Obsessive–Compulsive Disorder and Suicidal Experiences: The Role of Experiential Avoidance

Abstract

Objective Obsessive–compulsive disorder (OCD) is a disabling mental health problem that affects a significant proportion of the general population. Experiential avoidance appears to account for the development of anxiety and depressive symptoms. However, its relationship with OCD has yielded contradictory results. Furthermore, although OCD‐specific thoughts and behaviors, including obsessing, checking, washing, and ordering, have been suggested to significantly predict suicidal ideation and behaviors, this line of research has received scant empirical attention. The overarching aim of this study was to explore the relationship between OCD, OCD‐specific behaviors, experiential avoidance, and suicidal experiences. Methods Overall, 1,046 adults from the community who completed self‐report scales participated. Results Strong links between overall OCD severity, obsessing, experiential avoidance, and suicidal experiences were established. Results from mediational analyses showed that overall OCD severity and individual obsessive–compulsive thoughts and behaviors were both directly and indirectly linked with suicidal experiences, via experiential avoidance. Obsessing was among the critical obsessive–compulsive symptoms leading to suicidal experiences. Conclusions These findings are important because they identify experiential avoidance as a potential key explanatory construct in accounting for the development of OCD and suicidal experiences. However, future research using longitudinal and/or experimental designs is needed to infer causality.

Clarifying the Placement of Obsessive-Compulsive Disorder in the Empirical Structure of Psychopathology

“…In order to reflect the literature indicating that hoarding is empirically distinct from OCD (Abramowitz et al, 2008;Chmielewski & Watson, 2008;Weiss & Khan, 2015;Wu & Watson, 2005), we also tested a model that did not include the hoarding symptom cluster (cf. Angelakis et al, 2019), which did not affect the results for the other clusters. While the results in the present study may provide preliminary evidence for incorporating Hoarding Disorder into the HiTOP framework as part of the Thought Disorder and/or Fear spectra, hoarding-related symptoms were only measured with two items here about obsessions and compulsions related to hoarding, limiting both construct validity and reliability.…”

“…As mentioned above, we examined models with and without hoarding symptoms, as hoarding disorder is empirically distinct from OCD (cf. Angelakis et al, 2019). Finally, we hypothesized that accounting for the heterogeneity of OCD would improve model fit.…”

“…Finally, a version of the symptom cluster model excluding hoarding was tested to reflect the omission of hoarding symptoms from the diagnosis of OCD symptom in DSM-5 (cf. Angelakis et al, 2019).…”

Experiential avoidance in non‐suicidal self‐injury and suicide experiences: A systematic review and meta‐analysis

“…Recent evidence has implicated experiential avoidance (EA) or states of psychological inflexibility 1 as a potentially important factor in the engagement of NSSI and/or suicide ideation and behaviors (Angelakis & Gooding, 2020;Brausch & Woods, 2019). The EA model posits that the individual experiencing the avoidance is unable, or unwilling, to endure internal sources of aversive stimulation, including unwanted cognitions (e.g., memories and beliefs), mental images (e.g., forest fires and motor vehicle accidents), uncomfortable emotions (e.g., anger and fear), and/or bodily sensations (e.g., hunger, sweating) that can enact escape and/or avoidance behaviors (Hayes et al, 1996).…”

Suicidal ideation and suicidal attempts in patients with obsessive-compulsive tic-related disorder vs obsessive-compulsive disorder: results of a multicenter Italian study

“…7 Historically, focusing on suicidal behaviors, OCD has been considered to show an overall low suicide risk, which was mainly attributed to comorbidities, such as mood disorders. 8 Recent studies, however, highlighted how OCD per se is associated with increased levels of suicidality compared with the general population, 9,10 even without other psychiatric comorbidities. 11 A previous meta-analysis by Angelakis and coworkers and a recent review by Albert and colleagues estimated a median rate of suicidal ideation ranging from 26.3% to 73.5% and a median rate of suicide attempts from 10.3% to 14.2% for patients suffering from OCD.…”