Neural Mechanisms of Compulsive Hoarding

描述（由申请人提供）：强迫性囤积是一种常见的、使人衰弱的、难以治疗的综合征，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。尽管强迫性囤积症的认知行为模型正在兴起，但迄今为止，很少有研究从神经生物学角度研究这种综合征。本研究的目的是：(1)扩展我们之前的研究结果，即强迫性囤积行为的行为监测功能障碍，其中前扣带皮层（ACC）在决定丢弃物品时产生错误信号。这一预测与新兴的囤积认知行为模型保持一致，其理论基础是，这些错误的错误信号会让人感觉事情“不太对”，从而导致焦虑加剧，无法解决决策过程，最终降低丢弃的可能性。(2)进一步扩展了我们之前的研究结果，即强迫性囤积与症状激发时额纹状体回路的过度活跃有关。认知行为模型还表明，囤积者对他们的财产有一种夸张的依恋感。当决定丢弃物品时，这种依恋增加了囤积者做出错误决定的感知风险，从而导致回避决策。我们的试验数据表明，这种过度的依恋可能与眶额皮质（OFC）的激活有关。(3)明确前扣带皮层动作监测功能障碍与囤积行为的现象学指标如“不正确体验”和客体情感依恋的关系。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)在一个新颖的、唤起性的囤积相关症状挑衅任务中，研究强迫性囤积和控制性囤积的功能连通性。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激活的时间过程。

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.