Beyond Belief: Incremental Prediction of Obsessive-Compulsive Disorder by Looming Vulnerability Illusions

Cognitive models argue that obsessions and compulsions arise from distorted beliefs and exaggerated interpretations of intrusive thoughts. While these models have led to important advances, recent research has suggested the need to go beyond the factors the models identify. One new factor to consider may involve looming vulnerability, the production of dynamic mental scenarios of danger outcomes (e.g., contamination, harming, losing wanted possessions) as rushing through time and space and escalating in odds of harm for the self. Looming vulnerability is a different form of cognition that differs from belief factors because it concerns the process of anticipating noxious events as rapidly rising in risk rather than static beliefs about the final end states (e.g., responsibility, perfection). The present study tested looming vulnerability by examining a small cohort of 37 patients with obsessive-compulsive disorder (OCD). Results provide strong preliminary evidence that looming vulnerability in OCD-related themes (e.g., contamination, hoarding, and pure obsessional) contributes significant and substantial variance to the prediction of obsessive compulsive symptom severity on the Yale-Brown Obsessive-Compulsive Scale beyond the effects of beliefs and interpretations. Thus, looming vulnerability may represent a different form of cognitive vulnerability for the development and persistence of clinical obsessions that warrants further investigation.