Why are some obsessions more upsetting than others?

Little is known about why certain obsessional thoughts are more upsetting than others for people with obsessive compulsive disorder (OCD). Obsessional thought content often seems arbitrary to sufferers. The current study examined three possible reasons why particular thoughts would be especially upsetting for individuals, based on suggestions put forth by cognitive theories of obsessional thoughts. Twenty-eight individuals with a principal diagnosis of OCD completed questionnaires and interviews at two different periods of time on (1) their most upsetting current obsession and (2) their least upsetting current obsession. Results suggested that more upsetting obsessions were evaluated as more meaningful or significant than less upsetting obsessions, and more upsetting obsessions contradicted valued aspects of the self to a greater degree. All examples of current obsessions, both most and least upsetting, arose in the context of life concerns or issues. Results support cognitive theories in that the strength and nature of appraisal appears to be linked with the distress associated with a thought, and more upsetting thoughts are those that have implications for a person's sense of self.     

Differences in latent inhibition as a function of the autogenous-reactive OCD subtype

We examined differences in a visual search-based latent inhibition (LI) task in 48 non-treatment seeking individuals diagnosed with obsessive-compulsive disorder (OCD) and 26 non-OCD controls, using a visual search-based LI task as a function of participants’ primary obsessional presentation based on the autogenous-reactive subtype model of obsessions ( [Lee and Telch, 2005] and [Lee and Telch, 2007]). We hypothesized that LI would be significantly attenuated among OCD participants whose primary obsessions were characterized by aversive impulses, images, or thoughts with sexual, aggressive, blasphemous, and repulsive themes (autogenous obsessions) due to their weakened attentional inhibitory mechanisms and elevated schizotypal personality features, as compared with those whose primary obsessions were characterized by somewhat realistic aversive mental intrusions about contamination, mistakes, accidents, or disarray (reactive obsession) and non-OCD controls. Results showed that those primarily displaying autogenous obsessions failed to display LI, whereas those primarily displaying reactive obsessions and non-OCD controls displayed significant LI effects. Our data suggest that the magnitude of LI varies as a function of primary obsessional presentations among individuals with OCD.     

Are prepared fears less severe, but more resistant to treatment?

In order to investigate the relationship between the extent to which clinical fears are prepared and clinically relevant characteristics of these fears (i.e. severity, age of onset and treatment outcome). the records of 63 obsessional and phobic patients were examined. Four independent raters scored the usable records (N = 55) on preparedness. The preparedness scores were combined and related to objective indices of severity (patients' scores on the Fear Survey Schedule, the Zung Depression Scale and the Maudsley Obsessional-Compulsive Inventory, as well as the treatment duration), onset ages and treatment outcomes (pre-treatment minus post-treatment MOCI scores, for a subsample of obsessional patients only). In contrast to earlier studies, it was found that product-moment correlations among preparedness ratings were relatively low and that prepared fears did not make up a majority in the sample. Indices of severity either did not correlate at all or correlated negatively with preparedness ratings. The positive correlation between preparedness and onset ages reached borderline significance. Evidence suggestive of a resistance to treatment of prepared fears was obtained.     

Two different types of obsession: autogenous obsessions and reactive obsessions

We propose that obsessions are categorized into two subtypes, i.e. autogenous obsessions and reactive obsessions, which are different in terms of identifiability of their evoking stimuli, subjective experiences, contents, and subsequent cognitive processes. Autogenous obsessions tend to come abruptly into consciousness without identifiable evoking stimuli, which are perceived as ego-dystonic and aversive enough to be repelled, and include sexual, aggressive, and immoral thoughts or impulses. On the other hand, reactive obsessions are evoked by identifiable external stimuli, which are perceived as relatively realistic and rational enough to do something toward the stimuli, and include thoughts about contamination, mistake, accident, asymmetry, loss, etc. Through three empirical studies, we confirmed the differences between the two types of obsessional intrusion in their frequency, subjective experiences, subsequent appraisal and control strategy. In particular, autogenous obsessions led to high appraisal on 'control over thought' and 'importance of thought' and frequent use of 'avoidant control strategies', while reactive obsessions linked with high appraisal on 'responsibility' and frequent use of 'confrontational control strategies'. These findings are expected to provide a basis for classifying and explaining the heterogeneous phenomena of obsessive-compulsive disorder.     

Abnormal and normal obsessions

Three related, exploratory studies were carried out in order to ascertain the occurrence and nature of normal obsessions, and to relate them to abnormal obsessions. The subjects included 8 obsessional patients, and up to 124 non-clinical subjects.Broadly, the findings were that normal obsessions are a common experience and they resemble the form of abnormal obsessions. They also show some notable similarities of content. However normal and abnormal obsessions differ in several respects, including frequency, duration, intensity and consequences, among others.With repeated practice, the frequency, duration and discomfort of obsessions are observed to decrease. Overall, the findings are considered to be consistent with the noxious stimulus cum habituation theory.     

