According to Aardema and Wong (2020), OCD symptoms arise from a fear-of-self, which is a fear of who one might be or become. Individuals with OCD often fear being corrupted, culpable, or malformed (Aardema et al., 2021).
They magnify these self-related fears through inferential confusion, a dysfunctional cognitive process involving fixation on imagined possibilities, denial of sensory information, and reduced self-trust (Aardema et al., 2005; O’Connor et al., 2005).
This leads to detachment from reality-based information about one’s true self and the emergence of a feared possible self. Studies have supported the relationship between feared possible selves and inferential confusion (Audet et al., 2020; Baraby et al., 2021; Jaeger et al., 2015; Yang et al., 2021).
Khosravani, V., Samimi Ardestani, S. M., Wong, S. F., Moulding, R., Aardema, F., Sharifibastan, F., & Aminaee, M. (2023). Cross‐sectional direct and indirect relationships between the corrupted feared self and obsessive–compulsive symptoms in a clinical sample: The role of mental contamination. British Journal of Clinical Psychology, 62(4), 800-815. https://doi.org/10.1111/bjc.12440
Key Points
- The corrupted feared self had a direct association with all OCD symptom dimensions, even after controlling for obsessive beliefs, depressive symptoms, and comorbidity.
- The corrupted feared self was indirectly associated with contact contamination and unacceptable thoughts through mental contamination.
- Obsessive beliefs and depressive symptoms exhibited strong relationships with mental contamination and all OCD symptoms, sometimes stronger than the association with the feared corrupted self.
- The culpable and malformed feared selves did not have significant associations with OCD symptoms or mental contamination.
- The research, while informative, has limitations, such as relying on cross-sectional data and self-report measures.
- The topic is universally relevant as it contributes to understanding the psychological factors underlying OCD, a prevalent and debilitating mental health condition.
Rationale
Previous research has established significant relationships between a general feared self and contact contamination concerns in OCD, especially when considering the influence of mental contamination (Krause et al., 2020; Üzümcü et al., 2021).
However, these associations have not been explored in a clinical OCD sample using the multidimensional conceptualization of the feared self (i.e., corrupted, culpable, and malformed feared selves) as predictors (Aardema et al., 2021).
Furthermore, unacceptable thoughts, despite being strongly associated with both fear-of-self and mental contamination, were not explored as an outcome in previous studies (Inozu et al., 2022; Krause et al., 2020; Üzümcü et al., 2021).
This study aims to address these gaps by examining the direct and indirect associations (via mental contamination) between the different aspects of the feared self and dimensions of OCD symptoms in a large clinical sample.
Method
This study employed a cross-sectional design and path analysis to examine the relationships between feared self dimensions, mental contamination, and OCD symptom dimensions in a clinical sample of OCD patients.
Participants completed a series of self-report measures assessing OCD symptoms, feared self dimensions, mental contamination, obsessive beliefs, and depressive symptoms.
Sample
The sample consisted of 417 outpatients with a primary diagnosis of OCD (51.8% male, mean age = 31.71 years, SD = 11.40, age range = 15-68 years). Among them, 39.6% had a comorbid psychiatric disorder.
Measures
- Fear-of-Self Questionnaire – Multidimensional Version (FSQ-MV)
- Vancouver Obsessional Compulsive Inventory – Mental Contamination Scale (VOCI-MC)
- Dimensional Obsessive-Compulsive Scale (DOCS)
- Yale-Brown Obsessive-Compulsive Scale (Y-BOCS)
- Obsessive Beliefs Questionnaire – 44 (OBQ-44)
- Beck Depression Inventory – II (BDI-II)
Statistical measures
Path analysis with a maximum likelihood estimator (MLE) was used to explore the direct and indirect links between observed scores of each feared self dimension to OCD symptoms through mental contamination, controlling for depressive symptoms, obsessive beliefs, and comorbidity.
Results
The corrupted feared self had significant direct associations with all OCD symptom dimensions and mental contamination, even after controlling for covariates.
Mental contamination had significant direct links to contact contamination and unacceptable thoughts.
The corrupted feared self had a significant indirect link to contact contamination and unacceptable thoughts via mental contamination.
Insight
This study extends previous research by demonstrating the specific role of the corrupted feared self about OCD symptoms and mental contamination in a clinical sample.
The findings indicate that self-related perceptions, particularly the feared possible self, are closely linked to OCD and its symptoms.
These perceptions should be considered an integral part of the clinical presentation of OCD, rather than separate from other strongly associated factors such as obsessive beliefs and depressive symptoms.
The results align with previous research demonstrating linear relationships between the feared corrupted self and OCD symptoms in both clinical and non-clinical populations (Aardema et al., 2021; Sharifi Bastan et al., 2023). This highlights the importance of assessing and addressing feared self-perceptions when diagnosing and treating OCD.
The findings suggest that the fear of being corrupted may be associated with feelings of contamination in the absence of direct contact with a contaminant, which may then predict OCD symptoms of repugnant obsessional thoughts and contact contamination concerns.
The results highlight the importance of considering feared self-perceptions, particularly the corrupted feared self, when assessing and treating OCD.
Future research could explore the impact of manipulating feared self-perceptions on OCD symptoms and the effectiveness of interventions targeting the feared self in OCD treatment.
