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The Nature of Vulnerability in OCD: Summary and general hypotheses

Guy Doron

While other etiological models of OCD have been proposed (e.g., Greisberg & McKay, 2003), cognitive conceptualizations of OCD have generated a large body of empirical support and have led to the development of effective treatments. However, cognitive research has focused on factors (e.g., beliefs and management strategies) involved in the maintenance and exacerbation of the disorder rather than the underlying vulnerability to this disorder or associated factors from a developmental perspective. Drawing on cognitive, developmental, and attachment research, findings suggest that enduring cognitive-affective structures, such as internal representations of self, others and the world, may be important determinants of cognitive vulnerability to OCD. Further, both research findings and theory suggest a strong link between such internal representations and early parent-child interactions. For example, findings clearly show that early attachment experiences are related to the later development of self-concept.

Following on from this, it is argued that a distinctive self-structure, comprising limited domains that are "sensitive" and perceptions of the world as dangerous but controllable, underlie vulnerability in OCD. Intrusions relating to failure in "sensitive" self-domains and/or to the cognitions associated with them (e.g., "I will be abandoned") "endanger" an individual's sense of self-worth, triggering extreme anxiety and preoccupation. Such self sensitivity may trigger and/or increase the tendency for the development of OC related dysfunctional appraisals and OC symptoms in reaction to such intrusions. Specific beliefs regarding the nature of the world (e.g., how control over the environment can be achieved) further facilitate the development of OC symptoms by enhancing the need for control of the environment (i.e., external and/or internal stimuli). General perceptions of the world as threatening lead to a further increase in vigilance for "danger" cues (e.g., intrusive thoughts).

The literature review in chapter 1 and 2 has focused attention on several new areas of OCD research with the intent of expanding the focus of traditional cognitive-behavioral models. The aim was to enhance the understanding of OCD phenomena by identifying specific enduring cognitive-affective structures that may sensitize individuals to the development of OC symptoms. Possible factors that may lead to development of such structures were explored. This conceptualization of OCD vulnerability as involving a specific constellation of self and world representations may add to our understanding of this disabling disorder. In the following chapters we will attempt to determine the relationship between OC symptoms and specific self structure, world-view assumptions and attachment representations. Chapter three will present the specific aims and methodologies of the following four empirical studies.

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