. Decision making, although little studied, is emerging as a potential area of dysfunction that warrants further investigation.
Conclusions:
Given the incapacity that results from chronic doubt and indecision in the clinical population, it is surprising that decision making has not received greater consideration in conceptualizing this disorder. We posit a tentative model of OCD that provides a unique perspective of OCD within a decision-making framework. To examine the utility of this model, we propose a multimodal study incorporating functional neuroimaging and neuropsychological assessment in an attempt to dissect the individual stages of decision making in OCD. Understanding the neuroanatomical substrates will lead to the development of new physical and psychological treatments.
