The results from the four studies of this thesis are largely consistent with previous suggestions implicating attachment, perceptions of self, other and world in OC phenomena (e.g., Clark & Purdon, 1993; Ehntholt, Salkovskis, & Rimes, 1999; Guidano & Liotti , 1983; Rachman, 1997; Riskind, Wheeler, & Picerno, 1997; Salkovskis, 1985). Guidano and Liotti (1983) argued that attachment experiences influence the development of the individuals' perceptions of the self and the world. According to this view, individuals suffering from OC symptoms regard the world as threatening, but controllable. Attachment theory also suggests that such experiences influence the later development of perceptions of the self and the world (e.g., Bowlby, 1969, 1973, 1980; Bretherton, 1999; Catlin & Epstein, 1992).
The results of this thesis indicate that attachment representations are associated with perceptions of the self and the world. IWMs of others predicted perceptions of the world, and IWMs of self predicted sensitive self constructs (see chapter 6 of this thesis). Also, consistent with previous research linking attachment and dysfunctional cognitions such as perfectionism and exaggerated threat perceptions (e.g., Mikulincer, Birnbaum, Woddis, & Nachmias, 2000; Mikulincer, Dolev, & Shaver, 2004; Wei et al., 2004), the findings indicated that attachment representations are associated with OC related cognitions (see chapter 6 of this thesis). Thus, this thesis provided initial evidence for the link between adult attachment, OC related cognitions, self and world view, and OC symptoms.
Existing cognitive theories of OCD implicate perceptions of self in the dynamic of OCD. Individuals suffering from OCD were argued to be of 'tender conscience' (Rachman & Hodgson, 1980), to be "oversocialized" (Salkovskis, 1989, pp.53-54), show "dedication to work and an acute sense of social obligation" (Salkovskis et al., 1999, p. 1060) and be ambivalent with regard to their self worth (Guidano & Liotti, 1983; Bhar & Kyrios, 2000). Cognitive theorists also argued that the importance attributed to the intrusions and their content challenges the individual's perceptions of their own character (Rachman, 1997; Clark and Purdon,1993; Purdon & Clark, 1999). This results in the exacerbation of the intrusions into obsessions.
Consistent with these suggestions, this thesis examined whether sensitivity in particular self structures is associated with OC symptoms and cognitions. Support was found for the links between OCD and a particular self structure where the individual overvalues specific self domains (e.g., morality and job competence), but feels incompetent in these domains (see chapter 5, 6 and 7). Indeed, perceptions of one's moral constitution and actions 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).
Finally, current cognitive research has related OCD to perceptions of the world as threatening (e.g., looming vulnerability to threat; overestimation of threat) and controllable (e.g., responsibility, magical ideation and control of thoughts), along with specific perceptions of others (e.g., expected negative evaluation from others). The findings were consistent with such research. In a systematic examination of perceptions of self, others and the world, an association was found between the constructs with OC phenomena. Further, a constellation of such world assumptions to OC phenomena was found to be related to OC symptom over-and-above the influence of OC related beliefs.
Putting aside the potential limitations of the present studies (see below), the findings from this thesis are consistent with a model whereby negative internal working models of self and others stemming from attachment experiences increase vulnerability to OCD in several ways. Firstly, negative IWMs of self may 'guide' the gradually differentiating self to more negative self evolutions. This, together with an emphasis on particular domains of competence, possibly through parental influence, may result in the formation of sensitive self structures (i.e., perceptions of incompetence in valued domains of self). Secondly, negative IWMs of others may promote negative perceptions of others and world. This, together with persistent demands on performance in certain areas (e.g., morality or job competence), and again possibly through parental influence, may encourage perceptions of the world as predictable (also see limitation and future research section below). Finally, negative IWMs result in a chronic activation of the attachment system. As a consequence, constant scanning for external/internal danger cues occurs. This increases the likelihood for developing dysfunctional beliefs associated with OCD (e.g., overestimation of threat). Also, such chronic activation of the attachment system leads to increased vigilance to intrusive thoughts, in particular those that challenge sensitive self domains. Sensitive self structures and world assumptions then further increase vulnerability to OC cognitions and symptoms (see figure 6).