When faced with a choice between an immediate reward or a greater prize in the future, how do you decide? Decision-making has long been a subject of fascination and study for people with obsessive-compulsive disorder (OCD). Often, it is tied to assumptions about impulsivity and risk tolerance. But, a recent study by the Association for Psychological Science (APS) challenges conventional ideas. It reveals that decision-making in people with OCD may be more similar to neurotypical (referred to as normal) people.
OCD, a condition characterized by persistent, unwanted thoughts and repetitive behaviors, is known to significantly impact quality of life. Many people with OCD face hurdles in achieving financial stability, educational success, and social well-being compared to their neurotypical peers. With these challenges in mind, researchers have sought to understand whether cognitive processes, such as decision-making, contribute to these disparities.
Karolina Lempert along with other researchers examined two key facets of decision-making: delay discounting and risk tolerance. These two measures provide a window into how people prioritize immediate versus delayed discounts and their willingness to risk tolerence in uncertain situations.
Understanding the Measures
Delay discounting refers to the preference for instant gratification over waiting for a larger reward in the future. It’s often used as a proxy for impulsiveness. For example, someone with high delay discounting might choose to receive $10 immediately instead of waiting 100 days for $25. This tendency has been linked to behaviors such as addiction, overspending, and sedentary lifestyles in previous research.
On the other hand, risk tolerance measures a person’s comfort with uncertainty. It gauges how willing someone is to gamble on an outcome with unknown results. Low-risk tolerance often results in hesitation, making decision-making particularly difficult in ambiguous situations. Previous studies have suggested that people with OCD tend to exhibit lower risk tolerance, contributing to what is often described as “decision paralysis.”
Given these patterns, Lempert and her team hypothesized that individuals with OCD would show high delay discounting and low-risk tolerance, making decision-making especially challenging for them.
Research Analysis: Delay Discounting
To test their hypothesis, the researchers studied 268 individuals with OCD and 256 neurotypical participants from around the globe including Brazil, India, the Netherlands, South Africa, and the United States. None of the participants were on medication during the study, ensuring that the results reflected their natural cognitive tendencies.
The team first examined delay discounting through 51 trials. Participants were asked to choose between receiving a smaller sum of money immediately or a larger sum after a delay. For instance, they might decide whether to take $10 immediately or wait 100 days for $25.
The researchers analyzed the data of variables such as age, sex, and education, and found that people with OCD showed similar delay discounting patterns to neurotypical participants. Interestingly, within the OCD group, individuals with cooccurring conditions like anxiety demonstrated a slightly greater preference for immediate rewards. This nuance underscores the role of confounding factors like anxiety in shaping decision-making tendencies.
“It was pretty clear that there was no difference between people with OCD and healthy controls on that task and in that preference. To me, results were actually not much surprising,” Lempert explained.
This finding challenges the assumption that most psychiatric disorders are linked to heightened delay discounting. If delay discounting is only altered in specific conditions, it could become a diagnostic tool for identifying and understanding those disorders.
Research Analysis: Risk Tolerance
Next, the researchers examined risk tolerance through 60 trials. Participants were presented with hypothetical scenarios where they had to choose between a guaranteed smaller reward and a gamble with a higher potential payoff. For example, they might decide whether to accept $1 for certain or take a 50% chance of earning $10.
Lempert noted, “As we discover the exact symptoms linked to specific decision tendencies, we can better predict what to expect from an individual’s decision-making.”
Once again, the researchers found no significant differences between the OCD group and the control group. Even participants with co-occurring anxiety showed similar risk tolerance levels to neurotypical individuals.
Implications and Future Directions
The study’s findings are significant because they disrupt commonly held beliefs about decision-making in OCD. Lempert highlighted the importance of focusing future research efforts on other cognitive processes that may better explain the unique challenges faced by people with OCD.
The diversity of the study sample also adds weight to the findings, as it represents a broader range of cultural and socioeconomic contexts than many earlier studies. This inclusivity enhances the reliability of the results and underscores the importance of examining mental health through a global lens.
A Step Toward Better Understanding
While OCD remains a complex and often debilitating condition, studies like this one pave the way for a deeper understanding of how cognitive processes influence mental health. By challenging assumptions and refining diagnostic tools, researchers can work toward more personalized and effective interventions for people with OCD and other psychiatric conditions.
In the end, the study serves as a reminder that people with OCD are not defined by their struggles with decision-making. Instead, their cognitive processes may mirror those of the general people more closely than we realize. This research offers hope for a future where mental health care is more nuanced, informed, and individualized.