The relationship among guilt, dysphoria, anxiety and obsessions in a normal population

Seventy-six college students reported intrusive thoughts and impulses on a checklist. These students also completed questionnaires assessing depression, trait anxiety and perceived guilt. Results indicated for this normal population that intrusive thoughts were more distressful, more difficult to dismiss and occur with a greater variety of content compared to intrusive impulses. Multiple regression analysis showed that guilt was the best predictor of intrusive thoughts and impulses. Self-reported depression and anxiety were not strong predictors with respect to nonclinical obsessions and impulses. Discussion focuses on the utility of assessing guilt with obsessional disorders, the lack of a relationship between self-report trait anxiety and nonclinical obsessions, and the need to examine the relationship between guilt and anxiety with clinically obsessional subjects.     

Cognitive Behavior Therapy for Obsessions and Compulsions: New Applications and Emerging Trends

This paper describes recent developments in the cognitive behavioral treatment (CBT) of obsessive compulsive disorder (OCD). Although behavioral treatment of OCD consisting of exposure and response prevention (ERP) has been shown to be clinically effective, certain limitations with ERP have led clinical researchers to propose that treatment should be augmented with direct cognitive interventions. Modification of dysfunctional beliefs and faulty appraisals or interpretations of the obsession are now considered a crucial component of CBT for obsessions and compulsions. This paper discusses the conceptual basis of the new CBT for OCD and reviews its limited empirical status. A case example is provided in which CBT is used to treat obsessional ruminations of becoming sick. The article concludes with a discussion of the challenges and pitfalls involved in offering CBT for obsessions and compulsions.     

Implicit awareness of ambiguity: a role in the development of obsessive-compulsive disorder

The cognitive-behavioral model of obsessive-compulsive disorder proposes that obsessional symptoms are the consequence of the manner in which intrusive cognitions are interpreted [e.g., Salkovskis, P. M. (1998). Cognitive-behavioral approach to understanding obsessional thinking. British Journal of Psychiatry, 173(35S), 53-63]. The present study suggests that this may be attributable to maladaptive implicit cognitive processing, a deficit that results in the explicit awareness of ambiguity in idiographic obsessive-compulsive disorder (OCD) stimuli. The present study examines decision-making responses of low and high OCD scorers in a non-clinical undergraduate sample. Via a computer console, participants were shown sentence statements for three levels of ambiguity. They were then presented with a propositional statement for which they had to indicate agreement or disagreement for sentences of varying ambiguity. After this, the participants indicated whether they were completely confident or unconfident as regards their previous agree-disagree decisions. Results indicate that the high compared to the low OCD scoring group had less agreement and subsequent less confidence in decisions made for sentences of varying ambiguity. Response latencies partially fitted the predicted hypotheses. Consequently, an addition to Salkovskis, Forester, and Richards' [1998. Cognitive-behavioral approach to understanding obsessional thinking. The British Journal of Psychiatry, 173(35S), 53-63] model of OCD is suggested: namely that an implicit ambiguity deficit mediates the likelihood of normally occurring intrusions developing into abnormal obsessions. Methodological limitations and future research are considered.     

The Legacy of Seligman’s "Phobias and Preparedness" (1971)

Seligman’s (1971) classic article, "Phobias and Preparedness," marked a break from traditional conditioning theories of the etiology of phobias, inspiring a line of research integrating evolutionary theory with learning theory. In this article, I briefly sketch the context motivating the preparedness theory of phobias before summarizing the initial wave of laboratory conditioning experiments pioneered by Öhman and conducted by his team and by others to test predictions derived from Seligman’s theory. Finally, I review the legacy of Seligman’s article, including theoretical developments embodied in Öhman and Mineka’s fear module approach as well as alternatives for explaining “preparedness” phenomena, including the selective sensitization, expectancy, and nonassociative theories. Although Seligman himself soon moved on to other topics, his seminal article in Behavior Therapy continues to inspire research more than four decades later that has deepened our understanding of the etiology of phobias.     

Obsessive intrusive thoughts in nonclinical subjects. Part I. Content and relation with depressive, anxious and obsessional symptoms

The present study reports on the development and preliminary validation of a 52 item self-report instrument designed to assess intrusive thoughts, images and impulses that are similar to the aggressive, sexual and disease-related thinking characteristic of clinical obsessions. Two hundred and ninety-three students completed the Obsessive Intrusions Inventory (OII) as well as standard self-report measures of negative cognitions and obsessive, anxious and depressive symptoms. Regression analysis revealed that intrusive thinking was a significant and unique predictor of obsessional but not anxious or depressive symptoms. Furthermore, intrusive thinking showed a moderate correlation with anxious but not depressive cognitions. The results indicate that the intrusive thoughts assessed by the OII are distinct from other forms of negative thinking and may, in fact, constitute an analogue form of clinical obsessions in nonclinical populations.     

