The doc and its emotions
Obsessive compulsive disorder (DOC) is a highly disabling and tendentially chronic psychopathological disorder characterized by the presence of clinical obsessions and compulsions.
Obsessions are thoughts, impulses, involuntary mental images and perceived as intrusive and disturbing by the individual. The compulsions are Visible behaviors or mental actions aimed at reducing, eliminating and preventing the discomfort connected to obsessions (American Psychiatric Association (APA), 2013).
Although the Doc has been placed for years within anxiety disorders, more recently the international diagnostic manuals describe it as a disorder with diversified events, also on an emotional-emotional level.
This is demonstrated by the fact that international psychiatric nosography has recognized a role in its own right and very different from other anxiety disorders. Terms such as “anxiety” and “fear” have been replaced by Words such as “discomfort” or “distress”to describe the typical emotional state experienced by the patient when in the obsessive state.
The forms of emotional discomfort
The term “discomfort” however imprecise refers to a wide range of emotional nuances that can accompany mental obsessions.
In fact, the DOC, initially described as a picture connoted by anxiety linked to the fear of being responsible for errors (obsessions) and the need to eliminate doubts about it (compulsions), has proven to be a more varied and diversified problem in terms of motivations and emotions underlying symptoms.
Hypertrophic and fear of guilt in the doc
Obsessive compulsive disorder has always been associated with theme of responsibility and guilt.
Already in psychoanalysis, Freud had attributed the obsessive symptoms to the effect of an excessively rigid and severe superio.
In 1985 Salkovskis described the concept of “Hypertrophic responsibility” As the belief of having a fundamental power in preventing catastrophic consequences of certain events (Salkovskis & Forrester, 2002). Since then the construct has been at the center of large strands of research on the DOC and its mechanisms.
The confirmations to this result come from experimental and non-experimental studies, which highlighted the association between the sense of responsibility and obsessive-compulsive symptoms.
Studies on hypertrophic liability
The induction of the sense of liability also produces obsessive -like symptoms in non -clinical subjects (of Olimpio & Mancini, 2014; Mancini et al, 2004) and a reduction in the sense of responsibility leads to symptoms in obsessive patients (Lopatka & Rachman 1995; Jónsson et al., 2011).
What we know today is that Hypertrophic liability plays a fundamental role in theziopathogenesis of the disorder Also by checking other significant variables such as anxiety, depression and symptoms pre -morbid symptoms (Abramowitz et al., 2006).
The construct of the fear of guilt
The concept of hypertrophic responsibility was then put in association with the construct of the fear of guilt: Obsessive subjects, in fact, precisely because they are convinced that they must prevent any possible damage for their responsibility, would be more prone to engage in strategies to cancel the risk of error for Avoid consequent emotions of guilt.
Currently the fear of guilt is at the center of the cognitive-behavioral conceptualization of the disorder (Mancini et al., 2016) where obsessive symptoms are considered a method of neutralization or prevention of the possibility of feeling guilty for irresponsibility (Salkovskis, 1985; Rachman, 1993, 2002, 2006; Van Oppen & Arrntz 1994; Salkovskis & Forrester 2002; Mancini; & Gangemi 2004, 2011).
In the field of research, the fear of guilt has proven to be the fundamental predictor of the severity of obsessive symptoms, more than personological variables such as sensitivity or propensity to guilt (Cosentino et al., 2020).
Not Just Right Experience (NJRE) in DOC
The first contributions that considered a motivational factor other than the fear of guilt in the DOC are those of Summerfeldt (2004) and Coles and collaborators (2003).
The authors highlighted a class of DOC symptoms not totally explained by the constructs of hypertrophic liability or fear of guilt but associated with the need to eliminate or prevent a subjective feeling of discomfort identified with the term “Not Just Right Experiences” (Njres).
The Njre has been described as a subjective feeling that something is not as it must be, a discomfort connects to the perception of inaccuracy or incompleteness of certain objects in the world or aspects of oneself (Coles et al., 2003; Rasmussen & Eisen, 1992).
Since then, a series of evidence have been collected regarding the importance of the role of NJRE’s progress in etiology and in the maintenance of obsessive symptoms (Belloch et al., 2016; Coles & Ravid, 2016; Bottese et al., 2017; Cougle et al., 2013; Sica et al., 2015; Summerfeldt et al., 2014).
This emotional dimension seems to be Particularly widespread among DOC patients with order symptoms and symmetry (Coles et al 2003; Ferrao et al., 2012), although some studies have shown a transversal role in all the symptoms sub -categories (Sica et al., 2016)
The role of disgust in the doc
Over the past 10 years it has been observed how a third emotional factor exists that motivates obsessive-compulsive behaviors: disgust.
