Realism of confidence in obsessive-compulsive checkers

The study examined whether obsessive-compulsive (OC) checkers have reduced confidence in their knowledge. OC checkers were compared with panic disorder (PD) patients and nonpatient controls using a calibration-of-knowledge procedure. Participants completed a general knowledge questionnaire, rated their confidence in each answer, and estimated the total number of correct answers. These responses were converted to 2 measures of confidence relative to performance--over/underconfidence and over/underestimation. OC checkers had lower scores than nonpatients did on both measures, whereas the PD patients did not differ from either group. For the OC checkers, relative confidence was inversely related to the severity of obsessions. The authors speculate that confidence may depend on a confirmation bias in testing hypotheses and that the reduced confidence in OC checkers may reflect a disconfirmation bias in this population.     

Negative priming for obsessive-compulsive checkers and noncheckers

Negative priming--the slowing of a response to an item that was recently ignored--was investigated in three groups: obsessive-compulsive disorder (OCD) checkers, OCD noncheckers, and nonclinical control participants. All groups performed both a standard negative priming task, selecting targets based on a perceptual feature (i.e., color), and a modified negative priming task, selecting targets based on a semantic feature (i.e., referent size). All three groups demonstrated significant negative priming in both tasks, although the negative priming was much larger in the novel, semantic task than in the common, perceptual one. The findings suggest that patients with OCD do not demonstrate impairments in negative priming, contrary to earlier claims (Enright & Beech, 1990, 1993a, 1993b; Enright, Beech, & Claridge, 1995).     

Effects of imaginal exposure to feared disasters in obsessive-compulsive checkers

The combined effects of imaginal exposure to feared catastrophes and in vivo exposure to external stimuli were compared with the effects of in vivo exposure alone in 15 obsessive-compulsives with checking rituals. The first group received 90 min of uninterrupted exposure in imagination, which concentrated mainly on disastrous consequences, followed by 30 min of exposure in vivo to stimuli-situations which triggered rituals. The second group was given 2 hr of exposure in vivo only. Both groups were prevented from performing rituals. Treatment consisted of 10 daily sessions within a 2 week period.Assessments were conducted before and after treatment and at follow-up ranging from 3 months to 2.5 yr with a mean of 11 months. At post-treatment both groups improved considerably and did not differ. But at follow-up those who received imaginal and in vivo exposure maintained their gains, whereas the group who were treated by exposure in vivo alone evidenced partial relapse on four of the six dependent measures. The results tend to indicate that a closer match between a patient's internal fear model and the content of exposure enhances long term treatment efficacy.     

Memory and metamemory in obsessive-compulsive disorder

Studies on the link between checking and memory problems have produced equivocal results regarding a general memory deficit in patients with obsessive-compulsive disorder and subclinical checkers. However, there is clear and consistent evidence that patients with obsessive-compulsive disorder (OCD) show lack of confidence in their memory performance. The purpose of the present study was to investigate memory and metamemory performance (feeling-of-knowing judgments) for neutral and threat-related material in three groups: OCD patients (OCs), subclinical checkers (SCs), and normal controls (NCs). Participants studied a list of neutral and threat word pairs. After an initial cued-recall test, they provided feeling-of-knowing (FOK) judgments for unrecalled word pairs, followed by a recognition test. The results showed that OCs but not SCs were impaired in both recall and recognition compared to NCs. OCs were also less confident about their future memory performance than the other two groups, as reflected in their lower FOK ratings. Moreover, FOK judgments of the OCs were not reliable predictors of their recognition performance. Finally, neither OCs nor SCs showed any evidence of memory bias for threat-relevant information. The results support the idea of a general memory and a metamemory deficit in OCs.     

Memory and memory confidence in obsessive-compulsive disorder

Pathological doubt, often found in individuals with obsessive-compulsive disorder (OCD), has been theoretically linked to memory deficits, but empirical evidence for such deficits has been mixed. In contrast, many studies suggest that individuals with OCD have low confidence in their memories. The present study aimed to build upon previous research by measuring memory accuracy and confidence in OCD using ecologically valid, idiographically-selected stimuli. Individuals with OCD (OCs), anxious controls (ACs), and nonanxious controls (NACs) were exposed to a set of objects that the OCs had identified as safe, unsafe, or neutral. Participants were then asked to recall as many objects as possible and to rate their confidence in each memory. This process was repeated 6 times, using the same stimuli for each trial. Contrary to hypothesis, no group differences emerged in memory accuracy. However, OCs' memory confidence for unsafe objects showed a progressive decline over repeated trials. This pattern was not observed among NACs or ACs. Furthermore, OCs with primary checking reported lower confidence in long-term memory than did OCs without primary checking. These results suggest that when OCs are repeatedly exposed to threat-related stimuli (such as repeated checking), their level of confidence in remembering these stimuli paradoxically decreases.     

