The role of working memory in compulsive checking and OCD: A systematic classification of 58 experimental findings

doi:10.1016/j.cpr.2011.06.004

Clinical Psychology Review

Volume 31, Issue 6, August 2011, Pages 1004-1021

https://doi.org/10.1016/j.cpr.2011.06.004 Get rights and content

Abstract

Despite the large body of research regarding the role of memory in OCD, the results are described as mixed at best (Hermans et al., 2008). For example, inconsistent findings have been reported with respect to basic capacity, intact verbal, and generally affected visuospatial memory. We suggest that this is due to the traditional pursuit of OCD memory impairment as one of the general capacity and/or domain specificity (visuospatial vs. verbal). In contrast, we conclude from our experiments (i.e., Harkin & Kessler, 2009, 2011; Harkin, Rutherford, & Kessler, 2011) and recent literature (e.g., Greisberg & McKay, 2003) that OCD memory impairment is secondary to executive dysfunction, and more specifically we identify three common factors (EBL: Executive-functioning efficiency, Binding complexity, and memory Load) that we generalize to 58 experimental findings from 46 OCD memory studies. As a result we explain otherwise inconsistent research – e.g., intact vs. deficient verbal memory – that are difficult to reconcile within a capacity or domain specific perspective. We conclude by discussing the relationship between our account and others', which in most cases is complementary rather than contradictory.

Highlights

► We provide a novel system to explain otherwise contradictory OCD memory research. ► We extend the recent executive basis of OCD memory impairment argument. ► This includes Executive-Functioning, Binding Complexity and Memory Load. ► Therefore, OCD memory impairment is not primarily an issue of capacity and/or domain. ► We then compare the EBL system to other models of memory impairment in OCD.

Introduction

Despite a large body of research the evidence for memory impairments in OCD is described as mixed at best (Hermans, Engelen, Grouwels, Joos, Lemmens, & Pieters, 2008). For example, there are inconsistent findings regarding a general mnestic deficit (e.g. Tallis, 1997 vs. MacDonald et al., 1997, McNally and Kohlbeck, 1993), verbal memory (e.g., intact: Henseler, Gruber, Kraft, Krick, Reith, & Falkai, 2008 vs. deficit: Tuna, Tekcan, & Topcuoglu, 2005) and generally affected visuospatial memory (Hermans et al., 2008, Mataix-Cols et al., 1999, Muller and Roberts, 2005). We attribute this to the traditional pursuit of OCD memory impairment as one of the general capacity and/or domain specific deficits (visuospatial vs. verbal).

In contrast, a body of research indicates a more subtle relationship, with memory impairments secondary to executive dysfunction (Greisberg & McKay, 2003). If a memory task taps into a dysfunctional component of executive functioning, memory impairment will follow (see Table 1). In this understanding, it is executive deficits in conjunction with task requirements that differentiate memory functioning in OCD from controls (Olley, Malhi, & Sachdev, 2007). This review aims at providing a more precise level of explanation based on Baddeley's extended working memory model (2000) that offers an optimal platform for relating executive functions to representations in memory.

Section snippets

A working-memory explanation

Baddeley's original model (1986) included a central executive, phonological loop and visuospatial sketchpad and was deemed separate from long-term memory (LTM). While this simple model explained a range of data (e.g., phonological similarity, word-length effect), it could not account for all experimental phenomena. For example, the visuospatial sketchpad, a capacity limit of 4 units was observed for the maintenance of individual features (colors or orientations) as well as for integrated

Empirical evidence from subclinical checkers

With these points in mind, our recent experiments (Harkin and Kessler, 2009, Harkin and Kessler, 2011, Harkin et al., 2011) set out to: (1) engage the EB using stimuli that required multimodal conjunctions between various object features and spatial locations and to (2) hamper EB functionality by confronting high and low checkers with misleading/irresolvable information during the WM retention interval. In Harkin and Kessler (2009), we employed this novel paradigm for the first time. We

The EBL (Executive-Functioning, Binding Complexity, Memory Load) classification system

Our synthesis so far leads us to conclude that checkers' memory impairment results from a complex interaction between (1) executive dysfunction in encoding organization, multimodal integration, selective attention (inhibition), maintenance control, and set-shifting and (2) the task components of load (e.g., high load, requiring chunking), multimodality (e.g., location + identity + color), distraction (e.g., dual task paradigm), retrieval dimension (e.g., location), and stimulus salience (e.g.

