Obsessions and compulsions and intolerance for uncertainty in a non-clinical sample

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Abstract

It has been hypothesized that decision-making difficulties in patients with obsessive–compulsive disorder may arise from intolerance for uncertainty. We investigated the relationship between obsessivity and intolerance for uncertainty (defined in terms of need for cognitive closure), controlling for state and trait anxiety and depression. We tested non-clinical subjects through the Need for Closure Scale (NFCS), the Padua Inventory Revised (PI-R), the Beck Depression Inventory (BDI), and the State–Trait Anxiety Inventory (Form-Y; STAI-Y). A principal component analysis showed a lack of correlation between the PI-R and the NFCS subscales. A set of multiple regression analyses performed on PI-R subscales showed that the need for cognitive closure cannot be considered as a strong predictor of obsessions and compulsions. These results speak against the hypothesis that people with high obsessivity have difficulties in taking decisions because of a cognitive need for certainty. We instead argue that difficulties in taking decisions may be related to other specific cognitive beliefs or meta-beliefs.

Introduction

Intolerance for uncertainty and indecision have been considered central cognitive features of the obsessive–compulsive disorder (OCD). Patients with OCD have long been described as extremely doubtful and as having difficulties in coming to a decision (e.g., Beech and Liddell, 1974, Guidano and Liotti, 1983, Kozak et al., 1987). In addition, Beech and Liddell (1974) proposed that ritualistic behaviors are maintained not only to reduce immediate discomfort, but also to partially address the need for certainty before terminating an activity. Support comes from studies showing that OCD subjects, compared to other groups, are more cautious, take longer to categorize objects and more frequently request information to be repeated (e.g., Frost, Lahart, Dugas, & Sher, 1988). People with OCD also display greater doubt about their decisions being correct (Frost & Shows, 1993).

Recently, the Obsessive Compulsive Cognitions Working Group (1997) hypothesized that decision-making difficulties may arise from beliefs about the need for certainty. Intolerance for uncertainty has long been observed in OCD patients (e.g., Carr, 1974; McFall and Wollersheim, 1979, Guidano and Liotti, 1983). Intolerance for uncertainty can be defined as a relatively broad construct representing cognitive, emotional and behavioral reactions to uncertainty in everyday life situations. Sookman et al. (Sookman and Pinard, 1995, Sookman and Pinard, 1997) defined “intolerance for uncertainty” so as to include difficulty with ambiguity, newness, and unpredictable change. In this view, intolerance for uncertainty would be a dispositional feature of obsessive patients: they would be intolerant for uncertainty in any situation, not only in symptomatic ones, and even before decompensation. These authors (Sookman & Pinard, 1997) reported that the Domain of Vulnerability and the Response to Unpredictability, Newness and Change (RUNC), strongly discriminated between OCD and other psychiatric patients and normal control.

Although several instruments have been developed to measure intolerance for uncertainty (Steketee, Frost, & Cohen, 1998; Sookman & Pinard, 1995), this construct is still ambiguous. It is unclear whether it has to be considered either as an instrumental need or as an epistemic need. In fact, there could be two ways of showing intolerance for uncertainty. In the first one we could imagine that people are intolerant because they would achieve the right answer. In this sense, intolerance for uncertainty can be described as an instrumental need: who is intolerant for uncertainty in this sense, is not looking for any answer, he/her doesn’t want to achieve a certainty per se. The certainty is only a step, a way for the achievement of an aim (for instance, to know that he/she fulfills his/her duty, or to be sure he/she did the right think). In the second sense, intolerance for uncertainty could be viewed as an epistemic motivation. People who are intolerant for uncertainty may orient their cognitive processes in order to reduce uncertainty and achieve a reliable, doubt-free knowledge, through adequate cognitive operations, independently of the amount of available information (epistemic need).

Because of the increasing number of instruments act to measure intolerance of uncertainty, and the subsequent increasing ambiguity about it, the first aim of this work was to give an operational definition of intolerance of uncertainty, in terms of an epistemic need. To do this, we used a questionnaire developed in a psychosocial area: the Need for Cognitive Closure Scale (NFCS, Webster & Kruglansky, 1994). We describe intolerance for uncertainty in terms of need for cognitive closure, the epistemic motivation underlying Kruglansky’s Lay Epistemic Theory (LET, Kruglansky, 1980). Need for cognitive closure is defined in terms of a desire for “an answer on a given topic, any answer, … compared to confusion and ambiguity” (Kruglansky, 1990).

Specifically, the aim of this work was to investigate, in non-clinical subjects, the possible link between obsessive–compulsive behavior and intolerance for uncertainty, defined as a cognitive need for closure, controlling for state and trait anxiety and depression. In our opinion, if OCD patients were intolerant for uncertainty, they should not be in the sense of a need of any answer. They instead need and struggle for the right one. In this way, it seems that OCD patients, looking for the right answer, could show more doubts and have difficulties in decision making relating to a specific answer to a given topic. If this is the case, we should have a lack of correlation between obsessive–compulsive behavior and need for cognitive closure.

Behavioral and cognitive-behavioral theories argue for a continuum between OCD patients and normals, i.e., for a dimensional basis of OCD (Rachman & de Silva, 1978; Salkovskis, 1989), and suggest that non-clinical and clinical obsessivity will differ more in degree than in kind. A number of empirical studies (Freeston et al., 1992, Clark, 1992, Purdon, 1992) have shown a significant link between unwanted intrusive thoughts and obsessivity in non-clinical subjects. Furthermore, there is some empirical evidence that OCD in non-clinical populations is similar to clinical OCD. Burns et al. (1995) found that most students with the highest score in a self-report measure of obsessional symptoms met diagnostic criteria for OCD. These results, then, support the notion of a connection between clinical and non-clinical obsessive symptoms and suggest the possibility to study obsessivity in non-clinical subjects.

Section snippets

Method

The sample included 144 volunteers (62 males and 82 females), aged 18–35 years (mean=26.4; S.D.=4.7), recruited from three geographical areas: North Italy, Central Italy, and Sardinia. Eighty-eight percent of the participants had completed high school. Participants were recruited from normal population. No a priori criteria of exclusion were set. Personal information about subjects was processed according to the regulations in force, after obtaining a written informed consent.

Subjects were

Results

Table 1 reports mean scores and standard deviations in each test, for the whole sample and for males and females separately.

It can be observed that, compared to other samples (e.g., Frasure-Smith et al., 2000), Italian subjects seem to report higher BDI scores. Similar results were reported both in Italian (e.g., Scilligo, 1988) and Australian (Bhar & Kyrios, 1999) non-clinical samples.

We used a principal components analysis (PCA) with oblique rotation to examine the relationship between the

Discussion

The main result of the present work is the lack of a substantial relationship between obsessivity and need for cognitive closure. The principal component analysis indicated that “need for closure” and “obsessions and compulsions” are two unrelated factors. Although a scale from NFCS (decisiveness), and the impulses and ruminations subscales from the PI-R all loaded on the same factor (general distress), it still has to be noted that these subscales (mostly decisiveness and impulses) are

Acknowledgements

We are grateful to Gaspare Galati for his comments and his valuable help in reviewing an early version of the manuscript.

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