Mild Uncertainty Promotes Checking Behavior in Subclinical Obsessive-Compulsive Disorder

Abstract

Patients with obsessive-compulsive disorder respond to clinical uncertainty with perseverative checking, which, ironically, enhances uncertainty. However, patients also display general subclinical uncertainty, which may tempt vulnerable individuals to seek reassurance by perseveration in response to mild uncertainty that is superimposed on general uncertainty. An experimental eye-tracking paradigm was developed to investigate whether mild uncertainty indeed induces checking behavior in people with high obsessive-compulsive tendencies (OC+, n = 34), compared to people with low obsessive-compulsive tendencies (OC–, n = 31). Participants were presented 50 visual search displays, and they indicated whether a target was “present” or “absent.” Decisions about target presence induced little uncertainty, but decisions about its absence were more ambiguous, because participants relied on not having overlooked the target. Results revealed no differences on target-present trials. However, in target-absent trials, OC+ participants searched longer and used more fixations. Thus, even in mildly uncertain situations, individuals with subclinical obsessive-compulsive disorder respond with more checking behavior, which has implications for treatment.

Uncertainty, checking, and intolerance of uncertainty in subclinical obsessive compulsive disorder: An extended replication

“…Finally, when looking at the whole range of OC tendencies, there was a positive relation between OC tendencies and checking behavior. The findings (partly) replicated those of Toffolo et al (2013) and add to their robustness. …”

“…This type seems more general and occurs in a wide range of domains and ambiguous situations, which is displayed, for instance, by less confidence in one's memory (Tuna, Tekcan, & Topcuoglu, 2005), perception (Hermans et al, 2008), concentration abilities (Nedeljkovic & Kyrios, 2007), and general knowledge (Dar, Rish, Hermesh, Taub, & Fux, 2000). Researchers argued that this elevated level of subclinical, general uncertainty may precede clinical OCD by acting as a vulnerability factor for the disorder (Nedeljkovic & Kyrios, 2007;Toffolo et al, 2013). Subclinical uncertainty may tempt individuals to seek reassurance by repeated checking in response to normal doubts.…”

Mental contamination: Relationship with psychopathology and transdiagnostic processes

“…Intolerance of uncertainty can be defined as the excessive tendency to react negatively to an uncertain or ambiguous event or situation, even if the probability of such an event occurring or the likelihood of negative consequences is very low (Ladouceur, Gosselin, & Dugas, 2000). Experimental studies inducing uncertainty in subclinical people with obsessive compulsive symptoms demonstrate that such uncertainty leads to checking behaviour (Toffolo, Van den Hout, Hooge, Engelhard, & Cath, 2013) and there is considerable work demonstrating that, in turn, checking causes doubt (Radomsky, Dugas, Alcolado, & Lavoie, 2014). In a large analogue sample, intolerance of uncertainty was found to mediate the relationship between perfectionism and OCD (Reuther et al, 2013).…”

Obsessive–compulsive symptoms and attentional bias: An eye-tracking methodology

“…Research examining attentional bias in OCD using eye-tracking methodologies is at an early stage with only a handful of studies using this approach on non-clinical populations (e.g., Armstrong Olatunji, Sarawgi & Simmons, 2010;Armstrong, Sarawgi, & Olatunji, 2012;Toffolo, van den Hout, Hooge, Engelhard & Cath, 2013). Results support the presence of attentional bias in OCD; however, there is still a lack of consistency regarding the precise type of attentional processing involved in this process (i.e., vigilance vs. delayed disengagement/maintenance).…”