Risk judgment in Obsessive–Compulsive Disorder: Testing a dual-systems account

Dual-systems theorists posit distinct modes of reasoning. The intuition system reasons automatically and its processes are unavailable to conscious introspection. The deliberation system reasons effortfully while its processes recruit working memory. The current paper extends the application of such theories to the study of Obsessive–Compulsive Disorder (OCD). Patients with OCD often retain insight into their irrationality, implying dissociable systems of thought: intuition produces obsessions and fears that deliberation observes and attempts (vainly) to inhibit. To test the notion that dual-systems theory can adequately describe OCD, we obtained speeded and unspeeded risk judgments from OCD patients and non-anxious controls in order to quantify the differential effects of intuitive and deliberative reasoning. As predicted, patients deemed negative events to be more likely than controls. Patients also took more time in producing judgments than controls. Furthermore, when forced to respond quickly patients' judgments were more affected than controls'. Although patients did attenuate judgments when given additional time, their estimates never reached the levels of controls’. We infer from these data that patients have genuine difficulty inhibiting their intuitive cognitive system. Our dual-systems perspective is compatible with current theories of the disorder. Similar behavioral tests may prove helpful in better understanding related anxiety disorders.