Understanding OCD Characteristics

Understanding Obsessive Compulsive Disorder sufferers with certain characteristics which suggest that cognitive therapy could be useful.

Responsibility. An exaggerated sense of responsibility tends to run through many Obsessive Compulsive Disorder symptoms. We have all observed, for example, the case in which people who must check door locks and stoves, etc., several times before leaving their own home are quite content to leave a neighbor's house with no concern whatever about locked doors, or stoves that may be left on.

In fact studies that have manipulated responsibility have found that urges to check and checking behaviors increase in compulsive checkers when perceived responsibility is high. In a non-clinical sample, Frost et al. (1995) found that higher ratings on a hoarding scale were associated with higher estimates of perceived responsibility for both being prepared and the well-being of the possession.

There was also a reliance on possessions for emotional comfort, along with excessive concern about control over the possessions. Since the severity and probability of negative outcomes are associated with the perception of responsibility in Obsessive Compulsive Disorder, the distortions in evaluations of these factors need to be treated with cognitive therapy.

Unrealistic threat appraisal. Carr (1974) reviewed the literature on `compulsive neurosis' and concluded that patients with `compulsive neurosis' had unrealistic appraisals of threat. McFall and Wollersheim (1979) followed this up by suggesting that the appraisals of threat in obsessive-compulsives are influenced by cognitive distortions, such as perfectionism and the belief that rituals can prevent disasters. Unrealistic threat appraisal is another indication for cognitive therapy.

Memory confidence. One question that leaps to mind when considering Obsessive Compulsive Disorder checkers is whether they can actually remember what they have done. Rubenstein et al. (1993) examined subclinical checkers and found that subjects failed to remember as many words as noncheckers. They concluded that memory deficits may lead to the development of excessive checking. Sher et al. (1984) found deficits on a memory-for-actions task and logical memory in compulsive checkers.

Checking was negatively related to memory functioning, and subjects had difficulty in recalling the details of meaningfully linked sequences. However, McNally and Kohlbeck (1993) have argued that obsessional doubt may not involve memory deficits but memory confidence. In their study, they found that compulsive checkers reported less vivid memories and less confidence in their memories.

Memory vividness has received some attention recently. Constans et al. (1995) found that although compulsive checkers did not differ from control subjects in accuracy of recalling whether an event was real or imagined (reality-monitoring), they felt that their memories were less vivid than they would have liked in order to feel satisfied. They were not deficient in memory and actually showed superior recall of actions when those actions elicited anxiety. The authors conclude that checkers require more memory detail before they are comfortable with their recall. It is possible that cognitive therapy could be useful here, also for Obsessive Compulsive Disorder.

Indecisiveness. Frost and Shows (1993) found indecisiveness to be associated with obsessional thoughts and compulsive checking. Indecisiveness was also associated with hoarding (Frost & Gross, 1993), consistent with the known difficulty hoarders have in making decisions about whether or not to throw things out, and with procrastination. Indecisiveness and procrastination are certainly amenable to cognitive therapy.

Contradictory beliefs. In working with Obsessive Compulsive Disorder washers who have a contamination obsession, I have come across an interesting phenomenon. Patients can hold contradictory beliefs that they are unaware of and, when these contradictions are pointed out, they have a great deal of difficulty understanding the point I'm trying to make! For example, I have one patient who spent 8-12 hours each night sleeping in a bed with sheets that had not been cleaned for months, and yet was afraid to touch the light switch when he got up in the morning because he might touch it again later in the day and become recontaminated.

This amounts to a fear of being less contaminated! I have observed this same phenomenon in several patients. Others have noticed problems with logic in Obsessive Compulsive Disorder patients. Kozak and Foa (1994) have suggested that a cognitive bias favoring threat cues may combine with failures in syllogistic reasoning that occur under conditions of threat to influence the formation and maintenance of obsessional beliefs.