Is OCD fuelled by a fear of the self?

Most of us have unwanted thoughts and images that pop into our heads and it's not a big deal. But for people with a diagnosis of obsessive-compulsive disorder (OCD) these mental intrusions are frequently distressing and difficult to ignore. A new article in Clinical Psychology and Psychotherapy explores the possibility that the reason these thoughts become so troubling to some people is that they play on their fears about the kind of person they might be.

The reasoning goes something like this: If, for instance, you or I  had a sudden mental of image of stabbing someone, we might find it strange and unpleasant, but – assuming we are mentally well – the moment would quickly pass and be forgotten. In contrast, to someone with an ongoing, nagging fear that they are dangerous and that they might one day harm somebody, the unwanted image could fuel their anxieties and end up becoming part of long-running obsession, no matter that their fears have no basis in reality.

Gabriele Melli and his colleagues recruited 76 participants diagnosed with OCD, who were about to embark on psychotherapy at a private clinic in Italy. The researchers interviewed the participants about their OCD-related symptoms, their anxiety and depression, and their self-related fears. This last measure featured items like "I fear perhaps being a violent, crazy person"; "I am afraid of the kind of person I could be"; and "I often doubt that I am a good person" to which the participants rated their agreement.

Even after factoring out the part played by anxiety, depression and a general tendency for obsessive beliefs (for example, thinking that having a bad urge is as bad as carrying out that urge), the researchers found that a greater fear of the self was independently associated with having more unacceptable and repugnant thoughts, and also to the importance the participants attributed to these thoughts and the need they had to control them.

While cautioning that their results are only preliminary – the sample is relatively small, the measures depended on self-report, were correlational, and there was no control group – Melli and his colleagues believe there could be important clinical insights here. For instance, some patients with OCD might benefit from help realising their obsessive thoughts have no basis in reality and are not a reflection of their "true self". The findings also build on past research that's shown, for example, that people with OCD find intrusive thoughts more troubling when they seem to contradict a valued aspect of their sense of self, and that people with OCD are more uncertain than healthy controls about their self-concept.

Further reading

Melli, G., Aardema, F., & Moulding, R. (2016). Fear of Self and Unacceptable Thoughts in Obsessive-Compulsive Disorder Clinical Psychology & Psychotherapy, 23 (3), 226-235 DOI: 10.1002/cpp.1950