The classical cognitive-behavioral theory of obsessive-compulsive disorder (OCD) holds that compulsions are performed to reduce distress that is evoked by obsessions, whereas a recent neuroscience-inspired theory suggests that compulsivity results from a disbalance between goal-directed and habit-related neural networks. To bridge these theories, we investigated whether the balance between goal-directed and habit networks in patients with OCD was affected during psychological distress. Twenty-three OCD patients and twenty-three healthy controls participated in a controlled stress induction paradigm using the socially evaluated cold-pressor test in a crossover design. Stress responses were evaluated through cortisol levels, blood pressure, and anxiety ratings. Functional connectivity of the caudate nucleus and posterior putamen was assessed using seed region analysis of resting-state functional magnetic resonance imaging data, which are hubs of the goal-directed and habit network, respectively. Stress induction increased blood pressure and psychological stress measures across groups and resulted in blunted cortisol responses in patients. Furthermore, patients showed a blunted reduction in connectivity between the caudate nucleus and precuneus during psychological distress, which was positively correlated with compulsivity but not obsession severity. The posterior putamen showed no significant group differences in distress-induced connectivity. These results suggest that compulsivity in OCD is associated with altered connectivity between the goal-directed and default mode networks during psychological distress.

强迫症 (OCD) 的经典认知行为理论认为，强迫症是为了减少由强迫症引起的痛苦，而最近一项受神经科学启发的理论表明，强迫症是由目标导向和习惯相关之间的不平衡引起的神经网络。为了弥合这些理论，我们调查了强迫症患者的目标导向和习惯网络之间的平衡是否在心理困扰期间受到影响。23 名强迫症患者和 23 名健康对照者在交叉设计中使用社会评估的冷加压试验参与了受控压力诱导范式。通过皮质醇水平、血压和焦虑等级评估压力反应。使用静息状态功能磁共振成像数据的种子区域分析评估尾状核和后壳核的功能连通性，这些数据分别是目标导向和习惯网络的中心。压力诱导增加了各组之间的血压和心理压力测量，并导致患者的皮质醇反应减弱。此外，患者在心理困扰期间尾状核和楔前叶之间的连接性减弱，这与强迫症呈正相关，但与强迫症的严重程度无关。后壳核在窘迫引起的连接中没有显示出显着的组间差异。