This thesis aimed to identify and investigate several cognitive-affective structures linked with attachment experiences, which may constitute vulnerability to obsessive compulsive (OC) phenomena. In this chapter, the findings of the four empirical investigations will be briefly reviewed and integrated within the literature presented in earlier chapters. It is hoped that this will demonstrate how the current investigation has contributed to existing theory and research dealing with OCD. The applied implications of the present research will be discussed and suggestions for future research in this field will be suggested. Finally, an overall summary of this thesis will be presented and several concluding remarks offered.
OCD is a disabling and relatively highly prevalent disorder (e.g., Foa & Franklin, 2001; Rasmussen & Eisen, 1994) that includes obsessions and/or compulsions. Current cognitive models of OCD have proposed that obsessions and compulsions are a result of the dysfunctional response to commonly occurring intrusive phenomena (OCCWG, 1997; Rachman, 2002; Salkovskis, 1985). The Obsessive Compulsive Cognitions Working Group has focused on six main belief domains that play an important role in the development of obsessions from intrusive thoughts: inflated personal responsibility; the overimportance of thoughts, beliefs about the importance of controlling one´â”¢s thoughts, the overestimation of threat, intolerance for uncertainty, and perfectionism.
Implicit within existing cognitive theories are particular perceptions of the self (e.g., being personally responsible for preventing harm) and the surrounding world (e.g., perceptions of danger). For instance, the OCCWG (1997, 2003) and others (e.g., Jones & Menzies, 1997, 1998; Menzies et al., 2000) found overestimation of threat to be one of the central beliefs associated with OCD. Rachman (1997, 1998) has also argued that catastrophic interpretations of the personal significance of intrusive thoughts are the main cause of the exacerbation of intrusions into obsessions. Clark and Purdon (1993; Purdon & Clark, 1999) proposed that the ego-dystonic nature of the intrusions (i.e., contradictory to the individuals´â”¢ perceptions of themselves and their beliefs and values) contributes to their worsening into obsessions. Salkovskis (1985, 1999) suggested that an increased sense of personal responsibility is associated with OCD; where responsibility is defined as the individual´â”¢s tendency to believe that they may be pivotally responsible for causing or failing to prevent harm from occurring to themselves or others. Nevertheless, few researchers have investigated the links between perceptions of self, others and the world and obsessive-compulsive thoughts and behaviors (e.g., Bhar & Kyrios, 2000; Guidano & Liotti, 1983; Riskind et al., 1997; Sookman, Pinard, & Beauchemin, 1994).
Furthermore, while cognitive models of OCD have enabled a better understanding of OCD and the development of improved treatments, recent findings suggest that a substantial proportion of individuals with OCD do not show high levels of the previously identified dysfunctional beliefs (e.g., Taylor et al., 2006) and findings regarding the specificity of the identified dysfunctional beliefs to OCD have been equivocal (e.g., OCCWG, 2005; cf. Taylor et al., 2006). Cognitive theories have also been criticized for not sufficiently addressing developmental issues and the motivational basis of the disorder (Doron & Kyrios, 2005; Guidano & Liotti, 1983; O'Kearney, 1998, 2001; Safran, 1990; O'Kearney, 1998, 2001; cf. Freeston & Salkovskis, 2001; Salkovskis & Freeston, 2001). Thus, the identification and examination of the relationship between OC cognitions and symptoms and other cognitive-affective structures such as perceptions of self, others and the world and attachment related representations may help in the identification of additional factors that are important in the dynamic of OCD, and also help us to better understand the developmental antecedents of this disorder.
It has been argued in this thesis and elsewhere (Doron & Kyrios, 2005) that developments in cognitive, attachment, self concept, and world-view research may provide links between cognitive-affective structures such as perceptions of self and the world, and vulnerability to obsessive-compulsive symptoms and cognitions. The cross-sectional nature of the studies presented in this thesis could not provid evidence for vulnerability. However, examining the relationship between adult attachment representation that have been strongly linked with early attachment experiences, these cognitive affective structures and OC phenomena may provid clues with regards to the early experiences involved in the development of OCD, and inform theories by providing a plausible explanation for the excessive motivation underlying the ´â”¢need to act´â”¢ seen in OCD patients. Examining the link between particular perceptions of self and OC phenomena may also lead to a better understanding of the process underlying sensitivity to particular (rather than all) intrusive phenomena. Finally, a systematic examination of perceptions of others and the world may result in the identification of additional factors that are involved in the dynamic of OCD.
The four studies presented in this thesis aimed to answer three main questions: whether perceptions of self and the world are associated with OC phenomena, whether dysfunctional adult attachment representations are linked to a sensitive self-structure, dysfunctional world view assumptions and OC phenomena, and whether hypothesized profiles of attachment, self and world perceptions are specific to OCD.