Impairment of arbitration between model-based and model-free reinforcement learning in obsessive–compulsive disorder

INTRODUCTION: Obsessive–compulsive disorder (OCD) is characterized by an imbalance between goal-directed and habitual learning systems in behavioral control, but it is unclear whether these impairments are due to a single system abnormality of the goal-directed system or due to an impairment in a separate arbitration mechanism that selects which system controls behavior at each point in time. METHODS: A total of 30 OCD patients and 120 healthy controls performed a 2-choice, 3-stage Markov decision-making paradigm. Reinforcement learning models were used to estimate goal-directed learning (as model-based reinforcement learning) and habitual learning (as model-free reinforcement learning). In general, 29 high Obsessive–Compulsive Inventory-Revised (OCI-R) score controls, 31 low OCI-R score controls, and all 30 OCD patients were selected for the analysis. RESULTS: Obsessive–compulsive disorder (OCD) patients showed less appropriate strategy choices than controls regardless of whether the OCI-R scores in the control subjects were high (p = 0.012) or low (p < 0.001), specifically showing a greater model-free strategy use in task conditions where the model-based strategy was optimal. Furthermore, OCD patients (p = 0.001) and control subjects with high OCI-R scores (H-OCI-R; p = 0.009) both showed greater system switching rather than consistent strategy use in task conditions where model-free use was optimal. CONCLUSION: These findings indicated an impaired arbitration mechanism for flexible adaptation to environmental demands in both OCD patients and healthy individuals reporting high OCI-R scores.