AN INVESTIGATION INTO THE PHENOMENOLOGY OF REWARD AND HABIT IN OCD: LOOKING FOR SOCIODEMOGRAPHIC AND CLINICAL CORRELATES

Introduction Emerging neurobiological evidence suggests that the boundaries between compulsive symptoms in obsessive-compulsive disorder (OCD) and both addictive and habitual behaviors may not be impervious as previously though. For instance, attenuated activity in the nucleus accumbens during reward anticipation in OCD patients compared with healthy controls has been reported. 1 This effect was most pronounced in patients with contamination fears. 1 There is also evidence of an increased tendency to form both avoidance and “rewarding” habits in OCD, leading to the hypothesis that OCD compulsions are in fact overlearned habits. 2 Nevertheless, we are not aware of any phenomenological study attempting to investigate to contribution of reward and/or habit processes to compulsive behaviors in OCD and whether they are associated to any specific sociodemographic or clinical correlates. Methods To help filling this gap, 73 OCD patients attending a university-based clinic had their most clinically significant compulsive behaviors assessed with (1) the Temporal Impulsive Compulsive Scale (TICS) , a self-report instrument that measures how frequently (from 0=never to 4=always) positive (rewarding) and negative affective states are experienced before, in anticipation, during, and after the OCD patients’ compulsive behavior; and (2) the Self-Report Habit Index (SRHI) a self-report instrument that assesses perceptions of habit strength (including prior behavior, automaticity, and identity expression). Patients were also assessed with a (3) a modified version of the Yale-Brown Obsessive-Compulsive Scale (YBOCS) to measure severity of compulsive symptoms (including avoidance), and (4) the Obsessive-Compulsive Inventory-Revised (OCI-R), to provide severity of symptoms across obsessions, washing, checking, ordering, neutralization and hoarding dimensions. Additional instruments were selected on the basis of whether they were thought to measure other aspects of reward and/or punishment and fear including: (5) the Temporal Experience of Pleasure Scale (TEPS) ; (6) the Behavioral Inhibition/Activation Scales (BIS/BAS) ; (7) the Urgency, Premeditation, Perseverance, Sensation seeking, and Positive Urgency scale (UPPS-p); (8) the Obsessive Beliefs Questionnaire (OBQ-44) ; and (9) the Intolerance of Uncertainty Scale (IUS-12) . Results Reward in anticipation and after the performance of OCD compulsive behaviors in the TICS correlated positively with anticipatory (r=0.25; p=0.03) and consummatory (r=0.28; p=0.02) pleasure in the TEPS, respectively. In terms of symptom content, anticipated reward (i.e., predicted positive affect prior to initiating compulsive behavior as measured on the TICS) correlated positively with severity of washing symptoms (r=0.24; p=0.04) and negatively with checking (r=-.024; p=0.04) and neutralization symptoms (r=0.25; p=0.03). In contrast, habit strength correlated positively with checking (r=0.27; p=0.02), hoarding (r=0.36; p=0.01), and ordering (r=0.29; p=0.13) and negatively with BIS scores (r=-0.26; p=0.03). Conclusions Our preliminary findings suggest that the ability to experience reward in anticipation and after the performance of OCD compulsions may be partially depend on whether patients are able to experience anticipatory and consummatory pleasure in domains other than those related to OCD compulsions. We were also able to confirm the finding that OCD patients with washing symptoms experience greater reward in anticipation of their OCD compulsions. In contrast, the greater the severity of checking, hoarding and ordering, the more habitual features the OCD compulsions tend to display.