Intolerance of uncertainty as a cognitive vulnerability for obsessive-compulsive disorder: A qualitative review.
Open accessAbstract
Intolerance of uncertainty (IU) is the tendency to react negatively to uncertain situations. In this review, we critically evaluate the evidence for IU as a cognitive vulnerability for obsessive-compulsive disorder (OCD), including (a) evidence for a robust association between IU and OCD symptoms, (b) evidence that IU is stable and trait-like, (c) evidence for IU as a causal risk factor that influences the development of OCD directly or indirectly, and (d) evidence that IU is malleable to intervention. The available evidence suggests that IU is likely a candidate cognitive vulnerability factor for OCD, though additional research is needed to determine if increasing tolerance for uncertainty is a mechanism of effective OCD treatment. Future research examining IU across multiple levels of analysis and a more rigorous examination of the nomological network of IU may identify specific pathways contributing to the development and maintenance of OCD.
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One investigation noted that OCD patients (and anxious controls) lacked the normal frontally maximal N2 seen in healthy subjects and failed to show the expected lengthening of N2 latency under increased inhibitory load.
“one investigation noted that OCD patients (and anxious controls) lacked the normal frontally maximal N2 seen in healthy subjects and failed to show the expected lengthening of N2 latency under increased inhibitory load [26].”
From Neural correlates of response inhibition following cognitive behavioral therapy in obsessive–compulsive disorder: a randomized controlled EEG study (2026) · cites this paper as [26]
The Multimodal Measurement of IU section discusses P300 and error-related negativity, but not N2 findings in OCD patients or anxious controls. Searches for frontally maximal N2, N2 latency, and inhibitory load found no passage addressing the claimed investigation; page numbers were not available in our copy. (LLM, conf=0.75)
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Jacoby, R. J., Reuman, L., Blakey, S. M., Hartsock, J. T., & Abramowitz, J. S. (2017) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2017.11.003 · Cited by 8 · see citing works
Osmanağaoğlu, N., Creswell, C., & Dodd, H. F. (2021) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2021.101654 · Cited by 7 · see citing works
Ferry, R. A., & Nelson, B. D. (2021) · Biological Psychology · doi:10.1016/j.biopsycho.2021.108094 · Cited by 7 · see citing works
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Assessment of intolerance of uncertainty: Validation of a modified anagram task
O’Bryan, E. M., Beadel, J. R., McLeish, A. C., & Teachman, B. A. (2021) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2021.101671 · Cited by 4 · see citing works
Flagged first, then by citations
Research works printed but not linked: 2
- Jacoby RJ, & Abramowitz JS (2017). Intolerance of uncertainty in OCD. In Pittenger C (Ed.), Obsessive-compulsive disorder: Phenomenology, pathophysiology, and treatment (pp. 171– 177). Oxford University Press. http://search.proquest.com/psycinfo/docview/2018649740/4525F0583DC44084PQ/68
- Pinciotti CM, Riemann BC, & Wetterneck CT (2020). Differences in intolerance of uncertainty in OCD and comorbid PTSD underlying attenuated treatment response. Annals of Psychiatry and Mental Health, 8(1), 1142. https://www.jscimedcentral.com/public/assets/articles/psychiatry-8-1142.pdf
Cited by
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Self-citationVincenzo, C. D., Demaria, F., Bertoncini, I., Menghini, D., Antonietti, A., Vicari, S., & Pontillo, M. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1750938 · Cited by 5 · see citing works
Tolerance to uncertainty as a factor in the mental health of the population in conditions of war
Trofimov, A. Y., & Zabolotna, V. (2023) · Social & Legal Studios · doi:10.32518/sals3.2023.189 · Cited by 11 · see citing works
Factors Associated With Misophonia: A Systematic Review
Koroglu, S., & Durat, G. (2024) · Revista Colombiana de Psiquiatría · doi:10.1016/j.rcp.2024.04.010 · Cited by 4 · see citing works
Laposa, J. M., & Puccinelli, C. (2026) · Journal of Clinical Psychology · doi:10.1002/jclp.70081 · Cited by 3 · see citing works
