Neural Mechanisms of Compulsive Hoarding

描述(申请人提供)：强迫性囤积是一种常见的、衰弱的和治疗抵抗综合征，其特征是过度获取、难以丢弃和过度杂乱，导致明显的损害和健康风险。尽管强迫性囤积的认知-行为模型正在出现，但到目前为止，很少有研究研究这种综合症的神经生物学方面。这项拟议的研究的目的是：(1)扩展我们之前的发现，即强迫性囤积的行为监控功能障碍，即前扣带回(ACC)在做出关于丢弃财产的决定时会产生错误信号。这一预测与新兴的囤积认知-行为模型一致，其理论基础是，这些错误信号被体验为感觉事情“不只是正确的”，导致焦虑增加，无法解决决策过程，最终减少丢弃的可能性。(2)扩展我们之前的发现，即强迫囤积与症状激发期间额叶-纹状体环路的多动有关。认知-行为模型还表明，囤积者会对自己的财产产生一种夸张的依附感。当做出关于丢弃财产的决定时，这种依恋增加了囤积者做出错误决定的感知风险，从而导致避免决策。我们的先导数据表明，这种过度的依恋可能与眼眶额叶皮质(OFC)的激活有关。(3)明确ACC行为监控功能障碍与囤积行为现象学指标如“不只是正确的体验”和对物体的情感依恋之间的关系。为了验证观察到的激活模式，我们将神经激活与决策缺陷的主观和行为指标联系起来。(4)考察强迫囤积症患者的功能连通性，并在一项新的和唤起的囤积症相关症状激发任务中控制被试。我们将使用尖端的数据分析程序来检查相互关联的神经激活模式以及整个决策过程中的激活时间过程。

DESCRIPTION (provided by applicant): Compulsive hoarding is a common, debilitating, and treatment-resistant syndrome characterized by excessive acquisition, difficulty discarding, and excessive clutter leading to marked impairment and health risk. Although a cognitive-behavioral model of compulsive hoarding is emerging, to date few studies have examined the neurobiological aspects of this syndrome. The aims of the proposed study are: (1) To extend our previous findings suggesting a dysfunction in action monitoring for compulsive hoarding, in which the anterior cingulate cortex (ACC) produces false error signals when making decisions about discarding possessions. This prediction, in keeping with the emerging cognitive-behavioral model of hoarding, is based on the theory that these false error signals are experienced as the feeling that things are "not just right," leading to increased anxiety, inability to resolve the decision-making process, and ultimately a decreased likelihood of discarding. (2) To extend our previous findings suggesting that compulsive hoarding is associated with hyperactivity in frontal-striatal circuits during symptom provocation. The cognitive-behavioral model also suggests that hoarders experience an exaggerated sense of attachment to their possessions. When making decisions about discarding possessions, this attachment increases hoarders' perceived risk of making a wrong decision and thus leads to avoidance of decision-making. Our pilot data suggest that this excessive attachment may be related to activation in orbitofrontal cortex (OFC). (3) To clarify the relationship between ACC action-monitoring dysfunction and phenomenological indices of hoarding such as "not just right experiences" and emotional attachment to objects. In order to validate observed activation patterns, we will relate neural activation to subjective and behavioral indices of decision-making deficits. (4) To examine functional connectivity in compulsive hoarding and control participants during a novel and evocative hoarding-related symptom provocation task. We will use cutting-edge data analytic procedures to examine patterns of interrelated neural activation as well as the time course of activation across the decision making process.