Applying the EBL classification system to 58 experimental findings

Fig. 1 explains where we do and do not expect to observe OCD memory impairments relative to controls; this we suggest is influenced by the degree of executive function efficiency (E), binding complexity (B) and memory load (L) within any given neuropsychological task. First, we do not expect memory performance to differ between OCD patients and controls for tasks that are low in executive demand, binding and load (see: white region in top-left quadrant of Fig. 1). Second, likelihood for

Comparison of EBL classification system to other models in the OCD literature

The EBL classification system allowed us to explain, in a unified manner, how executive impairments observed in OCD/checking tend to impair memory when the episodic buffer is extensively relied upon. However, we are aware that our EBL classification system is primarily cognitive in nature, which poses the question: How does it relate to alternative and more phenomenogical explanations of OCD symptoms in general and of memory impairments in particular?

Salkovskis (1999) provided one of the most

Limitations of the EBL classification system

We highlight the following limitations to the EBL classification system. First, it is a good fit for OCD patients with prominent checking cognitions/behaviors, but appears not to describe symptoms such as cleaning or hoarding. We propose that if the EBL factors are sufficiently stressed (as discussed above) then memory impairment could be observed in symptoms other than checking. However, we do concur that due to the specific impairments (i.e., inhibition; Omori et al., 2007) and cognitive

Conclusions

This review reconciles inconsistent findings as to memory deficits in OCD by suggesting that the classic view in terms of modality-specific (verbal vs. visuospatial) deficits and/or general capacity issues might not be the optimal way of conceiving of the problem, while we propose to follow and extend the more recent argument that OCD memory impairments are secondary to executive dysfunction. Using our research as a basis, we argue that memory impairments occur when: (1) a task taps into

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The role of working memory in compulsive checking and OCD: A systematic classification of 58 experimental findings

Abstract

Highlights

Introduction

Section snippets

A working-memory explanation

Empirical evidence from subclinical checkers

The EBL (Executive-Functioning, Binding Complexity, Memory Load) classification system

Applying the EBL classification system to 58 experimental findings

Comparison of EBL classification system to other models in the OCD literature

Limitations of the EBL classification system

Conclusions

Trends in Cognitive Sciences

Behaviour Research and Therapy

Psychiatry Research

Neuroscience and Biobehavioral Reviews

Clinical Psychology Review

Personality and Individual Differences

Journal of Anxiety Disorders

Clinical Psychology Review

Behaviour Research and Therapy

Biological Psychiatry

Behaviour Research and Therapy

Journal of Anxiety Disorders

Psychiatry Research

Journal of Psychiatric Research

Biological Psychology

Behaviour Research and Therapy

Biological Psychiatry

Behaviour Research and Therapy

Behaviour Research and Therapy

Journal of Anxiety Disorders

Journal of Affective Disorders

Journal of Psychiatric Research

Psychiatry Research

Neuropsychologia

Biological Psychiatry

Behaviour Research and Therapy

Behaviour Research and Therapy

Journal of Behavior Therapy and Experimental Psychiatry

Progress in Neuro-Psychopharmacology & Biological Psychiatry

Progress in Neuro-Psychopharmacology & Biological Psychiatry

Psychiatry Research

Behaviour Research and Therapy

Behaviour Research and Therapy

Biological Psychiatry

Behaviour Research and Therapy

Journal of Psychiatric Research

Behaviour Research and Therapy

Behaviour Research and Therapy

Current Opinion in Neurobiology

Is the binding of visual features in working memory resource-demanding?

Journal of Experimental Psychology. General

Working memory

Sentence comprehension and phonological memory — Some neuropsychological evidence

Attention and Performance

Executive functions in obsessive–compulsive disorder: State or trait deficits?

The Australian and New Zealand Journal of Psychiatry

The Revised Visual Retention Test

Visuospatial abilities, memory, and executive functioning in trichotillomania and obsessive–compulsive disorder

Journal of Clinical and Experimental Neuropsychology

Selective cognitive deficits in obsessive–compulsive disorder compared to panic disorder with agoraphobia

Acta Psychiatrica Scandinavica

Missing the forest for the trees? Deficient memory for linguistic gist in obsessive–compulsive disorder

Psychological Medicine

Nonverbal memory dysfunction in obsessive–compulsive disorder patients with checking compulsions

Depression and Anxiety

Strategy implementation in obsessive–compulsive disorder and trichotillomania

Psychological Medicine

Impact of age on drawing the Rey–Osterrieth Figure

The Clinical Neuropsychologist