(PS7-4) Alterations in Self-reported Decision-making Styles Are Related to Symptom Severity and Risk-taking in People with OCD

Behavioral task data have demonstrated deficits in decision-making performance among people with obsessive compulsive disorder (OCD). However, little work has examined the cognitive decision-making styles that underlie these deficits. The Decision Styles Questionnaire (DSQ; Leykin & DeRubeis, 2010) was developed to identify decision-making styles in people with depression and has been administered to a mixed group of people with OCD and hoarding (Siev et al, 2019). However, no work has examined the decision-making styles that specifically characterize OCD. Here, we use the DSQ to compare decision-making styles between people with OCD (n=30) and non-psychiatric controls (n=30) and to examine the relationship between decision-making styles and OCD symptom severity and performance on two tasks measuring decision-making under risk. Decision-making styles were measured using the following 9 DSQ subscales: 7 decision-making subtypes (Intuitive, Spontaneous, Vigilant, Dependent, Anxious, Brooding, Avoidant) and 2 measures of decisional self-esteem (Confident, Respected). OCD symptom severity was measured using the Dimensional Obsessive-Compulsive Scale (DOCS). Participants completed two decision-making tasks: the Balloon Analogue Risk Task (BART; Lejuez et al., 2002) and the Beads Task (Huq et al., 1988). The OCD group scored significantly higher on the Anxious (d=.77, p< .001), Dependent (d=.68, p=.005), Brooding (d=.68, p< .001), and Avoidant (d=.89, p< .001) DSQ subscales, and significantly lower on the Confident (d=.81, p< .001) and Intuitive (d=.61, p< .001) subscales. The Avoidant (r=.45, p=.011), Anxious (r=.52, p=.003), and Brooding (r=.40, p=.029) DSQ subscales were significantly positively correlated with DOCS total score in the OCD group while the Intuitive subscale and DOCS total were significant negatively correlated (r=-.37, p=.044). Within specific OCD symptom dimensions, we found positive correlations between DOCS Harm and the Avoidant (r=.44, p=.015), Anxious (r=.38, p=.039), and Vigilant (r=.43, p=.017) subscales as well as a positive association between DOCS Symmetry and the Brooding subscale (r =.46, p=.01), although these relationships did not remain significant after Benjamini-Hochberg adjustment for multiple comparisons. Within the OCD group we observed no relationship between DSQ subscales and draws to decision on the Beads Task; however, the Respect subscale was positively correlated with number of balloon pumps on the BART (r =.47, p=.009) while the Anxious subscale was negatively correlated with number of pumps (r =-.38 p=.038). Our results indicate robust differences in decision-making styles in people with OCD compared to controls. People with OCD described themselves as more anxious, dependent, brooding (i.e., tendency to reflect on past bad decisions), and avoidant, and as less confident and intuitive, when making decisions. These alterations were related to both symptom severity and to a behavioral measure of risk-taking in the OCD group, suggesting that they may characterize an underlying cognitive mechanism of OCD and may be a useful target for future interventions, as a predictive measure, or as a potential mechanism to track treatment response.