Although obsessive-compulsive disorder (OCD) is treatable, studies indicate that individuals with this condition often experience a reduced quality of life compared to those without it. Many find it challenging to reach the same educational and financial milestones as their neurotypical peers.
While obsessive-compulsive disorder (OCD) can be managed effectively, studies have revealed that individuals with OCD generally experience a diminished quality of life compared to neurotypical individuals (Remmerswaal et al., 2016). Many face difficulties in attaining comparable educational achievements and financial security as those without the condition.
In a recent study published in Clinical Psychological Science, researchers proposed that one cognitive aspect might contribute to these challenges: decision-making. In their November 2024 research, Karolina Lempert and her colleagues investigated decision-making processes in people with OCD, concentrating on two key areas: delay discounting and risk tolerance.
The team initially focused on delay discounting, which refers to the human tendency to favor immediate rewards over larger ones that are delayed, even when the latter offers greater benefits. This concept is often associated with impulsivity. Previous research has indicated that individuals who score higher in delay discounting are more prone to issues such as addiction, excessive spending, and lack of physical activity (Amlung et al., 2017; Bartels et al., 2023; MacKillop et al., 2011; McClelland et al., 2016).
Research has also indicated that individuals with OCD tend to exhibit lower risk tolerance—a measure of how prepared someone is to take chances on uncertain outcomes—which complicates decision-making processes in unpredictable situations, according to Lempert.
Lempert and her team posited that individuals with OCD would show a tendency towards high delay discounting and low risk tolerance, which could exacerbate their decision-making difficulties. This situation is akin to the feeling of decision paralysis experienced by neurotypical individuals when faced with an overwhelming array of choices.
To validate their hypothesis, the researchers studied 268 individuals with OCD and 256 without it, sourced from Brazil, India, Netherlands, South Africa, and the United States, none of whom were on medication during the study.
The team conducted 51 trials to test for delay discounting, where participants chose between receiving a smaller sum of money immediately or a larger sum later. For instance, they might be asked to select between $10 now or $25 after 100 days.
After adjusting for variables like sex, age, and education, Lempert and her colleagues discovered no significant differences in delay discounting between participants with OCD and those without. However, within the OCD group, those who also experienced high levels of anxiety showed a stronger preference for immediate rewards compared to those without such coexisting conditions.
“The findings clearly showed that those with OCD and healthy individuals had no notable differences on that specific task and preference, which was somewhat expected to me,” said Lempert in an interview.
She explained that these results challenge the common view that individuals with most psychiatric disorders exhibit heightened levels of delay discounting. If it turns out that only certain conditions impact delay discounting, psychiatric professionals may be able to utilize this information in their diagnostic processes.
“Understanding which symptoms are tied to specific decision-making tendencies will enhance our ability to predict what might occur in an individual’s decision-making,” Lempert noted.
The researchers also conducted 60 trials intended to assess risk aversion. In this part of the study, participants were asked to choose between a guaranteed smaller monetary reward or the chance to win a larger amount through a gamble. For example, a participant might select between guaranteeing $1 or risking a 50% chance of winning $10.
The results showed no significant differences in risk aversion between the OCD participants and the control group, even among those with accompanying anxiety. Previous studies have reported similar findings, but Lempert’s research included a larger and more diverse sample size.
Given that both delay discounting and risk tolerance appeared unaffected in individuals with OCD, Lempert proposed that future research should explore other cognitive and decision-making assessments that might yield more insightful results.
“Understanding these specifics will greatly aid in the development of more tailored interventions going forward,” Lempert added.
