The relationship between obsessions and the self: Feared and actual self-descriptions in a clinical obsessive-compulsive disorder sample

Cognitive models of obsessive-compulsive disorder (OCD) posit the relevance of the self in OCD, although the nature of this association is still unclear. We aimed to explore actual and feared selves and its association with obsessions and intrusions in a group of OCD patients. A group of 58 patients with OCD identified their most upsetting obsession and intrusion (non-clinical obsession) experienced in the past 3 months. These cognitions were classified as either moral-based or autogenous (obsessions n = 32; intrusions n = 26) or non-moral-based or reactive, depending on their content. Next, patients described their actual self and their feared self, that is, the person they feared being or becoming, and whether they believed these descriptions were associated with their obsessions/intrusions. Results indicate that individuals with OCD described themselves as insecure, anxious and fearful, but also as good and nice. They particularly feared a selfish, aggressive, bad, liar, coward, insecure and arrogant self. Two-thirds of the patients believed that their obsessions said something about their actual self (65.52%) and that their obsessions brought them closer to the person they do not want to be (62.06%). A third of patients believed their intrusions said something about their actual self (actual self: 30.35%; feared self: 25%), which was a significantly lower percentage than for obsessions. These associations existed independent from the content of the obsession and/or intrusion, although patients with obsessions with moral-based contents more often tended to believe that their obsessions brought them closer to the person they do not want to be. Results suggest the relevance of the real and feared selves in the maintenance of obsessions

Is context a crucial factor in distinguishing between intrusions and obsessions in patients with obsessive-compulsive disorder?

Objective Some cognitive models of obsessive‐compulsive disorder (OCD) posit that intrusions exist on a continuum with obsessions; others consider that they may be unrelated phenomena that differ in the context where they occur. We aimed to examine and compare, at two different moments, the context of the occurrence of intrusions and obsessions. Method Sixty‐eight patients with OCD completed an interview appraising their most upsetting obsession and intrusion. Results At their onset, the obsessions/intrusions were associated with experiencing negative emotional states and life events, and they were more likely to appear in 'inappropriate' contexts. The context of the obsessions/intrusions differed the last time they were experienced. Autogenous obsessions/intrusions occurred more frequently in contexts with an indirect link. Conclusions The context distinguishes between intrusions and obsessions, not when they emerge, but when the obsession is already established. The results support that there is a continuum or progression from intrusions to obsessions

Spanish version of the Inferential Confusion Questionnaire-Expanded Version: Further support for the role of inferential confusion in obsessive-compulsive symptoms

Objective Some cognitive models of obsessive‐compulsive disorder (OCD) posit that intrusions exist on a continuum with obsessions; others consider that they may be unrelated phenomena that differ in the context where they occur. We aimed to examine and compare, at two different moments, the context of the occurrence of intrusions and obsessions. Method Sixty‐eight patients with OCD completed an interview appraising their most upsetting obsession and intrusion. Results At their onset, the obsessions/intrusions were associated with experiencing negative emotional states and life events, and they were more likely to appear in 'inappropriate' contexts. The context of the obsessions/intrusions differed the last time they were experienced. Autogenous obsessions/intrusions occurred more frequently in contexts with an indirect link. Conclusions The context distinguishes between intrusions and obsessions, not when they emerge, but when the obsession is already established. The results support that there is a continuum or progression from intrusions to obsessions

Validation of the Spanish version of the Fear of Self Questionnaire

Cognitive models, from both the appraisal and inferential confusion perspectives, propose that the self is a relevant variable in the development and maintenance of obsessive-compulsive (OC) disorder. In this study, we examined the psychometric properties of the Spanish version of the Fear of Self Questionnaire (FSQ) and analyzed the role of the fear of self (the sort of person we are afraid of becoming) as a predictor of OC beliefs and symptoms. A sample of 359 non-clinical participants completed a set of questionnaires, including the FSQ. Confirmatory factor analysis replicated the original one-factor solution for both the FSQ-8- and 20-item versions. The FSQ demonstrated excellent reliability, and fear of self predicted OC symptoms and cognitions, especially unacceptable obsessions

