Obsessive-Compulsive Disorder and Decision Making under Ambiguity: A Systematic Review with Meta-Analysis

In the last decade, decision-making has been proposed to have a central role in obsessive-compulsive disorder (OCD) aetiology, since patients show pathological doubt and an apparent inability to make decisions. Here, we aimed to comprehensively review decision making under ambiguity, as measured by the Iowa Gambling Task (IGT), in OCD, using a meta-analytic approach. According to PRISMA Guidelines, we selected 26 studies for a systematic review and, amongst them, 16 studies were included in a meta-analysis, comprising a total of 846 OCD patients and 763 healthy controls (HC). Our results show that OCD patients perform significantly lower than HC at the IGT, pointing towards the direction of a decision making impairment. In particular, this deficit seems to emerge mainly in the last three blocks of the IGT. IGT scores in OCD patients under the age of 18 were still significantly lower than in HC. Finally, no difference emerged between medicated and unmedicated patients, since they both scored significantly lower at the IGT compared to HC. In conclusion, our results are in line with the hypothesis according to which decision making impairment might represent a potential endophenotype lying between the clinical manifestation of OCD and its neurobiological aetiology.