Cognitive Processes in Obsessive-Compulsive Disorder: An Investigation of Evaluation of Thoughts, Intolerance of Uncertainty, and Risk Aversion in Adults With OCD

Abstract

Obsessive-compulsive disorder (OCD) is a debilitating illness characterized by repetitive intrusive thoughts and ritualistic behavior. Cognitive models of OCD have underscored the importance of dysfunctional thoughts in the etiology and maintenance of the disorder. Researchers have identified three broad domains of beliefs that figure prominently in the cognitive model, including inflated responsibility and estimation of threat, importance of and need to control thoughts, and perfectionism and intolerance of uncertainty. In this dissertation, I examined specific aspects of these thoughts to clarify their relation to OCD. Three papers are presented. Paper one demonstrates that people with OCD and those with social anxiety disorder (SAD) evaluate their own thoughts as more significant than they do others’ thoughts. Moreover, a heightened belief that one’s thoughts increase the likelihood of harm to others distinguished people with OCD from those with SAD and those without anxiety disorders. Paper two indicates that OCD and SAD individuals report heightened negative affect in response to hypothetical scenarios involving even minimal uncertainty. However, whereas socially anxious subjects showed a preference for negative outcomes to uncertainty (even if there was a possibility of a better outcome in the future), those with OCD did not. Neither group demonstrated an intolerance of uncertainty for positive outcomes. Paper three featured a gambling task enabling me to examine affective forecasting ability in people with and without OCD. Obsessive-compulsive individuals performed similarly to socially anxious and non-anxious individuals, indicating that they are not less accurate in predicting their emotional response to positive and negative events. Moreover, discrepancies between predicted and experienced affect were not associated with how subjects rated the riskiness of different behaviors. Taken together, these findings are consistent with the theory that people with OCD are more prone to dysfunctional thinking than are non-anxious individuals. However, these studies also revealed that people with clinically significant social anxiety disorder possess similarly elevated levels of biased thinking. Moreover, this dissertation clarifies aspects of dysfunctional thinking (e.g., the specificity of the Thought-Action Fusion bias) that may have important treatment implications. These findings call into the question whether the cognitive model can adequately explain how dysfunctional thoughts are uniquely related to OCD. These dysfunctional thought patterns are insufficient to produce OCD if people with SAD alone exhibit them as well. Hence, this dissertation underscore the importance of examining transdiagnostic factors that contribute to the development of OCD and anxiety disorders and of identifying shared areas of intervention for them.