Decisions, decisions

In patients with hoarding disorder, parts of a decision-making brain circuit are under-activated when dealing with others’ possessions, but over-activated when deciding whether to keep or discard their own things, a National Institute of Mental Health (NIMH)-funded study has found. 

Brain scans of hoarders revealed the abnormal activation in areas of the anterior cingulate cortex and insula known to process error monitoring, weigh the value of things, assess risks, manage unpleasant feelings, and make emotional decisions.

NIMH grantee David Tolin, Ph.D., of Hartford Hospital, Hartford, Conn., and colleagues, report on their functional magnetic resonance imaging (fMRI) study in the August 2012 issue of the journal Archives of General Psychiatry.

"The results of this study reflect an accelerating trend toward finding disturbed regulation of brain systems responsible for various dimensions of behavior that may cut across mental disorders as traditionally defined," said Bruce Cuthbert, Ph.D., director of NIMH's Division of Adult Translational Research.

In this case, the implicated brain areas are hubs of a salience network that weighs the emotional significance of things and regulates emotional responses and states. Hoarding patients' severity of symptoms, self-ratings of indecisiveness, and feeling of things being "not just right" were correlated with the degree of aberrant activity in these hubs. The results add to evidence of impaired decision-making in hoarding disorder and may help to disentangle its brain workings from those of OCD and depression.