Guo, Q., Zhu, R., Zhou, H., Wang, D., & Zhang, X. (2025) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2025.103048 · Cited by 3 · see citing works
Ding, X., Zhao, Z., Wang, J., Chen, C., Ding, S.-C., Gao, J., Deng, J., & Liu, D.-D. (2025) · PeerJ · doi:10.7717/peerj.19791 · Cited by 5 · see citing works
Fu, C., Jin, L., Ye, B., & Yang, Q. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1277146 · Cited by 3 · see citing works
ТОЛЕРАНТНІСТЬ ДО НЕВИЗНАЧЕНОСТІ ЯК ЧИННИК УХВАЛЕННЯ РІШЕНЬ ТА СТРЕСОВОЇ АДАПТАЦІЇ КЕРІВНИКІВ БІЗНЕСУ
Гура, Г. Н. (2023) · Scientific Bulletin of Kherson State University Series Psychological Sciences · doi:10.32999/ksu2312-3206/2023-2-6 · Cited by 2 · see citing works
Spinoni, M., Giorgia, C., Porpora, M. G., & Grano, C. (2025) · The Journal of Sexual Medicine · doi:10.1093/jsxmed/qdaf046 · Cited by 1 · see citing works
Wang, D., Wang, D., Zong, T., Nie, X., Wu, X. C., & Hu, Y. (2025) · Current Psychology · doi:10.1007/s12144-025-07837-5 · Cited by 1 · see citing works
Zhang, L., & Takahashi, Y. (2025) · The Journal of Psychology · doi:10.1080/00223980.2025.2591890 · Cited by 1 · see citing works
Çınaroğlu, M., Ülker, S. V., Yılmazer, E., & Sayar, G. H. (2026) · BMC Psychology · doi:10.1186/s40359-026-05201-1
“Other studies have observed topographical and timing abnormalities: one investigation noted that OCD patients (and anxious controls) lacked the normal frontally maximal N2 seen in healthy subjects and failed to show the expected lengthening of N2 latency under increased inhibitory load [26].”
Exploring intolerance of uncertainty with an autistic older adult.
Kavanagh, K., & Le Brun, S. D. (2025) · FPOP Bulletin: Psychology of Older People · doi:10.53841/bpsfpop.2025.1.171.64
Chronic stress increased intolerance of risk but decreased intolerance of ambiguityPreprint
Chen, W., Yu, X., Deng, L., Yi, W., & Wu, J. (2024) · Research Square · doi:10.21203/rs.3.rs-4987490/v1
ETIOPATHOGENETIC ASPECTS OF OBSESSIVE-COMPULSIVE DISORDER
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Faro, A. L., Wolenski, R. A., Lee, C. B., Guvenek‐Cokol, P. E., Dickstein, D. P., & Fraire, M. G. (2025) · Children · doi:10.3390/children12040505
Ren, J.-X., Wang, X., Li, S.-H., & Wang, H. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-07522-8 · Cited by 1 · see citing works
Huang, B., Wu, C., Cao, H., Bi, Z., Song, G., Cheng, J., Gao, J., Wang, Y., Li, D., Zhao, Q., et al. (2025) · European Journal of Psychotraumatology · doi:10.1080/20008066.2025.2580890
Shnayder, S., Agin-Liebes, G., Hubert, T., Ching, T. H. W., Hokanson, J., Pittenger, C., Kelmendi, B., & Adams, T. G. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1799543
Perfectionism and Obsessive-Compulsive Symptom Dimensions in University Students
Quarantini-Alvim, Y., Lima, M. O., Alves-Pereira, R., Christo, R. B., Alves, G. S., Dib, L., Roiter, D. G., Cupertino, F., Quarantini, L. C., & Sampaio, A. (2026) · Cureus · doi:10.7759/cureus.109940
Koob, G., Becker, C. B., Hazzard, V. M., Varzeas, K. A., Wesley, N. Y., Rowan, M. R., & Stewart, T. M. (2026) · Journal of Eating Disorders · doi:10.1186/s40337-026-01703-w
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Optimistic Update Bias in Response to False Information
Razi, H., Sambrook, T. D., & Garrett, N. (2026) · Computational Brain & Behavior · doi:10.1007/s42113-026-00341-4
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- Authors
- Knowles, K. A., & Olatunji, B. O.
- Affiliations
- Hartford Hospital (US)
- Vanderbilt University (US)
- Venue
- Clinical Psychology: Science and Practice
- Published
- 2023-09
- Volume
- 30
- Issue
- 3
- Pages
- 317-330
- ISSN
- 0969-5893 (ISSN-L)
- 1468-2850
- PMC
- PMC11488751
- OpenAlex
- W4377021379
- Cited by
- 26
- References
- 87
- Citations by year
- 2026: 8 · 2025: 11 · 2024: 4 · 2023: 3
- FWCI
- 7.58
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Psychology Science and Practice (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (T32MH018921)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Perfectionism, Procrastination, Anxiety Studies
- Keywords
- intolerance of uncertainty, obsessive-compulsive disorder, cognitive vulnerability, causal risk factors, uncertainty tolerance, nomological network
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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