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

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.

A neuropsychological evaluation of orthorexia nervosa

“…While the literature examining memory performance in OCD is quite mixed [36], a recent meta-analysis [37] implicates WM as the link between executive dysfunction and long-term memory impairment. Specifically, Harkin and Kessler [37] pinpoint the episodic buffer [38], which permits multimodal, temporarily-integrated binding of environmental features, as the element of WM that is deficient in OCD, the idea being that intrusive thoughts interfere with ongoing episodic binding.…”

The neurobiological link between OCD and ADHD

“…Several studies report problems in visuo-spatial working memory (Moritz et al 2011; Savage et al 1996), implicit learning tasks (Goldman et al 2008; Kathmann et al 2005), and, less consistently, visuo-spatial learning (see Simpson et al 2006; Penades et al 2005; Savage et al 1999; meta-analyses by Olley et al 2007; Abramovitch et al 2013; but see analysis by Harkin and Kessler 2011). Deficits in motor and processing speed have also been reported (Burdick et al 2008) with slower responding in OCD compared to controls.…”

Assessing neurocognitive function in psychiatric disorders: A roadmap for enhancing consensus

“…Thus, it is possible that checking compulsions in OCD patients stem from deficits in other functional domains, such as lack of memory confidence leading to patients mistrusting memories that they know are accurate (MacDonald et al, 1997; Tolin et al, 2001; van den Hout & Kindt, 2003). Interestingly, several studies have suggested that repeated checking directly decreases memory confidence, even in healthy controls, which may give hints about the origin of compulsive checking (Giele et al, 2013; Harkin & Kessler, 2009; Harkin & Kessler, 2011; Harkin, Rutherford, & Kessler, 2011; van den Hout & Kindt, 2004). Other factors that may contribute to the evolution of checking compulsions include feelings of incompletion, doubt, and uncertainty (Jacoby, Fabricant, Leonard, Riemann, & Abramowitz, 2013; Tolin, Abramowitz, Brigidi, & Foa, 2003); increased salience of imagined feared outcomes (Psychometri, 2005; Salkovskis, 1985); and/or overestimation of the likelihood of occurrence of feared events (Cisler & Koster, 2010; Jones & Menzies, 1997; Jones & Menzies, 1998; Moritz & Jelinek, 2009).…”

“…The challenges of studying working memory in OCD patients highlight a larger issue in the field-how do we rigorously investigate neurocognitive function in psychiatric illness with consistency across multiple sites? As discussed in both meta-analyses and a recent review (Abramovitch et al, 2013; Harkin & Kessler, 2011; Shin et al, 2013), discrepancies in the literature abound, and are attributable to a variety of factors. These issues are broadly relevant to the study of neurocognitive function in psychiatric illness, and are discussed in detail below.…”

“…Though there are many points of controversy in the field, one question that leads to spirited debate is whether OCD patients have memory deficits when compared to healthy controls. In addition, memory deficiencies have been proposed as an explanatory model for how checking compulsions in a particular subtype of OCD might develop (Harkin & Kessler, 2011; Jaafari et al, 2013; Moritz, Jacobsen, Willenborg, Jelinek, & Fricke, 2006). …”