OCD As Aberrant Integration of Uncertainty from Local Goals to Global Goals

Compulsivity is a key feature of obsessive-compulsive disorder (OCD), with compulsions—repetitive, stereotyped behaviors and mental acts meant to relieve distress—often posing significant obstacles to daily function. The last few years have seen increases in compulsive behaviors; yet, the specific mechanisms of compulsions in OCD remain unknown. Previous research holds mixed findings on compulsivity-linked cognitive deficits, and, while many accounts assume compulsions aim to reduce anxiety, most individuals with anxiety do not develop compulsions—suggesting that the anxiety-reduction account is incomplete. A deeper insight into the neural and cognitive mechanisms underpinning compulsions holds immediate potential benefits for improving treatment options for OCD patients. We propose here that one factor in the formation of compulsions is the inability to integrate uncertainty across hierarchical goal levels. Using a predictive inference task with a hierarchical structure relying on local uncertainty reduction (short-term goals) in the service of global uncertainty reduction (long-term goal), we tested local and global learning in OCD patients (n = 20) and healthy age-matched controls (n = 20). Both groups showed the ability to reduce uncertainty locally, learning the statistical structure of the local environment based on observed data; however, only the healthy volunteers showed evidence of integrated learned knowledge at the local level into reducing uncertainty about the higher level of the task hierarchy. We suggest that this indicates a potential mechanism for compulsions that relies on the inability to adaptively prioritize and “toggle” among different local goals in the service of global goals.