Time series analysis of obsessional behavior and mood during self-imposed delay and response prevention

Time series analysis of more than a year of daily self-report of three subjects showed that self-imposed delay and response prevention was effective in decreasing obsessions and compulsions. The subject-controlled treatment had a varied effect on mood—anxiety decreased in two subjects, but depression increased in one. (A similar worsening of mood after elimination of obsessional behavior was found in a previous case study.) Apparently, successful treatment of obsessional behavior will not necessarily lead to an improvement in mood. Concurrent mood symptoms need to be targeted separately; and, plans should be made to deal with mood symptoms that may occur once obsessional behavior is removed.     

Heterogeneity among specific phobia types in DSM-IV

Recently, it has been suggested that situational specific phobias (e.g., phobias of driving, flying, enclosed places) are more closely related to agorophobia than are other specific phobia types. The present study investigated this hypothesis by examining heterogeneity among the four main DSM-IV specific phobia types, particularly with respect to variables believed to be associated with agoraphobia. Using interviews and behavioral testing, 60 patients with specific phobias of animals, heights, blood/injections, or driving were compared with respect to etiology, age of onset, physiological response, predictability of panic attacks, and focus of apprehension. Fifteen patients suffering from panic disorder with agoraphobia served as a comparison group for some measures. Relative to the other specific phobias, driving phobias were most strongly associated with a later age of onset, similar to that of individuals with agoraphobia. Height phobias were also associated with a late age of onset as well as a more internal focus of apprehension, relative to other groups. Finally, individuals in the blood/injection phobia group reported a more internal focus of apprehension than those in other groups and were the only group to report a history of fainting in the phobic situation. Overall, the results did not support the hypothesis that situational phobias are a variant of agoraphobia. In fact, on several of the variables for which groups did differ, individuals with height phobias (a phobia from the natural environment type) showed a pattern most similar to individuals with agoraphobia. The implications of these results for the classification of specific phobias are discussed.     

An evolutionary hypothesis for obsessive compulsive disorder: a~psychological immune system?

A new hypothesis is presented within the framework of evolutionary psychology that attempts to explain the origins of obsessive-compulsive disorder. It is suggested that obsessions and compulsions originate from the overactivity of a mental module that the majority of humans possess and has the function of generating risk scenarios without voluntary intervention. It is hypothesised that obsessional phenomena function as an off-line risk avoidance process, designed to lead to risk avoidance behaviour at a future time, thus distinguishing it from anxiety and related phenomena as on-line emotional states, designed to lead to the avoidance of immediate and direct risks. Finally, the hypothesis makes a number of specific predictions that are testable and refutable. It is contended that the present hypothesis if supported by empirical evidence could serve as a basis for future research on this important disorder.     

What Drives OCD Symptom Change During CBT Treatment? Temporal Relationships Among Obsessions and Compulsions

Cognitive behavior therapy (CBT) is an effective treatment for obsessive-compulsive disorder (OCD). However, less is known about how obsessions and compulsions change during treatment, either in tandem, sequentially, or independently. The current study used latent difference score analysis to show path-analytic dynamic modeling of OCD symptom change during CBT. Four competing models of the temporal relationship between obsessions and compulsions were examined: no coupling (obsessions and compulsions are not dynamically related), goal directed (obsessions lead to subsequent changes in compulsions), habit driven (compulsions lead to subsequent changes in obsessions), and reciprocal. Treatment seeking participants (N = 84) with a principal diagnosis of OCD completed 12 weeks of CBT group therapy and completed measures assessing obsession and compulsion severity at pretreatment, Sessions 4 and 8, and end of treatment. Bivariate results supported the goal directed traditional CBT model, where obsession scores are temporally associated with subsequent changes in compulsion scores. These results have implications for theoretical and treatment modelling of obsessions and compulsions in OCD treatment.     

The relationship between disgust sensitivity, anxiety and obsessions

Three hundred participants, including volunteers from an obsessional support group, filled in questionnaires relating to disgust sensitivity, health anxiety, anxiety, fear of death, fear of contamination and obsessionality as part of an investigation into the involvement of disgust sensitivity in types of obsessions. Overall, the data supported the hypothesis that a relationship does exist between disgust sensitivity and the targeted variables. A significant predictive relationship was found between disgust sensitivity and total scores on the obsessive compulsive inventory (OCI; Psychological Assessment 10 (1998) 206) for both frequency and distress of symptomatology. Disgust sensitivity scores were significantly related to health anxiety scores and general anxiety scores and to all the obsessional subscales, with the exception of hoarding. Additionally, multiple regression analyses revealed that disgust sensitivity may be more specifically related to washing compulsions: frequency of washing behaviour was best predicted by disgust sensitivity scores. Washing distress scores were best predicted by health anxiety scores, though disgust sensitivity entered in the second model. It is suggested that further research on the relationship between disgust sensitivity and obsessionality could be helpful in refining the theoretical understanding of obsessions.     

