Ironic effects of compulsive perseveration

Obsessive-compulsive symptoms and dissociative experiences: Suggested underlying mechanisms and implications for science and practice

A strong and specific link between obsessive-compulsive disorder or symptoms (OCD/S) and a tendency for dissociative experiences (e.g., depersonalization-derealization, absorption and imaginative involvement) cannot be explained by trauma and is poorly understood. The present theoretical formulation proposes five different models conceptualizing the relationship. According to Model 1, dissociative experiences result from OCD/S through inward-focused attention and repetition. According to Model 2, dissociative absorption causally brings about both OCD/S and associated cognitive risk factors, such as thought-action fusion, partly through impoverished sense of agency. The remaining models highlight common underlying causal mechanisms: temporo-parietal abnormalities impairing embodiment and sensory integration (Model 3); sleep alterations causing sleepiness and dreamlike thought or mixed sleep-wake states (Model 4); and a hyperactive, intrusive imagery system with a tendency for pictorial thinking (Model 5). The latter model relates to Maladaptive Daydreaming, a suggested dissociative syndrome with strong ties to the obsessive-compulsive spectrum. These five models point to potential directions for future research, as these theoretical accounts may aid the two fields in interacting with each other, to the benefit of both. Finally, several dissociation-informed paths for further developing clinical intervention in OCD are identified.

From brooding to detachment: Rumination longitudinally predicts an increase in depersonalization and derealisation

OBJECTIVES

Depersonalization-derealization (DEP-DER) is a dissociative experience which is related to psychopathology and distress. Yet, the aetiological factors leading to DEP-DER are not sufficiently clear. In this study, we suggest rumination as one possible antecedent. Thus, the goal of the study was to explore the longitudinal relationship between rumination and DEP-DER.

DESIGN

Longitudinal self-report study; mixed clinical and community sample.

METHODS

The study was conducted on 98 participants, 49 of them were diagnosed with depression, anxiety disorders, or obsessive-compulsive disorder, and the other 49 were healthy, matched community controls. The participants underwent a structured clinical interview and completed a battery of questionnaires. Then, the participants completed the same battery again once a month, for five additional assessment points (6 months in total). The data were analysed using multilevel linear modelling with time-lag analysis.

RESULTS

We found that levels of rumination and DEP-DER increased and decreased simultaneously, meaning that on assessments in which people reported that they tended to ruminate, they also reported higher levels of DEP-DER symptoms. In addition, we found support for a unidirectional association, consistent with our theoretical hypothesis. Specifically, rumination levels on a certain month longitudinally predicted a higher likeliness for reporting DEP-DER on the following month, even when controlling for the contemporaneous relationship. Conversely, DEP-DER symptoms did not longitudinally predict increased rumination.

CONCLUSIONS

These findings suggest that rumination may be an antecedent of DEP-DER, but not vice versa. Possible mechanisms to explain this link are discussed.

PRACTITIONER POINTS

Rumination and DEP-DER oscillate together over time; additionally, rumination predicts a longitudinal increase in DEP-DER. Clinicians noticing ruminative thought followed by decreased emotionality should distinguish between an authentic decrease of distress versus detachment. The findings provide one possible explanation for the frequency of DEP-DER symptoms in anxiety and depressive disorders. Poor sleep quality and emotion regulation difficulties should be explored as potential mediators explaining this link.

The the the the induction of jamais vu in the laboratory: word alienation and semantic satiation

Jamais vu is a phenomenon operationalised as the opposite of déjà vu, i.e. finding subjectively unfamiliar something that we know to be familiar. We sought to document that the subjective experience of jamais vu can be produced in word alienation tasks, hypothesising that déjà vu and jamais vu are similar experiential memory phenomena. Participants repeatedly copied words until they felt "peculiar", had completed the task, or had another reason to stop. About two-thirds of all participants (in about one-third of all trials) reported strange subjective experiences during the task. Participants reported feeling peculiar after about thirty repetitions, or one minute. We describe these experiences as jamais vu. This experimentally induced phenomenon was related to real-world experiences of unfamiliarity. Although we replicated known patterns of correlations with déjà vu (age and dissociative experiences), the same pattern was not found for our experimental analogue of jamais vu, suggesting some differences between the two phenomena. However, in daily life, those people who had déjà vu more frequently also had jamais vu more frequently. Findings are discussed with reference to the progress that has been made in déjà vu research in recent years, with a view to fast-tracking our understanding of jamais vu.

Intolerance of Uncertainty in eating disorders: An update on the field

Pathological fear and anxiety regarding food, eating, weight and body shape are at the core of eating disorder (ED) psychopathology. To manage anxiety, patients develop complicated repertoires of ritualistic and repetitive behaviours, which can lead to total functional impairment. Yet the cognitive processes underlying anxiety, fear, and anxiety-driven behaviours in EDs remain poorly understood. Intolerance of Uncertainty (IU) is defined as a tendency to react negatively on an emotional, cognitive, and behavioural level to uncertain situations and events. There is substantial evidence that IU is a transdiagnostic process that contributes to the maintenance of anxiety disorders; however, IU may also be relevant to the understanding and treatment of EDs. The current review summarises the growing literature examining IU in relation to ED symptoms, including restriction, bingeing, purging, ritualised behaviours, reassurance-seeking and body checking. Extending from the obsessive-compulsive disorder (OCD) and anxiety disorder literature, we propose that IU provides a novel theoretical and clinical framework from which to understand the anxiety, fixation with rules and rituals, and the cognitively rigid profile that is characteristic of ED presentations. We conclude with suggestions for future research, and discuss IU as a potential treatment target for core features of EDs and comorbid symptoms.

