Specificity of performance monitoring changes in obsessive-compulsive disorder

• Overactive error monitoring is reliably found in obsessive-compulsive disorder (OCD).
• Larger error-related negativity (ERN) in groups with clinical and subclinical OCD.
• Larger ERN suggested as biomarker or endophenotype for OCD.
• Specificity is challenged by findings in anxiety and affective disorders.

Obsessive-compulsive disorder (OCD) is characterized by overactivity in frontal and striatal brain regions, and event-related potential studies have shown increased brain activity during performance monitoring. The error-related negativity (ERN) is a component of the event-related potential that is observed following incorrect responses, and signals the need for behavioral adjustments. ERN enhancements have even been considered as a biomarker or endophenotype of OCD. However over the past years, enhanced ERN amplitudes, although less reliably, were also found in anxiety and affective disorders. These results question the specificity of ERN alterations to OCD. The present review summarizes current findings on performance monitoring and feedback processing in OCD and their relation to behavioral measures. Further, it discusses possible differential mechanisms contributing to amplitude variations in different clinical conditions.