title: Neural response in obsessive-compulsive washers depends on individual fit of triggers.
abstract: BACKGROUND
  Patients with obsessive-compulsive disorder (OCD) have highly idiosyncratic triggers. To fully understand which role this idiosyncrasy plays in the neurobiological mechanisms behind OCD, it is necessary to elucidate the impact of individualization regarding the applied investigation methods. This functional magnetic resonance imaging (fMRI) study explores the neural correlates of contamination/washing-related OCD with a highly individualized symptom provocation paradigm. Additionally, it is the first study to directly compare individualized and standardized symptom provocation.
  
  
  METHODS
  Nineteen patients with washing compulsions created individual OCD hierarchies, which later served as instructions to photograph their own individualized stimulus sets. The patients and 19 case-by-case matched healthy controls participated in a symptom provocation fMRI experiment with individualized and standardized stimulus sets created for each patient.
  
  
  RESULTS
  OCD patients compared to healthy controls displayed stronger activation in the basal ganglia (nucleus accumbens, nucleus caudatus, pallidum) for individualized symptom provocation. Using standardized symptom provocation, this group comparison led to stronger activation in the nucleus caudatus. The direct comparison of between-group effects for both symptom provocation approaches revealed stronger activation of the orbitofronto-striatal network for individualized symptom provocation.
  
  
  CONCLUSIONS
  The present study provides insight into the differential impact of individualized and standardized symptom provocation on the orbitofronto-striatal network of OCD washers. Behavioral and neural responses imply a higher symptom-specificity of individualized symptom provocation.
authors: Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen Giessen, Germany ; Bender Institute of Neuroimaging, Justus Liebig University Giessen Giessen, Germany ; Outpatient Clinic for Behavior Therapy, Justus Liebig University Giessen Giessen, Germany.
authors: Ali
authors: A
authors: Baioui
authors: Juliane
authors: J
authors: Pilgramm
authors: Christian J
authors: CJ
authors: Merz
authors: Bertram
authors: B
authors: Walter
authors: Dieter
authors: D
authors: Vaitl
authors: Rudolf
authors: R
authors: Stark
keywords: OCD; basal ganglia; contamination; fMRI; individualization; orbitofronto-striatal network; symptom provocation; washers
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