Doubt and the decision-making process in obsessive-compulsive disorder

Gerald Nestadt, Vidyulata Kamath, Brion S. Maher, Janice Krasnow, Paul Nestadt, Ying Wang, Arnold Bakker, Jack Samuels

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


The diagnosis of obsessive-compulsive disorder (OCD) is based on the presence of specific symptoms and their consequence in the lives of those that exhibit them. It is likely that these symptoms emerge from a neurocognitive vulnerability in the mental life of the individual which has a basis in neurophysiology. The prominence of doubt/uncertainty/lack of confidence (These terms are used interchangeably in this paper.), in the clinical presentation of many patients suffering from OCD leads to our consideration of the cognitive basis for this phenomenon. In this paper, we propose that OCD emerges from a perturbation in the decision-making process. Specifically, we hypothesize that there is diminished confidence, conviction, or certainty with regard to assimilating the information necessary to reach a decision. Recent advances in the neuroscience of decision-making provide an opportunity to further our understanding of the vulnerability underlying OCD.

Original languageEnglish (US)
Pages (from-to)1-4
Number of pages4
JournalMedical Hypotheses
StatePublished - Nov 1 2016


  • Decision-making
  • Doubt
  • OCD/obsessive-compulsive disorder
  • Uncertainty

ASJC Scopus subject areas

  • General Medicine


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