"A man who flies from his fear may find he has only taken a shortcut to meet it." (John Ronald Reuel Tolkien)
Obsessive Compulsive Disorder (OCD) is one of the most incapacitating of the anxiety disorders, having been rated as a leading cause of disability by the World Health Organization (1996). OCD affects all cultural and ethnic groups and, unlike many related disorders, males and females are equally affected (Rasmussen & Eisen, 1992). Further, OCD is associated with high degrees of psychiatric comorbidity, including major depression and other anxiety disorders (American Psychiatric Association [APA], 1994).
The central features of OCD comprise obsessions and/or compulsions. Obsessions are defined as persistent unwanted thoughts, images, or impulses that intrude into consciousness and give rise to active resistance (APA, 1994). Compulsions are defined as deliberate, repetitive and rigid behaviors or mental acts that a person performs, often in response to obsessions, in order to prevent or reduce anxiety, distress or threat (Rachman & Hodgston, 1980).
The idea that enduring cognitive-affective structures sensitize individuals to psychopathology is central to cognitive theory. Beck (1976) described the triangle of negative views of self, the world and the future in the dynamic of depression. Young (1990) identified several early maladaptive schemas underlying personality difficulties. Others (Bowlby, 1969, 1973, 1988; Guidano & Liotti, 1983; Janoff-Bulman, 1991; Kyrios, 1998) invoked terms such as internal working models of self and other and world-view in their explanations of a range of different disorders. However, few researchers have applied the idea of an underlying cognitive-affective vulnerability operating in individuals with obsessive-compulsive thoughts and behaviors (e.g., Bhar & Kyrios, 2000; Guidano & Liotti, 1983; Sookman, Pinard, & Beauchemin, 1994).
It is within this context of identifying enduring cognitive-affective structures that underlie OCD that this dissertation considers an individual's perceptions of the self and their world-view as vulnerability factors for obsessive-compulsive symptoms and cognitions. This dissertation draws upon recent developments in cognitive (e.g., Clark & Purdon, 1993; Lee & Kwon, 2003; Purdon & Clark, 1993, 1994; Rachman, 1997; Rachman, 1998), attachment (e.g., Hazan & Shaver, 1987), self concept (e.g., Harter, 1998), and world-view research (e.g., Janoff-Bulman, 1989; 1991). This dissertation aims to extend previous theory and research into OCD by investigating the proposal that specific self-structures, world view variables and attachment representations may be associated with vulnerability to OCD.
In order to do this, Chapter 1 presents a general overview of OCD including a review of the phenomenology, prevalence, comorbidity and course of this disorder, and a discussion of current cognitive models. In Chapter 2, the rational for the investigations and the hypotheses are presented. Overall, it is argued that consideration of the individual's perception of self and world view may lead to a broader understanding of the development and maintenance of OCD.
Chapter 3 gives a short overview of the methodology and the hypotheses of the four studies conducted in the thesis. Chapters 4 and 5 describe and present the findings of two studies investigating the role of perceptions of the world and the self in OCD. Chapter 6 focuses on the inter-relationships between attachment representation, perceptions of self and world and OC phenomena. The aim in these chapters was to establish the existence of a significant relationship between self, world view, attachment representations and OC phenomena.
Chapter 7 presents and discusses the fourth empirical examination of the hypothesized relationship between the proposed cognitive-affective structures and OCD. In this study, perceptions of the world, self and adult attachment representation were examined in individuals presenting with a primary diagnosis of OCD, individuals presenting with other anxiety disorders and non-clinical community volunteers. In this chapter the question of whether the link between these cognitive affective structures and OCD is specific will also be addressed. Finally, chapter 8 summarizes the implications of the findings and suggests areas for further research.