Ethical sensitivity in obsessive-compulsive disorder and generalized anxiety disorder: The role of reversal learning

Background and objectives In obsessive-compulsive disorder (OCD), amplified moral sensitivity may be related to the orbitofrontal–striatal circuit, which is also critical in reversal learning. This study examined three questions: (1) What aspects of ethical sensitivity is altered in OCD?; (2) What is the relationship between ethical sensitivity and reversal learning?; (3) Are potential alterations in ethical sensitivity and reversal learning present in generalized anxiety disorder (GAD)? Methods Participants were 28 outpatients with OCD, 21 individuals with GAD, and 30 matched healthy controls. Participants received the Ethical Sensitivity Scale Questionnaire (ESSQ), rating scales for clinical symptoms, a reversal learning task, and the Wisconsin Card Sorting Test (WCST). Results We found higher ethical sensitivity scores in OCD compared with healthy controls in the case of generating interpretations and options and identifying the consequences of actions. Individuals with OCD displayed prolonged reaction times on probabilistic errors without shift and final reversal errors. Participants with GAD did not differ from healthy controls on the ESSQ, but they were slower on reversal learning relative to nonpatients. In OCD, reaction time on final reversal errors mediated the relationship between ethical sensitivity and compulsions. WCST performance was intact in OCD and GAD. Limitations Small sample size, limited neuropsychological assessment, self-rating scale for ethical sensitivity. Conclusion Prolonged reaction time at switching reinforcement contingencies is related to increased ethical sensitivity in OCD. Slow affective switching may link ethical sensitivity and compulsions.