Choosing Spouses and Houses: Impaired Congruence Between Preference and Choice Following Damage to the Ventromedial Prefrontal Cortex

Objective: A well-documented effect of focal ventromedial prefrontal cortex (vmPFC) damage is a deficit in real-world decision making. An important aspect of this deficit may be a deficiency in internal consistency during social decision making-that is, impaired congruence between expressed preferences versus actual behavioral choices. An example of low internal consistency would be if one expressed the desire to marry someone with impeccable moral character, yet proceeded to marry someone convicted of multiple felonies. Here, we used a neuropsychological approach to investigate neural correlates of internal consistency in complex decision making. Method: Sixteen individuals with focal vmPFC lesions, 16 brain damage comparison individuals, and 16 normal comparison individuals completed a 3-option forced-choice preference task in which choices were made using attribute sets. Participants also completed visual-analogue preference ratings to indicate how much they liked each option, and rated the influence of each attribute on their decision making. Options were either social (potential spouses) or nonsocial (potential houses). Internal consistency for a trial was defined as agreement between the choice and the most positively rated option. Results: A mixed design analysis of variance revealed that internal consistency between choices and preferences derived from summed attribute ratings was significantly lower for the vmPFC group relative to comparison participants, but only in the social condition (p eta(2)=.09), 95% CI [.002, .163]. Conclusions: Internal consistency during social decisions may be deficient in patients with vmPFC damage, leading to a discrepancy between preferences and choices. The vmPFC may provide an important neural mechanism for aligning behavioral choices with expressed preferences. General Scientific Summary This study suggests that persons with vmPFC damage may display poor congruence between their thoughts and actions during social decisions. This raises concerns about their ability to make important life decisions that involve social information (e.g., signing a will).