Memory deficits in compulsive checkers: replication and extension in a clinical sample

Thirteen checkers and twelve noncheckers, identified on the basis of their responses to the checking subscale of the Maudsley Obsessional-Compulsive Inventory (MOCI; Rachman and Hodgson, 1980), were recruited from a sample of 99 consecutive admissions to the outpatient department of a community mental health center. Consistent with our previous research with nonclinical samples of college students (Sher et al., 1983, 1984), checkers were found to show deficits in memory, especially recall for recently completed actions, compared to noncheckers. This result demonstrates the replicability of our previous findings across different types of samples and implicates deficits in memory for actions as a potentially important determinant of checking behavior. Assessment of spontaneous imagery associated with the anamnestic process suggested that checkers utilized less imagery, especially visual imagery, when recalling biographical information. Additional measures collected at the time of testing indicated that checkers were more neurotic and reported more psychological distress than noncheckers.     

Memory bias in obsessive-compulsive disorder (OCD).

There is a memory bias associated with depression, and good reason to expect a memory bias associated with anxiety. However, the results of studies reported to date have been ambiguous. Accordingly, an experiment was conducted to assess memory for contamination in people with different types of anxiety. Memory for contaminated stimuli among participants who met DSM-IV criteria for obsessive-compulsive disorder (OCD) and indicated a fear of contamination (n = 10) was compared to memory in a group of anxious controls (n = 10), and in undergraduate students (n = 20). Participants were shown 50 objects, 25 of which were contaminated by the experimenter and 25 which were touched but not contaminated. They then completed a neuropsychological memory assessment, after which the participants were asked to recall all of the objects touched by the experimenter. They were then asked to approach each object and to rate their anxiety about touching it. Finally, participants were asked about their perceptions of the cleanliness of each object. The OCD group had better memory for contaminated objects than for clean ones. Neither control group showed such a bias. Neuropsychological test scores indicated that this bias is not the result of differences in general memory ability. The results are discussed in terms of the memory-deficit theory of OCD and of behavioural and cognitive approaches to understanding the role of information processing in fear and anxiety.     

Memory and metamemory for semantic information in obsessive-compulsive disorder

Several studies have been conducted on OCD patients' memory and metamemory performance in episodic tasks. However, there is a clear lack of research addressing these issues for semantic memory (i.e., retrieval of information from long-term memory). Although findings regarding a memory deficit is somewhat equivocal, the empirical evidence clearly demonstrates that OCD patients with primarily checking compulsions show reduced confidence in their memory performance. The purpose of the present study was to investigate memory and metamemory performance of checkers in semantic memory domain. We compared checker OCD patients, non-checker OCD patients and normal controls on their ability to retrieve answers to general knowledge questions with a recall as well as a recognition test. We also investigated prospective (feeling-of-knowing (FOK)) and retrospective (confidence) metamemory judgments. Checker OCs were not poorer in retrieving semantic information from long-term memory. Neither were they less confident about their ability to remember currently unrecallable information in the future (FOK judgments) or about the accuracy of retrieved information (confidence judgments). Moreover, accuracy of metamemory judgments were comparable across groups. Overall, our results revealed that checker OCs do not show a memory or metamemory deficit when semantic memory was concerned, suggesting that any memory and metamemory deficit may be special to recently experienced materials.     

Deficits in set-shifting ability in nonclinical compulsive checkers

Recent studies suggest deficits in set-shifting ability in patients with obsessive-compulsive disorder (OCD) as measured by tasks such as the Wisconsin Card Sorting Test (WCST; Berg, 1948). The present study examined the extent to which these deficits were demonstrated by nonclinical subjects selected on the basis of their checking scores on the Maudsley Obsessional-Compulsive Inventory. A multivariate analysis revealed that frequent checkers performed significantly worse on the WCST than noncheckers, making more total errors and more perseverative errors and requiring more time to complete the test. A follow-up analysis on a subset of the original sample found similar performance deficits in checkers. While the poorer performance of checkers could be statistically accounted for by anxiety during the first administration of the WCST, anxiety could not explain the relationship between checking status and WCST performance at follow-up. Therefore, there does appear to be some relationship between checking status and WCST performance beyond what can be explained by affective variables.     

