Intrusive Uncertainty in Obsessive Compulsive Disorder

Abstract

In this article we examine obsessive compulsive disorder (OCD). We examine and reject two existing models of this disorder: the Dysfunctional Belief Model and the Inference‐Based Approach. Instead, we propose that the main distinctive characteristic of OCD is a hyperactive sub‐personal signal of being in error, experienced by the individual as uncertainty about his or her intentional actions (including mental actions). This signalling interacts with the anxiety sensitivities of the individual to trigger conscious checking processes, including speculations about possible harms. We examine the implications of this model for the individual's capacity to control his or her thoughts.

(Un)reasonable doubt as affective experience: obsessive–compulsive disorder, epistemic anxiety and the feeling of uncertainty

“…A similar alternative option has recently been put forward by Cochrane and Heaton (2017). They suggest that the persistent doubt in OCD sufferers results from the hyperactivation of a subpersonal signal of uncertainty.…”

“…I present some OCD symptoms as the result of such a chronically dysfunctional doubt, and I introduce two different views suggesting that dysfunctional experiences linked to subjective certainty or uncertainty underly these OCD symptoms. Expanding on Cochrane and Heaton (2017), I argue that the intrusive doubt of OCD patients suggests a chronic dysfunction of the metacognitive mechanisms underlying the feeling of uncertainty.…”

Obsessive-compulsive disorder and recalcitrant emotion: relocating the seat of irrationality

“…7 For a recent account identifying obsessive thoughts with doxastic attitudes, see Kampa (2020). Relatedly, while Cochrane & Heaton (2017) and Vazard (2021) don't identify obsessive thoughts with such doxastic attitudes, they claim that OCD is essentially associated with doubt or significant uncertainty as to whether the obsessive thoughts are false. This would also make world-directed insight impossible, since one cannot at once know and doubt that a thought is false.…”

Obsessive–compulsive akrasia

“…But you might think obsessions are not doxastic at all. Rather, what I have been calling “doxastic obsessions” might in fact reduce to pathological doubts (Cochrane & Heaton, ). On the doubt‐based account of OCD, Amelia does not believe she hit someone with her car; she merely doubts whether she hit someone with her car.…”