People With OCD Do Not Overvalue Immediate Rewards



People with obsessive-compulsive disorder (OCD) suffer from intrusive, obsessive thoughts. To ease their distress, they often feel compelled to engage in repetitive behaviors, or rituals, in response to these thoughts. For people diagnosed with OCD, performing these elaborate rituals gets in the way of daily functioning. The rituals provide relief in the short term, but they lead to negative consequences in the long term (e.g., lost productivity). Thus, people with OCD are often characterized as being impulsive or lacking in self-control.

But how do they perform in a typical impulsivity task? One hallmark measure of impulsivity is delay discounting—the extent to which people prefer smaller, sooner rewards over larger, later rewards. Delay discounting is measured by having people make a series of choices between smaller amounts of money they could receive today (e.g., $10 now) and larger amounts they could receive after a delay (e.g., $20 in seven days).

Delay discounting is elevated in people with conditions like substance use disorder and borderline personality disorder, where impulsivity is a key symptom. But most prior research on delay discounting in OCD has been inconclusive, with some studies finding that people with OCD have normal delay discounting and others showing that they have higher-than-average delay discounting. These previous studies had small sample sizes and often recruited people with OCD who were being treated with medication (e.g., selective serotonin reuptake inhibitors), thus making it hard to know whether there is truly no effect of OCD on discounting or if the effect is just small and possibly being masked by medication effects.

To address these limitations, I recently collaborated with a global team of OCD researchers from sites in Brazil, India, the Netherlands, South Africa, and the United States to examine whether people with OCD differ from healthy participants in their delay discounting. About 50 people with (unmedicated) OCD and about 50 healthy participants without OCD were recruited from each site, yielding a total sample size of 268 people with OCD and 256 healthy control participants. Great care was taken to harmonize the discounting task across sites. The results were definitive: People with OCD did not differ from healthy participants in their delay discounting.

How do we reconcile this null finding with the reality that people with OCD are unable to resist the urge for immediate relief that their rituals provide them? Well, despite how findings from this task have often been interpreted, the delay discounting task might not actually be measuring the ability to resist immediate gratification. Instead, it might be measuring negative expectations about the future. Indeed, within the OCD group in our study, delay discounting was not associated with either impulsive (e.g., drug use) or compulsive (e.g., hand-washing) behaviors. Instead, it was the people with OCD who were more depressed and anxious who were less willing to wait for delayed rewards. People who are depressed and anxious tend to prefer immediate rewards over delayed ones, probably because they have a pessimistic view of future outcomes.

Taken together, this recent study has two major implications. First, the tendency to prioritize immediate rewards can be more readily attributed to a negative view of the future than an inability to resist temptation. Second, people with OCD can be compulsive without necessarily being impulsive. They may have difficulty resisting the urge to perform rituals, but that doesn’t mean that they cannot find value in pursuing long-term rewards and planning for the future. (In fact, one study in people with obsessive-compulsive personality disorder found that they were more future-oriented than healthy participants.)

The conclusions of this study are strengthened not just by the large, diverse sample, but also by the fact that we controlled for other factors that might influence delay discounting, like age, gender, education, socioeconomic status, and general intelligence. Large-scale collaborative studies like the Global OCD study are speeding up our ability to gain psychological insights, which will help us to better understand decision-making processes and develop more effective treatments for disorders like OCD.


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