Level of agency in sub-clinical checking

This study examined cognitive representations of routine action, through the assessment of level of agency, in individuals with sub-clinical checking. The level of agency stems from Action Identification Theory [Vallacher, R. R., Wegner, D. M. (1989). Levels of personal agency: Individual variation in action identification. Journal of Personality and Social Psychology 57, 660-671], which states that how actions are usually identified (based on instrumental aspects or purpose) reflects the predominant accessibility of internal representation (movements executed vs. goal pursued). Furthermore, this framework proposed that altered action regulation is related to low-level of agency (i.e., action identification at an instrumental level). In the current study, the main result indicated that checking symptoms were related to a low-level of agency, that is, individuals with sub-clinical checking identified habitual actions on the basis of instrumental aspects. This seems to indicate that checkers may act with a lack of goal representations. The results are discussed in terms of the role of low-level of agency in checking phenomena and related cognitive dysfunction.     

Cognitive dysfunction in compulsive checkers: Further explorations

Recent evidence suggests a relationship between certain memory deficits and compulsive-checking behavior. The present study explores this relationship in the context of several additional memory capacities not yet investigated. Using the Maudsley Obsessional-Compulsive Inventory and the Everyday Checking Behavior Scale four groups of Ss were identified: (1) frequent checkers, (2) occasional checkers, (3) infrequent checkers and (4) noncheckers. Consistent with previous research, a memory-for-actions task indicated a deficit among compulsive checkers. Furthermore, checking status was found to be negatively related to memory functioning as measured by the Wechsler Memory Scale (WMS) and the Cognitive Failures Questionnaire (CFQ). This memory deficit was most pronounced on the Logical Memory subtest of the WMS. Checkers appear to have difficulty recalling details of meaningfully linked sequences, either presented in narrative form or engaged in personally. Although the reasons for these checking-related deficits are not clear, a complete understanding of checking phenomena will involve an appreciation of the role played by memory deficits.     

Cognitive deficits in compulsive checkers: An exploratory study

Compulsive-checking behavior can be conceptualized as resulting, in part, from a memory failure. In order to determine if memory difficulties are associated with compulsive checking, the performance of college-student checkers were compared with the performance of non-checkers on a number of cognitive tasks hypothesized to be relevant to understanding checking behavior. Using the Checking and Cleaning subscales of the Maudsley Obsessional-Compulsive Inventory, four groups of subjects were identified: (1) Cleaning Checkers (N = 13); (2) Noncleaning Checkers (N = 13); (3) Cleaning Noncheckers (N = 13); and (4) Noncleaning Noncheckers (N = 15). It was hypothesized that the cognitive deficits studied would characterize individuals with cheeking compulsions, but not persons with non-checking compulsions (i.e. Cleaning Noncheckers) or normal controls (i.e. Noncleaning Noncheckers). Compulsive checkers were found to have a poorer memory for prior actions than non-checkers and were also found to underestimate their ability at distinguishing memories of real and imagined events, a process referred to as reality monitoring. Both of these deficits were specific to compulsive checkers and can be viewed as contributing to the likelihood that an individual will engage in checking behavior. If an individual has difficulty in recalling whether an intended action has been executed, they may be inclined to engage in checking behavior to insure the intended action is carried out. Similarly, a tendency to underestimate reality-monitoring ability could result in increased checking behavior as the individual attempts to reduce his/her uncertainty over whether a previous behavior actually occurred or merely was thought to occur. It is concluded that the study of cognitive deficits in compulsive checking is a potentially fruitful avenue for further inquiry.     

Fear of criticism in washers,checkers and phobics

Fear of criticism in patients who manifested specific phobias, washing rituals and checking rituals was investigated. Six items from the Fear Survey Schedule measuring degree of anxiety to criticism were selected for this purpose. Results indicated that both washers and checkers showed more sensitivity to criticism than did phobics, while washers and checkers did not differ significantly. The implications of these findings for treatment are discussed.     

