title: Doubt and the decision-making process in obsessive-compulsive disorder.
abstract: The diagnosis of obsessive-compulsive disorder (OCD) is based on the presence of specific symptoms and their consequence in the lives of those that exhibit them. It is likely that these symptoms emerge from a neurocognitive vulnerability in the mental life of the individual which has a basis in neurophysiology. The prominence of doubt/uncertainty/lack of confidence (These terms are used interchangeably in this paper.), in the clinical presentation of many patients suffering from OCD leads to our consideration of the cognitive basis for this phenomenon. In this paper, we propose that OCD emerges from a perturbation in the decision-making process. Specifically, we hypothesize that there is diminished confidence, conviction, or certainty with regard to assimilating the information necessary to reach a decision. Recent advances in the neuroscience of decision-making provide an opportunity to further our understanding of the vulnerability underlying OCD.
authors.affiliation: Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD 21205, USA. Electronic address: gnestadt@jhmi.edu.
authors.forename: Gerald
authors.initials: G
authors.lastname: Nestadt
authors.affiliation: Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD 21205, USA.
authors.forename: Vidyulata
authors.initials: V
authors.lastname: Kamath
authors.affiliation: Johns Hopkins University Bloomberg School of Public Health, Department of Mental Health, Baltimore, MD 21205, USA.
authors.forename: Brion S
authors.initials: BS
authors.lastname: Maher
authors.affiliation: Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD 21205, USA.
authors.forename: Janice
authors.initials: J
authors.lastname: Krasnow
authors.affiliation: Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD 21205, USA; Johns Hopkins University Bloomberg School of Public Health, Department of Mental Health, Baltimore, MD 21205, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Nestadt
authors.affiliation: Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD 21205, USA.
authors.forename: Ying
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD 21205, USA.
authors.forename: Arnold
authors.initials: A
authors.lastname: Bakker
authors.affiliation: Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD 21205, USA.
authors.forename: Jack
authors.initials: J
authors.lastname: Samuels
mesh_terms: D001931:Brain Mapping; D003657:Decision Making; D004644:Emotions; D006801:Humans; D008569:Memory Disorders / Q000150:complications; D008959:Models, Neurological; D008962:Models, Theoretical; D009483:Neuropsychological Tests; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000523:psychology*; D035501:Uncertainty
keywords: Decision-making; Doubt; OCD/obsessive-compulsive disorder; Uncertainty