Treating delusional disorder : a comparison of cognitive-behavioural therapy and attention placebo control

Objective: Cognitive-behavioural therapy (CBT) has proved effective in treating delusions, both in schizophrenia and delusional disorder (DD). Clinical trials of DD have mostly compared CBT with either treatment as usual, no treatment, or a wait-list control. This current study aimed to assess patients with DD who received CBT, compared with an attention placebo control (APC) group. Method: Twenty-four individuals with DD were randomly allocated into either CBT or APC groups for a 24-week treatment period. Patients were diagnosed on the basis of structured clinical interviews for mental disorders and the Maudsley Assessment of Delusion Schedule (MADS). Results: Completers in both groups (n = 11 for CBT; n = 6 for APC) showed clinical improvement on the MADS dimensions of Strength of Conviction, Insight, Preoccupation, Systematization, Affect Relating to Belief, Belief Maintenance Factors, and Idiosyncrasy of Belief. Conclusion: When compared with APC, CBT produced more impact on the MADS dimensions for Affect Relating to Belief, Strength of Conviction, and Positive Actions on Beliefs

Fear of self and unacceptable thoughts in obsessive-compulsive disorder

Cognitive-behavioural models have linked unacceptable or repugnant thoughts in obsessive-compulsive disorder (OCD) with vulnerable self-themes and fear-of-self concerns. To investigate this notion, Aardema and coworkers recently developed and validated the Fear of Self-Questionnaire (FSQ) in non-clinical samples, finding it had strong internal inconsistency, and good divergent and convergent validity, including strong relationships to obsessional symptoms and with other processes implicated in cognitive models of OCD (e.g., obsessive beliefs and inferential confusion). The current article describes two studies that aim to replicate and extend these findings in clinical OCD and non-clinical samples. Study 1 investigated the psychometric properties of an Italian translation of the FSQ in a non-clinical sample (n=405). Results of confirmatory factor analysis supported the unidimensionality of the scale; the FSQ also showed very good internal consistency and temporal stability. Study 2 investigated the role of fear of self in OCD symptoms, and unacceptable thoughts and repugnant obsessions in particular, using a clinical OCD sample (n=76). As expected, fear of self was a unique, major predictor of unacceptable thoughts independent of negative mood states and obsessive beliefs. Moreover, even when considered with obsessive beliefs, anxiety and depression, the feared self was the only unique predictor of obsessionality, providing support for the notion that self-themes could explain why some intrusions convert into obsessions, whereas others do not. Implications for current cognitive-behavioural models are discussed

Contextual determinants of intrusions and obsessions: The role of ego-dystonicity and the reality of obsessional thoughts

The current study aimed to investigate whether lack of evidence for the potential reality of the intrusion and ego-dystonicity are contextual determinants of unwanted intrusive thoughts and clinical obsessions. To this end, a total 248 non-clinical participants were asked to report an intrusion they had experienced as well as the context in which the intrusion arose. Utilizing this information, three independent clinicians rated these intrusions on ego-dystonicity and whether the intrusion had occurred with or without any evidence for its potential reality. Results showed that ego-dystonicity and lack of evidence for the intrusions were related, but distinct constructs. In particular, intrusions that occurred without evidence were significantly associated with higher levels of self-reported OC symptoms and related cognitive domains, whereas ego-dystonicity was not related to OC symptoms. Overall, the results are consistent with the notion that abnormal intrusions occur without evidence in the here-and-now, whereas normal intrusions do not. Intrusions that have no evidence to back them up, yet occur without any apparent cause, may be particularly likely to invite further negative cognitive processing, over-interpretation and control attempts. Implications for further research and treatment are discussed