Stop checking: Repeated checking and its effects on response inhibition and doubt

BACKGROUND

Repeated checking is a common ritual in obsessive-compulsive disorder (OCD). van den Hout and Kindt (2003b) devised a task demonstrating paradoxical reductions in memory confidence following repeated checking. This effect was later found to be contingent upon response inhibition. The current study aims to (1) test an alternative interpretation, whereby repeated-checking effects are caused by viewing multiple exemplars, and (2) test whether repeated checking affects response inhibition.

METHOD

132 students participated in two experiments (66 in Experiment 1 and 66 in Experiment 2). Participants were randomly allocated to a repeated-checking task or a simple-action task that featured similar multiple exemplars without the need for checking. Both tasks were followed by a stop-signal task, measuring response inhibition. Experiment 1 featured a stop-signal task with neutral go-signals while Experiment 2 incorporated familiar and unfamiliar stimuli from the previous task as go-signals.

RESULTS

In both experiments, the repeated-checking group exhibited reduced memory confidence compared to the simple-action group. Groups did not differ in their response inhibition for neutral stimuli (Experiment 1), while familiar go-signals had a detrimental effect on response inhibition (Experiment 2).

LIMITATIONS

Our results examine the association between checking and response inhibition in healthy participants without attention deficit hyperactivity disorder and dyslexia. Replication with clinical samples awaits future studies.

CONCLUSIONS

Repeated checking impairs memory confidence. Increased familiarity of stimuli shortens the time it takes to respond to them while it impairs inhibition response to them. These effects possibly provide initial evidence for the hypothesized role of response inhibition in the maintenance of OCD.

Perseveration induces dissociative uncertainty in obsessive-compulsive disorder

BACKGROUND AND OBJECTIVES

Obsessive compulsive (OC)-like perseveration paradoxically increases feelings of uncertainty. We studied whether the underlying mechanism between perseveration and uncertainty is a reduced accessibility of meaning ('semantic satiation').

METHODS

OCD patients (n = 24) and matched non-clinical controls (n = 24) repeated words 2 (non-perseveration) or 20 times (perseveration). They decided whether this word was related to another target word. Speed of relatedness judgments and feelings of dissociative uncertainty were measured. The effects of real-life perseveration on dissociative uncertainty were tested in a smaller subsample of the OCD group (n = 9).

RESULTS

Speed of relatedness judgments was not affected by perseveration. However, both groups reported more dissociative uncertainty after perseveration compared to non-perseveration, which was higher in OCD patients. Patients reported more dissociative uncertainty after 'clinical' perseveration compared to non-perseveration..

LIMITATIONS

Both parts of this study are limited by some methodological issues and a small sample size.

CONCLUSIONS

Although the mechanism behind 'perseveration → uncertainty' is still unclear, results suggest that the effects of perseveration are counterproductive.

Differential role of visuospatial working memory in the propensity toward uncertainty in patients with obsessive-compulsive disorder and in healthy subjects

BACKGROUND

Obsessive-compulsive disorder (OCD) is associated with visuospatial working memory deficits. Intolerance of uncertainty is thought to be a core component of OCD symptoms. Recent findings argue for a possible relationship between abilities in visuospatial memory and uncertainty. However, this relationship remains unclear in both OCD patients and healthy subjects. To address this issue, we measured performance in visuospatial working memory and the propensity to express uncertainty during decision making. We assessed their relationship and the temporal direction of this relationship in both OCD patients and healthy subjects.

METHOD

Baseline abilities in visuospatial working memory were measured with the Corsi block-tapping test. A delayed matching-to-sample task was used to identify explicit situations of certainty, uncertainty and ignorance and to assess continuous performance in visuospatial working memory. Behavioural variables were recorded over 360 consecutive trials in both groups.

RESULTS

Baseline scores of visuospatial working memory did not predict the number of uncertain situations in OCD patients whereas they did in healthy subjects. Uncertain trials led to reduced abilities in visuospatial working memory to 65% of usual performance in OCD patients whereas they remained stable in healthy subjects.

CONCLUSIONS

The present findings show an opposite temporal direction in the relationship between abilities in working memory and uncertainty in OCD patients and healthy subjects. Poor working memory performance contributes to the propensity to feel uncertainty in healthy subjects whereas uncertainty contributes to decreased continuous performance in working memory in OCD patients.

Assessing neurocognitive function in psychiatric disorders: a roadmap for enhancing consensus

It has been challenging to identify core neurocognitive deficits that are consistent across multiple studies in patients with Obsessive Compulsive Disorder (OCD). In turn, this leads to difficulty in translating findings from human studies into animal models to dissect pathophysiology. In this article, we use primary data from a working memory task in OCD patients to illustrate this issue. Working memory deficiencies have been proposed as an explanatory model for the evolution of checking compulsions in a subset of OCD patients. However, findings have been mixed due to variability in task design, examination of spatial vs. verbal working memory, and heterogeneity in patient populations. Two major questions therefore remain: first, do OCD patients have disturbances in working memory? Second, if there are working memory deficits in OCD, do they cause checking compulsions? In order to investigate these questions, we tested 19 unmedicated OCD patients and 23 matched healthy controls using a verbal working memory task that has increased difficulty/task-load compared to classic digit-span tasks. OCD patients did not significantly differ in their performance on this task compared to healthy controls, regardless of the outcome measure used (i.e. reaction time or accuracy). Exploratory analyses suggest that a subset of patients with predominant doubt/checking symptoms may have decreased memory confidence despite normal performance on trials with the highest working memory load. These results suggest that other etiologic factors for checking compulsions should be considered. In addition, they serve as a touchstone for discussion, and therefore help us to generate a roadmap for increasing consensus in the assessment of neurocognitive function in psychiatric disorders.