Differences in clinical intrusive thoughts between obsessive–compulsive disorder, generalized anxiety disorder, and hypochondria

Abstract

Differences and similarities between intrusive thoughts typical of obsessive-compulsive disorder, generalized anxiety disorder, and hypochondriasis are relevant for their differential diagnosis, formulation, and psychological treatment. Previous research in non-clinical samples pointed out the relevance of some process variables, such as responsibility, guilt, or neutralization strategies. This research is aimed to investigate the differences and similarities between clinical obsessions, worries, and illness intrusions in some of these process variables. A second aim is to identify models based on these variables that could reliably differentiate between them. Three groups of patients with obsessive-compulsive disorder (n = 35; 60% women, mean age 38.57), generalized anxiety disorder (n = 36; 61.1% women, mean age 41.50), and hypochondriasis (n = 34; 70.6% women, mean age 31.59) were evaluated using the Cognitive Intrusions Questionnaire-Transdiagnostic Version (Romero-Sanchiz, Nogueira-Arjona, Godoy-Ávila, Gavino-Lázaro, & Freeston, ). The results showed that some appraisals (e.g., responsibility or egodystonicity), emotions (e.g., guilt or insecurity), neutralization strategies, and other variables (e.g., verbal content or trigger from body sensation) are relevant for the discrimination between obsessions, worries, and illness intrusions. The results also showed 3 stable models based on these variables for the discrimination between these thoughts. The implication of these results in the diagnosis, formulation, and psychological treatment of obsessive-compulsive disorder, generalized anxiety disorder, and hypochondriasis is discussed.

Illness‐related intrusive thoughts and illness anxiety disorder

“…The findings showed that more than half of the non‐clinical community participants had experienced illness‐ITs in the past three months, although their frequency was generally low (‘occasionally’). Nonetheless, it was noteworthy that the reported frequency was identical to what was observed for intrusive thoughts with obsessional contents in community samples (Belloch, Roncero, & Perpiñá, 2016), which supports the notion that intrusive thoughts can be viewed as transdiagnostic variables and might be considered vulnerability factors in different disorders (Belloch, 2012; Pascual‐Vera & Belloch, 2018a; Pascual‐Vera, Roncero, & Belloch, 2017; Romero‐Sanchiz et al , 2017).…”

“…For instance, some authors have reported that patients with IAD experience intrusive imagery about their health based on memories of an earlier event, and that the contents of these intrusions primarily refer to potential health threats and feared consequences of having medical problems (Muse, McManus, Hackmann, Williams, & Williams, 2010; Wells & Hackmann, 1993). More recently, Romero‐Sanchiz, Nogueira, Godoy, Gavino, and Freeston (2017) compared the similarities and differences among worries, obsessions, and illness intrusions in terms of the appraisals, emotions, and neutralizing strategies that these cognitive products instigate in patients with obsessive–compulsive disorder (OCD), hypochondriasis, and generalized anxiety disorder (GAD). Results showed that patients with OCD scored higher on responsibility and disapproval appraisals, egodystonicity, guilt, and their use of neutralizing strategies than patients with IAD and GAD.…”

“…Later, Langlois, Ladouceur, Patrick, and Freeston (2004) observed that, compared to obsessional intrusions and worries, illness intrusions were more egosyntonic. Arn aez, Garc ıa-Soriano and Belloch (2017) reported that illness-ITs experienced by undergraduate university students were unpleasant and activated not only negative emotional responses, but also dysfunctional appraisals and strategies to eliminate the discomfort caused by the thought. Additionally, a cross-cultural study with community participants in which illness-ITs were compared to obsessional-ITs showed that the two intrusive thought contents provoked a similar degree of disturbance across sites, even though illness-ITs were experienced less frequently than obsessional-ITs (Pascual-Vera et al, 2019).…”

Pain and Psychological Distress: Effect of Microvascular Decompression on Sleep Disorders and Obsessions in Trigeminal Neuralgia

“…In essence, obsession is a prerequisite for compulsion. 23 Clinically, we found that the majority of patients feared washing their faces, brushing their teeth, eating, and drinking because of severe pain. This psychological fear was found to affect patients' lives and to take up a lot of their time, severely reducing their quality of life.…”

Development and Evaluation of an Acceptance and Commitment Therapy based on Religious Content to Control Obsessive-Compulsive Disorder, Dysfunctional Beliefs, Feeling Guilty, Scrupulosity, and Thought Control among Muslims in Iran

“…In this regard, several studies and clinical observations have suggested the central role of guilt in the emergence and maintenance of OCD [13,14]. Additionally, dysfunctional metacognitive beliefs [15], obsession-related dysfunctional beliefs [16], and thought control strategies are among the factors involved in the development and persistence of OCD [17,18]. Furthermore, some studies suggest that changing dysfunctional beliefs associated with obsessions and compulsions is a suitable predictor of therapeutic changes and needs to be considered in interventions [16].…”