Toward understanding the heterogeneity in obsessive-compulsive disorder: Evidence from narratives in adult patients
Open accessAbstract
Background: Current attempts at understanding the heterogeneity in obsessive-compulsive disorder have relied on quantitative methods. The results of such work point toward a dimensional structure for obsessive-compulsive disorder. Existing qualitative work in obsessive-compulsive disorder has focused on understanding specific aspects of the obsessive-compulsive disorder experience in greater depth. However, qualitative methods are also of potential value in furthering our understanding of obsessive-compulsive disorder heterogeneity by allowing for open-ended exploration of the obsessive-compulsive disorder experience and correlating identified subtypes with patient narratives. Objective: We explored variations in patients’ experience prior to, during and immediately after performing their compulsions. Method: Semi-structured interviews were conducted with 20 adults with obsessive-compulsive disorder, followed by inductive thematic analysis. Participant responses were not analyzed within the context of an existing theoretical framework, and themes were labeled descriptively. Results: The previous dichotomy of ‘anxiety’ vs ‘incompleteness’ emerged organically during narrative analysis. In addition, we found that some individuals with obsessive-compulsive disorder utilized their behaviors as a way to cope with stress and anxiety more generally. Other participants did not share this experience and denied finding any comfort in their obsessive-compulsive behaviors. The consequences of attentional difficulties were highlighted, with some participants describing how difficulty focusing on a task could influence the need for it to be repeated multiple times. Conclusions: The extent to which patients use obsessive-compulsive disorder as a coping mechanism is a relevant distinction with potential implications for treatment engagement. Patients may experience ambivalence about suppressing behaviors that they have come to rely upon for management of stress and anxiety, even if these behaviors represent symptoms of a psychiatric illness.
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Studies of patients' descriptions have found that physiological fear and anxiety changes, such as a racing heart, play a key role in triggering obsessions and compulsions.
“In support, previous studies investigating the content of patients’ descriptions of their OCD symptoms have revealed that physiological changes associated with fear and anxiety, such as a racing heart, play a key role in triggering a variety of obsessions and compulsions [38].”
From Toward a neurocircuit-based taxonomy to guide treatment of obsessive-compulsive disorder (2021) · cites this paper as [38]
Some patients initially perform compulsions to elicit relief and continue performing them even after the rituals lose the ability to provide relief.
“Similarly, content analyses have revealed that some patients initially perform compulsions to elicit a sense of relief and that even though their compulsive rituals lose the ability to provide relief over time, the patients continue to perform the behaviors [38].”
From Toward a neurocircuit-based taxonomy to guide treatment of obsessive-compulsive disorder (2021) · cites this paper as [38]
Content analyses indicate that the ability to ignore obsessive thoughts and withhold associated compulsive behaviors is a key theme in patients' experiences of symptoms.
“In support, content analyses have indicated that the ability to ignore obsessive thoughts and withhold associated compulsive behaviors (i.e. use inhibition effectively) is a key theme in patients’ experiences of symptoms [38].”
From Toward a neurocircuit-based taxonomy to guide treatment of obsessive-compulsive disorder (2021) · cites this paper as [38]
Some OCD patients report reward and positive affect after completing compulsive behaviors.
“Previous work has also indicated that a proportion of patients with OCD report feelings of reward and positive affect following the completion of compulsive behaviors [24, 38].”
From Toward a neurocircuit-based taxonomy to guide treatment of obsessive-compulsive disorder (2021) · cites this paper as [38]
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- Authors
- Van Schalkwyk, G. I., Bhalla, I. P., Griepp, M., Kelmendi, B., Davidson, L., & Pittenger, C.
- Affiliations
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Yale University (US)
- Corresponding author
- Pittenger, Christopher
- Venue
- Australian & New Zealand Journal of Psychiatry
- Publisher
- SAGE Publications
- Published
- 2015-04-08
- Volume
- 50
- Issue
- 1
- Pages
- 74-81
- ISSN
- 0004-8674 (ISSN-L)
- 1440-1614
- PMC
- PMC4598276
- OpenAlex
- W2059492987
- Cited by
- 29
- References
- 34
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 5 · 2023: 3 · 2022: 3 · 2021: 2 · 2020: 3 · 2019: 1 · 2018: 3 · 2017: 3 · 2015: 1
- FWCI
- 2.89
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Australian & New Zealand Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Yale University
- National Institute of Mental Health (R01MH095790, R01MH091861)
- 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 › Psychoanalysis and Psychopathology Research
- Keywords
- obsessive-compulsive disorder, symptom heterogeneity, patient narratives, compulsive behavior, coping strategies, anxiety, incompleteness, attention deficits, treatment engagement, ambivalence
- MeSH terms
- Adaptation, Psychological, Adult, Anxiety, Attention, Female, Humans, Male, Middle Aged, Obsessive-Compulsive Disorder, Stress, Psychological, Narration, Qualitative Research, Young Adult
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