In support of these clinical observations, altered function of the ventral affective circuit has been reported in OCD and linked to OCD symptoms. For instance, increased functional connectivity between the NAcc and other reward circuit regions, including the OFC, during rest has been reported in OCD and this increased connectivity correlated with OCD symptom severity [140–141]. Similarly, studies examining neural activity during experimental paradigms that engage the reward circuit (see Table 2) have reported altered functional connectivity between the NAcc and/or OFC and other reward-related regions during the anticipation of reward and punishment in OCD [141–142]. Several studies have also reported underactivation of the NAcc and OFC during anticipation of reward (but not during anticipation of punishment) and during reward-based decision-making [136, 143–145] as well as poorer performance on reward-based decision-making and reward-learning tasks [146–147]. Impaired generalization of reward but not punishment has also been found in OCD [148]. These findings support the proposal that individuals with OCD have lowered sensitivity to rewards. Yet, findings from other studies support the view that individuals with OCD show enhanced sensitivity to, or