A large amount of experimental studies and has not shown how much the avoidance of the disgust is playing a decisive role in the genesis and maintenance of Obsessive-compulsive mechanisms (Cisler et al., 2010; Olatunji et al., 2020; Melli et al., 2015; D’Olimpio et al., 2013).
In particular, this appears to be central in the DOC symptoms connected to the fear of contamination (Calamari et al., 2006; Ecker & Gonner, 2008; Cisler, Olaunji & Lohr, 2009).
In fact, there are patients who present dirt fears and washing and cleaning rituals because they are concerned about the consequences of contamination (such as being able to contract a disease or intoxicate). These subjects therefore fear damage for their responsibility in the event that they have not been well cleaned and are motivated by fear of guilt.
However, there is a second class of symptoms in which the fear of contamination is associated with mere need to avoid an emotion of intense disgust without the person themes the consequences in terms of health damage (Olatunji et al., 2009).
Although the disgust is particularly present in the obsessive symptoms of contamination, we also find it in patients with religious obsessions (Olatunji, Tolin, Huppert, And Lohr, 2005).
A new tool for measuring emotions that guide the symptoms
On the basis of what has been said, it is easy to guess the need to have, among the evaluation tools aimed at obsessive-compulsive disorder, a measurement scale aimed at identifying the emotions underlying the DOC symptoms.
An analysis of current literature are not existing tools that measure all three of the emotional dimensions mentioned.
Given these conditions, a recent study (Carraresi et al., 2024) has made it possible to build, refine and validate a new self -administered tests aimed at identifying fear of guilt, disgust and NJre connected to obsessive-compulsive symptoms.
The construction of the test
The authors first created a large pool of item aimed at investigating the avoidance of guilt, disgust and NJRE and then submitting them to a group of experts and non -clinical subjects to have feedback on readability, comprehensibility and relevance. Some have been eliminated, others modified.
Some examples of items created were: “When I think I can be guilty of something I often feel the need to prevent it”, “often when I feel a feeling of disgust I worry about cleaning myself until it passes”, “I keep fixing things until I feel calm”.
The list of the 40 situations obtained towards which the subjects should have expressed their degree of agreement on a scale of 1 (not at all in agreement) to 5 (completely in agreement) went to form the preliminary version of the test.
This preliminary version was administered to a sample of 323 non -clinical subjects And the first analyzes of the data have made it possible to test the three factors of the scale. This after streamlining the instrument to a lower number of items by selecting the best, then evaluating its reliability.
The final version
The final version of the scale, reduced to 18 items with 3 subsbuses (fault, disgust and njre) each of 6 items, was then administered to a second large sample of non -clinical subjects always of Italian nationality and always randomly found as volunteers.
This second study confirmed the existence of Three subsidies And he further proven good results in terms of both validity of construct and temporal stability of the instrument.
The built scale, called Compulsive Obsessive Core Dimensions Scale (OC-CDS)It turns out to be a tool with good psychometric characteristics and can be considered a valid and reliable measure for the emotional factors connected to the OC symptoms.
Conclusions
To date we know that obsessive-compulsive disorder is a far from homogeneous disorder, not only in terms of phenomenology of symptoms but also in relation to the underlying motivational and emotional thrust.
It is evident in fact how The emotions that patients with doc attempt to avoid are not only anxiety and guilt, but also others, such as disgust and discomfort connected to the sense of incompleteness or njre.
This tool provides an excellent contribution in the clinical field within the assessment phase of the patient’s obsessive-compulsive symptomatology, which must be evaluated in its most varied manifestations, both in behavioral and emotional-cognitive terms.
To date, in fact, clinicians who deal with DOC treatment know that therapeutic strategies must also take into account this emotional dimensions. This is because specific and diversified intervention protocols have now been recognized (Melli and Carraresi, 2023).
The compulsive obsessive scale core dimensions scale (OC-CDS) can therefore be considered an important support in the correct early identification of the emotional factors at stake, allowing the clinician to plan therapeutic modules based on a correct formulation of the case.
Bibliographic notes
- APA (2013). DSM-5. Guilford Press.
- Carraresi, C., Caccico, L., Lebruto, A., Padovani, M., Paiardini, D., Galleschi, A. & Melli, G. (2024). Anxiety, disgust and njre: how to differentiate the three emotional factors that motivate the obsessive-compulsive symptoms, presentation 2nd CB-Italy National Congress, Palermo 18-19 October 2024.
- Coles, M., Frost, R., Heimberg, R., & Rheaume, J. (2003). “Not Just Right Experiences”: Perfectationism, Obsessive-Compulsive Features and General Psychopathology. Behaviour Research and Therapy, 41, 681e700.
- Melli, G. & Carraresi C. (edited by) (2023). Cognitive-behavioral therapy of obsessive-compulsive disorder. Erickson
