The ventral affective circuit includes the OFC, the ventral striatum (particularly the nucleus accumbens, NAcc) and the thalamus (Figure 5) [16, 135] and is involved in reward-related processes. One process relevant for OCD is reward responsiveness, which refers to the ability to anticipate, represent and respond to rewards (Table 2) and is largely mediated by dopaminergic signaling within the ventral affective circuit. In OCD, compulsions are suggested to function either as rewards or as a means to avoid punishments because they successfully (if maladaptively) diminish some of the anxiety associated with obsessions [136–137]. Reduced sensitivity to rewards and/or exaggerated anticipation of punishments have been proposed to underpin these reward responsiveness alterations [136–137] and can be observed in the clinical phenotype of OCD. For instance, the patient in Case vignette 5 (Table 1) describes a preference for staying at home rather than trying new things; his sensitivity to the potential rewards of trying new things appears to be blunted or at least overshadowed by exaggerated anticipation of potential punishment (feeling bad). Similarly, previous studies have reported clinically significant levels of anhedonia,