Differential performance on the go/no-go task as a function of the autogenous-reactive taxonomy of obsessions: Findings from a non-treatment seeking sample

It has been suggested that obsessive-compulsive disorder is characterized by impaired inhibitory control. Response inhibition is a cognitive process required for one to cancel or suppress dominant but inappropriate responses. The present study examined response inhibition among non-treatment seeking individuals diagnosed with OCD and individuals with low levels of OCD symptoms using a computerized visual go/no-go task. Specifically, we sought to examine a prediction from the autogenous-reactive subtype model of obsessions (Lee, H.-J., & Kwon, S.-M. (2003). Two different types of obsession: autogenous obsessions and reactive obsessions. Behaviour Research and Therapy, 41, 11-29; Lee, H.-J., & Telch, M. J. (2008). Autogenous obsessions and reactive obsessions. In J. Abramowitz, S. Taylor, & D. McKay (Eds.), Obsessive-compulsive disorder: subtypes and spectrum conditions. New York: Elsevier., asserting that OCD individuals presenting with the autogenous subtype of obsessions will display greater difficulty in inhibitory control relative to individuals presenting with obsessions of the reactive subtype. Results showed that individuals with OCD of the autogenous subtype displayed more deficient inhibitory control on the visual go/no-go task as indexed by a longer response delay between the original stimuli set and the reversed stimuli set compared to individuals with OCD of the reactive subtype or individuals with low levels of OCD symptoms.     

Exploring the unique and interactive roles of distress tolerance and negative urgency in obsessions

Recent research has implicated relationships between emotion dysregulation and obsessions. Evidence suggests low distress tolerance and greater tendency to act impulsively in the face of negative affect (or negative urgency) are strongly related to obsessions. The current study sought to examine the unique and interactive roles of distress tolerance and negative urgency in the prediction of obsessions. A large non-clinical sample (N = 238) was administered a range of self-report measures. Results revealed that both poor distress tolerance and greater negative urgency were uniquely associated with obsessions but not other obsessive-compulsive symptoms, even when controlling for gender, depression, anxiety, and generalized anxiety disorder symptoms. Additionally, low distress tolerance and high negative urgency interacted with each other in the prediction of greater obsession symptoms. Overall, the findings help clarify the emerging literature linking emotion dysregulation to obsessions.     

A cross-sectional investigation of autogenous and reactive obsessions and associated cognitive and symptom correlates in China

Categorizing clinical obsessions as either autogenous or reactive, a model that has been supported by several studies, may represent a parsimonious approach to characterizing individuals with obsessive-compulsive disorder (OCD). However, most published studies on autogenous and reactive obsessions have been carried out with participants in highly developed nations (e.g., United States, Australia). No studies have been carried out in less developed countries, such as China. It was hypothesized that the nature of autogenous and reactive obsessions and their correlates would generalize to China. This cross-sectional study incorporated three groups from China: a college student sample (N = 1,701), a clinical sample of patients with OCD (N = 158), and a clinical control group of patients with anxiety disorder other than OCD (N = 88). Confirmatory factor analysis provided support for the autogenous and reactive model of obsessions in a Chinese sample. The results also showed that autogenous and reactive obsessions demonstrated a pattern of associations with cognitive and symptom correlates (e.g., obsessive beliefs, traditional OCD subtype themes) that were comparable to those found in previous research. The current study supports the autogenous and reactive obsessions model of OCD and its correlates in China, providing additional evidence for the cultural invariance of the model.     

Multiple pathways to inflated responsibility beliefs in obsessional problems: possible origins and implications for therapy and research.

The purpose of this paper is to consider the possible origins of an inflated sense of responsibility which occupies an important place in the cognitive theory of obsessive compulsive disorder (Rachman, S. (1993). Obsessions, responsibility, and guilt. Behaviour Research and Therapy, 31, 149-154. Salkovskis, P. M. (1985). Obsessional-compulsive Problems: A cognitive-behavioural analysis. Behaviour Research and Therapy, 23 (5), 571-583). Clinical experience and consideration of current cognitive conceptualisations of obsessions and obsessive compulsive disorder suggest a number of possibilities, each of which is described after a brief introduction to the concept itself. While there are reasons to believe that some general patterns can be identified, the origins of obsessional problems are best understood in terms of complex interactions specific to each individual.