Altered Neural Activity during Negative Reinforcement in People with Obsessive-Compulsive Disorder

Compulsive behaviors in Obsessive-Compulsive Disorder (OCD) are posited to be negatively reinforced via short-term negation of distress-inducing triggers, but neural activity during negative reinforcement in the context of OCD remains poorly understood. In 18 people with OCD and 16 healthy matched comparison subjects completing functional MRI, we tested the effect of a novel negative reinforcement behavioral paradigm. Three visual stimulus types (Compulsion-Related, Negative, Neutral) were displayed in the scanner and removed by participants pressing a button, yielding two analysis epochs: image presentation and image removal. OCD patients showed a larger increase in medial orbitofrontal cortex (mOFC; BA11) activation after image removal that was specific to compulsion-related images. People with OCD also showed altered patterns of deactivation following compulsion-related and negative image removal in the right and left amygdala, respectively. People with OCD also showed larger deactivations in the ventral tegmental area (VTA) after removal of all image types, and increased overall activation to negative images in the right nucleus accumbens (NAcc). We provide initial data demonstrating altered neural activity during negative reinforcement in OCD patients, providing empirical support for dominant behavioral models emphasizing the role of negative reinforcement in etiology and maintenance of pathological compulsive behaviors.