Why are some obsessions more upsetting than others?

doi:10.1016/j.brat.2004.11.003

Behaviour Research and Therapy

Volume 43, Issue 11, November 2005, Pages 1453-1465

https://doi.org/10.1016/j.brat.2004.11.003 Get rights and content

Abstract

Little is known about why certain obsessional thoughts are more upsetting than others for people with obsessive compulsive disorder (OCD). Obsessional thought content often seems arbitrary to sufferers. The current study examined three possible reasons why particular thoughts would be especially upsetting for individuals, based on suggestions put forth by cognitive theories of obsessional thoughts. Twenty-eight individuals with a principal diagnosis of OCD completed questionnaires and interviews at two different periods of time on (1) their most upsetting current obsession and (2) their least upsetting current obsession. Results suggested that more upsetting obsessions were evaluated as more meaningful or significant than less upsetting obsessions, and more upsetting obsessions contradicted valued aspects of the self to a greater degree. All examples of current obsessions, both most and least upsetting, arose in the context of life concerns or issues. Results support cognitive theories in that the strength and nature of appraisal appears to be linked with the distress associated with a thought, and more upsetting thoughts are those that have implications for a person's sense of self.

Section snippets

Why are some obsessions more upsetting than others?

In recent years, there has been increasing interest in understanding the development and persistence of obsessional thoughts. Much of this interest has been generated from cognitive theories of obsessions, which propose a number of factors to explain the persistent nature of obsessions. A fundamental assumption of these theories is that obsessional thoughts arise from commonly occurring intrusive thoughts that are appraised as significant or meaningful (e.g., Rachman (1997), Rachman (1998);

Participants

Twenty-eight individuals with a principal diagnosis of OCD were recruited for this study (mean age of 32, SD=10.6, 71% female). Participants were recruited from among patients presenting to a specialty anxiety disorders clinic in Hamilton, Ontario. All diagnoses were made using the Structured Clinical Interview for DSM-IV (SCID-IV; First, Spitzer, Gibbon, & Williams, 1996). The principal diagnosis (i.e., the problem causing the most distress and functional impairment) was determined by the

Data screening

Data were examined for the presence of outliers. No outliers were found on the variables of interest.

Thought content

A wide range of thought content was reported for both the most upsetting and least upsetting obsessions. For most upsetting obsessions, 43% were aggressive, religious, or sexual obsessions, 32% were contamination concerns, and the rest (25%) were “other” obsessions, including needs for symmetry and exactness, need to know or remember, thoughts about saving things, and doubts about actions. For

Discussion

The results of the current study suggest several reasons why certain obsessions are so upsetting and persistent for people with OCD. The first factor is appraisal. Upsetting obsessions were appraised as more significant than less upsetting obsessions. This difference in strength of appraisals occurred for appraisals about the importance or meaning of simply having the thought, about the need to exercise control over one's thoughts, and about appraisals of responsibility for one's thoughts and

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Citation Excerpt :
In one study, Rowa and Purdon (2003) showed that the intrusive thoughts identified by nonclinical individuals as the most disturbing were more in conflict with their values than their least disturbing thoughts. They subsequently replicated this finding using participants with OCD (Rowa, Purdon, Summerfeldt, & Antony, 2005). In a naturalistic study of language used in online comments by individuals self-identified as suffering from sexual-orientation OCD (SO-OCD), Coimbra-Gomes and Motschenbacher (2019) found that expressions involving “don't want” featured prominently, particularly in connection to the possibility of a gay identity.
Cognitive-behavioral models of OCD and models of cognitive dissonance have converged in emphasizing how intrusive or dissonant thoughts conflict with – and therefore threaten - one's self-concept. In the present article, we review the rich history of theory on self-concept in OCD, culminating in the contemporary fear of self conceptualization. We then draw conceptual parallels between the internal psychological tension generated by intrusive thoughts, and the experience of cognitive dissonance. A review of the literature reveals considerable overlap between these two cognitive phenomena and demonstrates particular compatibility between self-affirmation theory and models of OCD in which fear of self is a central feature. Drawing on a theoretical synthesis of these literatures, it is suggested that cognitive dissonance research can provide insights that can be utilized to gain a deeper understanding of OCD. Potential applications of self-affirmation theory to OCD treatment are discussed.

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Why are some obsessions more upsetting than others?

Abstract

Section snippets

Why are some obsessions more upsetting than others?

Participants

Data screening

Thought content

Discussion

Psychosomatics

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Psychiatry Research

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Journal of Anxiety Disorders

A phenomenological analysis of symptoms in obsessive compulsive neurosis

British Journal of Psychiatry

Cognitive behavior therapy for obsessions and compulsionsnew applications and emerging trends

Journal of Contemporary Psychotherapy