Neural Mechanisms of Compulsive Hoarding

描述（由申请人提供）：强迫性囤积症是一种常见的、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。虽然一个认知行为模式的强迫囤积正在出现，迄今为止，很少有研究已经检查了这种综合征的神经生物学方面。本研究的目的是：（1）扩展我们先前的研究结果，即强迫性囤积的行为监控功能障碍，其中前扣带皮层（ACC）在做出丢弃物品的决定时产生错误的错误信号。这一预测与新兴的囤积认知行为模型相一致，其理论基础是，这些错误的错误信号被体验为感觉事情"不对劲"，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)扩展我们先前的研究结果，即强迫性囤积与症状激发时额叶-纹状体回路的过度活跃有关。认知行为模型还表明，囤积者对自己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)阐明前扣带回动作监测功能障碍与囤积的现象学指标如"不正确的经历"和对物体的情感依恋之间的关系。为了验证所观察到的激活模式，我们将神经激活与决策缺陷的主观和行为指标相关联。(4)在一项新的唤起性囤积相关症状激发任务中，研究强迫性囤积和对照组参与者的功能连接。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.