Costly avoidance in pediatric anxiety and OCD - The impact of emotional reactivity and reward sensitivity

A central feature of internalizing mental disorders, such as obsessive-compulsive disorder (OCD) and anxiety disorders, is the avoidance of rewarding situations to prevent the risk of experiencing distressing emotions. Previous research has shown that obsessive and anxious individuals avoid situations where rewards come at the cost of aversive experiences, a phenomenon termed costly avoidance. Costly avoidance has not previously been examined in clinical samples of youths with OCD or anxiety disorders, which is an important gap as these disorders typically onset during the first two decades of life. In this study, treatment-seeking youths with OCD (n = 62) and anxiety disorders (n = 43), and a comparison group of youths without mental disorders (n = 47) performed an approach-avoidance conflict task. Participants selected to face either neutral outcomes or to obtain rewards that co-occurred with aversive images and sounds. Results showed more costly avoidance in the OCD and anxiety disorder groups compared to the non-clinical comparison group, but no differences between the two clinical groups emerged. Trait reward sensitivity and subjective negative emotional reactions to aversive sounds and images were the best individual predictors of costly avoidance. The results of our study show that youths with OCD and anxiety disorders display elevated levels of costly avoidance, which is in line with clinical theories and previous findings in adults with anxiety disorders. We also show that these elevated levels of costly avoidance are best explained by individual differences in reward sensitivity and emotional reactivity, suggesting that sensitivity to appetitive and aversive outcomes might underlie differences in maladaptive costly avoidance.