Does disrupting the Orbitofrontal Cortex alter sensitivity to punishment? A potential mechanism of compulsivity

Abnormal orbitofrontal cortex (OFC) activity is one of the most common findings from neuroimaging studies of individuals with compulsive disorders such as substance use disorder and obsessive-compulsive disorder. The nature of this abnormality is complex however, with some studies reporting the OFC to be over-active in compulsive individuals relative to controls, whereas other studies report it being under-active, and a further set of studies reporting OFC abnormality in both directions within the same individuals. The OFC has been implicated in a broad range of cognitive processes such as decision-making and goal-directed action. OFC dysfunction could impair these processes leading to the kinds of cognitive/behavioural deficits observed in individuals with compulsive disorders. One such deficit that could arise as a result of OFC dysfunction is an altered sensitivity to punishment, which is one of the core characteristics displayed by individuals across multiple types of compulsive disorders. It is, therefore, the aim of the current review to assess the evidence implicating the OFC in adaptation to punishment and to attempt to identify the critical factors determining this relationship. We distil from this analysis some guidelines for future studies attempting to determine the precise role of the OFC in punishment.