Elsevier

Behavior Therapy

Volume 39, Issue 3, September 2008, Pages 224-231
Behavior Therapy

Moving Beyond an Exclusive Focus on Harm Avoidance in Obsessive Compulsive Disorder: Considering the Role of Incompleteness

https://doi.org/10.1016/j.beth.2007.08.004Get rights and content

Abstract

Cognitive-behavioral conceptualizations of obsessive compulsive disorder (OCD) have predominantly viewed compulsions as being motivated by harm avoidance. However, sensations of things being incomplete or not “just right” may also underlie compulsions in OCD. Preliminary research suggests that distinguishing between harm avoidance and incompleteness in OCD may have practical utility, but the research on this topic is very limited to date. The current study further addressed the role of incompleteness in OCD. A confirmatory factor analysis provided evidence for harm avoidance and incompleteness as separate constructs in a student sample. Supporting the benefits of considering incompleteness in addition to harm avoidance, self-reported levels of both constructs were significantly correlated with all domains of OCD symptoms and perfectionism assessed. Further, some evidence for unique relationships was found (e.g., incompleteness with ordering and personally prescribed perfectionism; harm avoidance with obsessing). The role of incompleteness in OCD warrants greater attention.

Section snippets

Participants

The sample consisted of 377 undergraduate students (62% female) at a state university who received course credit for completing a packet of self-report questionnaires. Students enrolled in psychology courses were required to complete a research requirement as partial fulfillment of the course. In order to complete the research requirement, students could chose to participate in available studies, including the current study, or write a brief research paper. The mean age for the sample was 18.28

Results

Descriptive statistics for all study measures are presented in Table 1. Scores on these measures represented a range of OC symptoms, harm avoidance, incompleteness and perfectionism. Furthermore, scores on the study measures were generally consistent with available data from previous student samples (see Flett et al., 1995, Frost et al., 1991, Simonds et al., 2000). However, it is noteworthy that both the OCI and FMPS showed respondents with scores at, and above, the means for samples of

Discussion

Although the compulsions characteristic of OCD have conventionally been viewed as being primarily, if not entirely, motivated by a desire to prevent harm, results of the current study suggest that incompleteness may also drive compulsions in OCD. First, results of a confirmatory factor analysis provide additional support for the validity of harm avoidance and incompleteness as separate, though highly correlated constructs in student samples (Summerfeldt et al., 2001). Second, our results showed

References (43)

  • SalkovskisP.M. et al.

    Responsibility attitudes and interpretations are characteristic of obsessive-compulsive disorder

    Behaviour Research and Therapy

    (2000)
  • SteketeeG.S. et al.

    Obsessive-compulsive disorder: Differences between washers and checkers

    Behaviour Research and Therapy

    (1985)
  • TallisF.

    Compulsive washing in the absence of phobic and illness anxiety

    Behaviour Research and Therapy

    (1996)
  • VerdellenC.W.J. et al.

    Exposure with response prevention versus habit reversal in Tourette’s syndrome: A controlled study

    Behaviour Research and Therapy

    (2004)
  • AkaikeH.

    Factor analysis and AIC

    Psychometrika

    (1987)
  • ArbuckleJ.L.

    Amos 5.0 [Computer software]

    (2003)
  • BaerL.

    Factor analysis of symptom subtypes of obsessive compulsive disorder and their relation to personality and tic disorders

    Journal of Clinical Psychiatry

    (1994)
  • BentlerP.M. et al.

    Practical issues in structural modeling

    Sociological Methods and Research

    (1987)
  • CohenJ.

    Statistical power analysis for the behavioral sciences

    (1988)
  • Coles, M. E., Pinto, A., Mancebo, M. C., Rasmussen, S. A., & Eisen, J. L. (in press). OCD with comorbid OCPD: A subtype...
  • FlettG.L. et al.

    Dimensions of perfectionism and goal commitment: A further comparison of two perfectionism measures

    Journal of Psychopathology and Behavioral Assessment

    (1995)
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      Specifically, as has been suggested in prior work (Cougle et al., 2011; Wahl et al., 2008), it may be that washing compulsions are intended in part to reduce feelings that things are “not just right.” It should be noted that HA and INC were strongly correlated in the current sample (r = 0.75), which is consistent with prior work suggesting HA and INC are distinct, yet highly correlated, constructs (Pietrefesa & Coles, 2008). Therefore, there may be value to assessing both HA and INC/NJREs throughout treatment to determine the extent to which symptoms may be driven by one or both motivational factors.

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    This paper was presented at the 40th annual meeting of the Association for the Advancement of Behavior Therapy, Chicago, IL, November 2006.

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