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OCD and the Multidimensional World-View Model

Guy Doron

The concept of world view is implied in cognitive behavioral theories of OCD. Examining basic assumptions about the world and the self may help in further understanding sensitivity to intrusive thoughts and why some individuals are more susceptible to particular OC symptoms (e.g., checking, contamination, and obsessions). Indeed, Doron and Kyrios (2005; see chapter 2 of this thesis) proposed that enduring cognitive-affective structures, consisting of particular structures of self and coupled with specific beliefs about the world, may underlie vulnerability for OCD. According to this model, vulnerability to intrusions is determined by a self-concept that comprises of several "sensitive" domains. Domains are sensitive if they are highly valued by the individual, but at the same time the individual feels that they are not competent within these domains. Particular views of the world may then engender neutralizing behaviors in response to intrusions. For example, views that the world is controllable but physically/socially threatening, or that outcomes in the world depend on one's moral worth and actions, may lead to particular neutralizing behaviors (e.g., compulsive checking or suppression of morally repugnant images in individuals "sensitive" to moral concerns).

Indeed, several variables relating to self and the world have already been linked to OC phenomena. For instance, Newth and Rachman (2001) argued that the concealment of symptoms commonly seen in OCD, is primarily due to a fear of negative evaluation from others. Anticipated negative reactions from others to the content of unwanted intrusions and other OCD symptoms decrease the possibility for normalization, leading to increased distress and resulting in more frequent use of neutralizing strategies (Newth & Rachman, 2001). Consistent with this, Bhar and Kyrios (1999) found that perceiving others as having unrealistic perfectionistic expectations of oneself (i.e., socially prescribed perfectionism) predicted unique variance in OC tendencies when controlling for depression in a non-clinical community sample. Thus, OC phenomena may be associated with negative appraisals of the benevolence of others.

Cognitive conceptualizations of OCD and its phenomenology suggest specific underlying assumptions about predictability (i.e., controllability beliefs) in the world and the importance of morality (i.e., justice beliefs). For instance, checking and washing symptoms imply the assumption that harm to self and others can be prevented through action. Indeed, the definition of responsibility as the individual's propensity to believe that they may be pivotally responsible for causing or failing to prevent harm (OCCWG, 1997) implies the presumption that harm is preventable and that one is able to prevent harm. Also, the belief that the world is controllable through means such as magic, luck and so forth has been linked to OC phenomena (Einstein & Menzies, 2004, 2004a). Assumptions about one's moral constitution and actions (i.e., being, acting and thinking morally) are implied in OC related beliefs, such as an inflated sense of personal responsibility (Salkovskis, 1985, 1999), exaggerated beliefs regarding the importance of controlling one's thoughts (Clark & Purdon, 1993) and "catastrophic misinterpretations" of the personal significance of intrusive thoughts (Rachman, 1997, 1998). Thus, OC phenomena may be associated with increased assumptions about the consequence of one's moral constitution and actions such as the justice and controllability beliefs.

Finally, OCD research could benefit from further evaluation of different aspects of self perception (Bhar & Kyrios, 2000; Clark, 2004; Rachman, 1998). Rowa and Purdon (2003) found that the distress evoked by intrusive thoughts is related to the content of the intrusions and the individual's self-perceptions. Testing Rachman's proposal that obsessions reveal important and hidden elements of one's identity, Ferrier & Brewin (2005) reported that, compared to anxiety and normal controls, individuals with OCD were more likely to draw negative inferences about themselves from their experiences of having intrusions. While anxiety controls showed a "feared self" characterised by fearfulness and hopelessness, those with OCD reported a "feared self" characterised as dangerous to self or others by virtue of being bad, immoral or insane. Bhar and Kyrios (2000) found that individuals presenting with OCD scored significantly higher on a measure of self ambivalence compared to non-clinical university students and community controls.

Consistent with such findings, repugnant intrusions (e.g., aggressive and sexual thoughts) may be linked with an increase of negative perceptions of the individuals' personal character. That is, low perceptions of one's own moral constitution may increase the likelihood of being distressed by the experience of intrusive thoughts. Moreover, such vulnerability to intrusive thoughts may be amplified by the belief that consequences in the world are determined by moral deservingness (i.e., people get what they morally deserve in the world). Similarly, individuals assuming that misfortune in the world can be avoided may be more susceptible to act upon danger related intrusive thoughts (e.g., being contaminated), in particular when holding the belief that their own actions are useful in the prevention of harm (e.g., washing). This may increase the likelihood of using neutralizing behaviors (Salkovskis, 1985). Thus, particular aspects of self evaluation and world assumptions may relate differently to specific OC dimensions. In fact, it has been suggested that different OC dimensions have differing etiology and cognitive correlates, requiring specific cognitive interventions (see McKay et al., 2004 for review).

In sum, a systematic multi-dimensional examination of self and world beliefs may advance our understanding of OCD by examining more general and potentially important aspects of self and world-view. Further, individual differences in perceptions of self and the world may influence vulnerability to specific OC symptom dimensions (Doron & Kyrios, 2005). Establishing the relative importance of world view assumptions in predicting OC symptoms over and above variables previously shown to be important in OCD is the first step in such an investigation.

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