Characterizing Decision Styles in OCD: Relationship to Symptom Severity and Behavioral Task Performance

Self-report and behavioral task data have demonstrated alterations in decision-making performance in people with obsessive-compulsive disorder (OCD) relative to non-psychiatric controls (NPCs). However, little work has characterized the phenomenology of cognitive decision styles. Accordingly, we used the Decision Styles Questionnaire (DSQ; Leykin & DeRubeis, 2010) to compare decision styles in 30 people with OCD and 30 NPCs. We then examined the relationship between decision styles and OCD symptom severity as well as decision-making in the context of two behavioral decision-making tasks–the Beads Task and the Balloon Analogue Risk Task (BART). Compared to the NPC group, people with OCD reported more anxiety around decision-making, greater avoidance of decisions, a greater tendency to brood over decisions, more dependence on others and less use of intuition when making decisions, and less confidence in themselves as decision-makers. Greater self-reported anxiety, avoidance, and brooding around decision-making were significantly related to elevated OCD symptom severity, although only the anxious style survived correction for multiple comparisons. Self-reported anxious and respected decision styles were associated with increased risk-aversion and risk-taking on the BART, respectively, although neither relationship survived correction. Higher self-reported decisional anxiety, avoidance, brooding, dependence, and lower confidence were related to greater self-reported distress during the Beads Task, with all relationships aside from self-reported dependence surviving correction. Future work should continue to test how self-reported decision styles relate to decision-making in naturalistic settings and explore whether decision styles may serve as a novel target for intervention.