Is a vivid imagination at the heart of OCD?

Considering that obsessive compulsive disorder (OCD) is characterised by a fear that "bad things" will happen if certain rituals are not performed, it's surprising that so little is known about the role of imagination in the condition.

All the more so given classic work by Daniel Kahneman and Amos Tversky that showed the easier we find it to imagine a given outcome, the more probable we think that outcome will be – a phenomenon they dubbed the simulation heuristic.

Following this logic, perhaps part of the reason people with OCD fear bad things will occur, if they don't perform their rituals, is because they find it so easy to imagine bleak consequences.

Nadine Keen and colleagues have made an initial attempt to plug this gap in the literature, by testing whether there is an association between the ability of people with OCD to imagine a given feared scenario and their subsequent worry and belief that that scenario will actually occur.

Seventeen men and thirteen women with OCD were presented with the beginnings and endings of various feared scenarios. For example, they were to imagine being served a meal in a restaurant by a waitress who they knew had just visited the toilet. They were then to imagine waking up the next morning feeling ill. Their task was to fill in the middle part of the story. The participants were presented with stories that were more or less relevant to their particular variety of OCD (e.g. hoarding or contamination-based), as well as control stories that had positive endings.

The key prediction was that the ease with which the participants were able to fill in the missing gaps (as gauged by independent judges) would be linked with how likely they subsequently rated that scenario as being in real life, and therefore how worried they would be about it. However, this wasn't found. Ease of imagination predicted subsequent worry, but not how likely the participants thought that scenario would be. Moreover, ease of imagination wasn't linked with any cognitive features of OCD such as perfectionism.

However, not all the results were negative. Participants found it easier to imagine the scenarios that were more relevant to their particular form of OCD, and the participants with more vivid imaginations showed more OCD-related symptoms.

Although the key result turned out negative, the researchers concluded that there is reason to pursue this line of enquiry further. "The present approach has the potential for tapping into the type of dynamic and cyclical thinking processes at the heart of disorders like OCD that questionnaire methods are inadequate for accessing," they said.

Further reading

Keen, N., Brown, G.P., Wheatley, J. (2008). Obsessive compulsive symptoms and the simulation of future negative events. British Journal of Clinical Psychology, 47(3), 265-279. DOI: 10.1348/014466508X282833