Relationships between anger, symptoms, and cognitive factors in OCD checkers

The purpose of this study was to examine whether individuals diagnosed with obsessive-compulsive disorder (OCD) with primary checking compulsions report higher levels of trait anger and anger expression compared with a student control group, and whether trait anger and anger expression are correlated with specific beliefs and interpretations that are common among individuals who compulsively check. A group of individuals with OCD reporting significant checking compulsions (n=33) and a group of undergraduate students (n=143) completed a questionnaire package that included measures of trait anger and anger expression, as well as measures of obsessive-compulsive symptoms and beliefs. The compulsive checking group reported greater trait anger, though not greater anger expression, than the student control group. Furthermore, beliefs concerning perfectionism and intolerance of uncertainty were positively correlated with anger expression and trait anger among compulsive checkers but not among the student control group. The implications of these findings are discussed in terms of cognitive-behavioural treatments for and models of compulsive checking in OCD.     

Executive function as a function of sub-clinical psychopathy

Some aspects of executive function are thought to be dysfunctional in psychopathic individuals. We administered a small battery of neuropsychological tests (spatial alternation task, object alternation task, and Porteus Maze) to two samples of college students and obtained a measure of psychopathy via a self-report questionnaire. Psychopathic traits were related to the tests of object alternation and Porteus Maze but not to the spatial alternation task. Our results support the hypothesis of orbitofrontal cortex (OFC) dysfunction with sparing of dorsolateral prefrontal cortex (DLPFC) in psychopathy and provide a downward extension of this theory to sub-clinical levels of psychopathy.     

Thought suppression in obsessive-compulsive disorder

Social cognition research has indicated that attempts to suppress thoughts can lead to a paradoxical increase in the frequency of that thought. This phenomenon has been a central component of cognitive-behavioural models of obsessive-compulsive disorder (OCD); however, research has yet to demonstrate deficient thought suppression ability in OCD patients. We examined whether individuals with OCD (OCs) exhibit a deficit in the ability to suppress thoughts. In Experiment 1, attempted thought suppression led to a paradoxical increase in self-reported thoughts for OCs, but not for nonanxious controls (NACs) or anxious controls (ACs). In order to rule out self-report biases, in Experiment 2 we utilized a lexical decision paradigm that measured priming strength of a target word under thought suppression conditions. Results paralleled those of Experiment 1: OCs showed decreased lexical decision latency of the 'suppressed' thought (thought to reflect either increased priming strength or disrupted processing of nonsuppressed thoughts), thus exhibiting a paradoxical effect of thought suppression. This effect was not seen in NACs or ACs. These findings suggest that deficits in cognitive inhibitory processes may underlie the intrusive, repetitive nature of clinical obsessions.     

Psychophysiological responses in obsessive-compulsive patients

Psychophysiological measures (pulse rate and skin conductance) and subjective anxiety ratings were taken in twelve obsessive-compulsive patients, during internal and external stimulation. Five identical assessments were carried out on each patient, prior to any treatment and shortly after the following flooding technique variants: short fantasy, long fantasy, short practice and long practice.Internal and. or external anxiety-provoking stimulation produced significantly, greater autonomie activity than neutral stimulation in almost all measures, before treatment. The difference became less significant or disappeared in some measures after treatment, and in particular after long flooding in practice. The internally elicited arousal by self-induced obsessive imagery was more resistant to change than externally elicited arousal. Heart rate showed the least decrement after treatment. Some prognostic variables are presented.     

Action-monitoring dysfunction in obsessive-compulsive disorder

Evidence suggests that a hyperactive frontal-striatal-thalamic-frontal circuit is associated with the symptoms of obsessive-compulsive disorder (OCD), but there is little agreement about the function of the exaggerated activity. We report electrophysiological evidence suggesting that part of this system monitors events and generates error signals when the events conflict with an individual's internal standards or goals. Nine individuals with OCD and 9 age-, sex-, and education-matched control participants performed a speeded reaction time task. The error-related negativity, an event-related brain potential component that reflects action-monitoring processes, was enhanced in the individuals with OCD. The magnitude of this enhancement correlated with symptom severity. Dipole modeling suggested that the locus of the enhancement corresponded to medial frontal regions, possibly the anterior cingulate cortex.