A study of doubt in obsessive-compulsive disorder

Abstract

Background and objectives: Obsessive-compulsive disorder (OCD) has been referred to as the “doubting disease,” yet there has been little foundational research on its phenomenology and characteristics. Studies of doubt have relied on researchers’ idiosyncratic conceptualizations of the construct, resulting in varied assessment methods and different prevalence rates (11–75%). We examined the nature and characteristics of doubt in people with clinical and subclinical OCD so as to identify its nature and characteristics, and factors that may be unique to OCD. Methods: A semi-structured interview about doubt was administered to people with OCD (N = 44) and with subclinical OCD (N = 21). Results: Doubt was highly prevalent and manifested as a form of obsession, uncertainty about whether a task was done properly, and/or lack of confidence in memory and perceptions. All participants took action to resolve doubt and/or proactively pre-empt or reduce future doubt. Doubt was deeply connected to negative core beliefs about the self. The groups did not differ on their experience of doubt, except that greater symptom severity was associated with greater interference from doubt, less ability to resist it, and less success of proactive, but not reactive, strategies to manage it. Limitations: We relied on retrospective report, and the subclinical group was relatively small. Conclusions: In subclinical and clinical OCD, doubt is pervasive, manifests in three domains, is connected to negative core beliefs, and is highly aversive. Continued empirical study of doubt is essential to proper assessment and to development of theories and treatment of OCD.