Strengths
- Large clinical sample
- Multidimensional assessment of feared self
- Inclusion of unacceptable thoughts as an outcome
- Controlling for relevant cognitive and affective constructs and comorbidity
- Culturally and linguistically diverse sample
Limitations
- Reliance on cross-sectional data, preventing the establishment of causal relationships
- Use of self-report measures, which are susceptible to bias
- Limited generalizability to non-clinical populations
Clinical Implications
The study’s novel finding was that the feared corrupted self is most relevant to contact contamination and unacceptable thoughts due to its association with feelings of contamination, even without physical contact with a contaminant.
The findings emphasize the potential need for psychological interventions to address an individual’s feared self, particularly the corrupted feared self, to alleviate symptoms across varying presentations of OCD.
The results highlight the potential need for interventions addressing the feared self to alleviate symptoms across different OCD presentations, such as inference-based cognitive-behavioral therapy targeting reasoning distortions and rebuilding self-trust.
The study’s insights can inform clinical practice by highlighting the relevance of assessing and addressing feared self-perceptions and mental contamination in OCD patients.
References
Primary reference
Khosravani, V., Samimi Ardestani, S. M., Wong, S. F., Moulding, R., Aardema, F., Sharifibastan, F., & Aminaee, M. (2023). Cross‐sectional direct and indirect relationships between the corrupted feared self and obsessive–compulsive symptoms in a clinical sample: The role of mental contamination. British Journal of Clinical Psychology, 62(4), 800-815.
Other references
Aardema, F., O’Connor, K. P., Emmelkamp, P. M., Marchand, A., & Todorov, C. (2005). Inferential confusion in obsessive–compulsive disorder: The inferential confusion questionnaire. Behaviour Research and Therapy, 43(3), 293–308. https://doi.org/10.1016/j.brat.2004.02.003
Aardema, F., Radomsky, A. S., Moulding, R., Wong, S. F., Bourguignon, L., & Giraldo-O’Meara, M. (2021). Development and validation of the multidimensional version of the fear of self questionnaire: Corrupted, culpable and malformed feared possible selves in obsessive–compulsive and body-dysmorphic symptoms. Clinical Psychology & Psychotherapy, 28(5), 1160–1180. https://doi.org/10.1002/cpp.2565
Aardema, F., & Wong, S. F. (2020). Feared possible selves in cognitive-behavioral theory: An analysis of its historical and empirical context, and introduction of a working model. Journal of Obsessive-Compulsive and Related Disorders, 24, 100479. https://doi.org/10.1016/j.jocrd.2019.100479
Audet, J. S., Wong, S. F., Radomsky, A. S., & Aardema, F. (2020). Not all intrusions are created equal: The role of context, feared-self perceptions and inferential confusion in the occurrence of abnormal intrusions. Journal of Obsessive-Compulsive and Related Disorders, 26, 100537. https://doi.org/10.1016/j.jocrd.2020.100537
Baraby, L. P., Wong, S. F., Radomsky, A. S., & Aardema, F. (2021). Dysfunctional reasoning processes and their relationship with feared self-perceptions and obsessive-compulsive symptoms: An investigation with a new task-based measure of inferential confusion. Journal of Obsessive-Compulsive and Related Disorders, 28, 100593. https://doi.org/10.1016/j.jocrd.2020.100593
Inozu, M., Kahya, Y., Üzümcü, E., & Evliyaoğlu, E. S. (2022). An examination of the fear of self and religiosity as either related or independent vulnerability factors for mental contamination. Journal of Obsessive-Compulsive and Related Disorders, 34, 100740. https://doi.org/10.1016/j.jocrd.2022.100740
Jaeger, T., Moulding, R., Anglim, J., Aardema, F., & Nedeljkovic, M. (2015). The role of fear of self and responsibility in obsessional doubt processes: A Bayesian hierarchical model. Journal of Social and Clinical Psychology, 34(10), 839–858. https://doi.org/10.1521/jscp.2015.34.10.839
Krause, S., Wong, S., O’Meara, M. G., Aardema, F., & Radomsky, A. S. (2020). It’s not so much about what you touch: Mental contamination mediates the relationship between feared self-perceptions and contact contamination. Journal of Obsessive-Compulsive and Related Disorders, 25, 100507. https://doi.org/10.1016/j.jocrd.2020.100507
O’Connor, K., Aardema, F., & Pélissier, M. C. (2005). Beyond reasonable doubt: Reasoning processes in obsessive-compulsive disorder and related disorders. John Wiley & Sons.
Üzümcü, E., Evliyaoğlu, E. S., & Inozu, M. (2021). The role of gender, fear of self and disgust propensity in mental contamination: A model test using mental contamination induction. Current Psychology, 42(12), 9596–9608. https://doi.org/10.1007/s12144-021-02285-3
Yang, Y. H., Moulding, R., Wynton, S. K., Jaeger, T., & Anglim, J. (2021). The role of feared self and inferential confusion in obsessive compulsive symptoms. Journal of Obsessive-Compulsive and Related Disorders, 28, 100607. https://doi.org/10.1016/j.jocrd.2020.100607
Keep Learning
- How might the findings of this study inform the development of new cognitive-behavioral interventions for OCD?
- What are some potential challenges in addressing the corrupted feared self in OCD treatment, and how might these be overcome?
- How could future research further explore the causal relationships between the corrupted feared self, mental contamination, and OCD symptoms?
- What are some possible reasons for the corrupted feared self being more strongly associated with OCD symptoms compared to the culpable and malformed feared selves?
- How might cultural and religious factors influence the manifestation of the corrupted feared self and its relationship to OCD symptoms?
