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Discussion

Guy Doron

In this study, it was suggested that a multifaceted examination of world view may expand current cognitive conceptualizations of OC phenomenon. Consistent with this, assumptions regarding the self, the world and others were found to relate to OC cognitions and predict OC symptoms. An overall model consisting of world-view assumptions, OC related cognitions and depression symptom scores predicted over half the variance in OC severity scores. Importantly, benevolence of the world, negative self-deservingness moderated by high justice beliefs and self-controllability moderated by strong controllability beliefs added significantly to the prediction of OC symptom severity scores after controlling for OC related cognitions and affective variables. Also, different dimensions of OC symptoms were found to be predicted by different world view assumptions over and above depressive symptoms and OC related cognitions.

These results are largely consistent with current research examining the relationship between OC phenomena and variables related to self and world view (e.g., Clark & Purdon, 1993; Ehntholt, Salkovskis, & Rimes, 1999; Rachman, 1997; Riskind, Wheeler, & Picerno, 1997; Salkovskis, 1985). For Guidano and Liotti (1983), OC phenomena are characterized by perceptions of social and physical threat coupled with the view of the world as controllable. Such perceptions of environment are thought to stem from early parenting experiences such as attachment relationships (Guidano & Liotti, 1983). Our results support Guidano and Liotti's (1983) suggestion in so far as they indicate that perceiving the world as a predictable place where misfortune is avoidable and where one's moral character and actions bear future consequences leads to increased sensitivity to OC phenomena. Further, perceiving others as uncaring and unkind was also found to increase OC vulnerability, in particular, for individuals distressed by shameful intrusions (i.e., thoughts of harm). Thus, an examination of wider assumptions about the world may enable a better understanding of OC phenomena by outlining a more detailed relationship between self, world view and traditional OC-relevant cognitions.

The controllability assumption predicted total OC symptoms severity only indirectly (i.e., moderated by the influence of self-controllability). As expected, beliefs relating to harm prevention through action (i.e., self-controllability and controllability interaction) predicted overt symptoms such as contamination and checking symptoms over and above OC related cognitions and mood. Also as predicted, morality based assumptions (i.e., justice and self-deservingness interaction) predicted thoughts of harm. In fact, morality based assumptions significantly predicted obsessions of harm and contamination symptoms over and above mood and OC related cognitions. These findings are consistent with the theoretical emphasis on moral reasoning and control discussed by various researchers (Clark & Purdon, 1993; Moulding & Kyrios, in press; Rachman, 1998; Salkovskis, 1985).

Somewhat unexpectedly, both world view assumptions and OC related cognitions did not add significantly to the prediction of impulses of harm. This may be a result of the strong correlation between impulses of harm and mood symptoms in our sample (r=.48, p<.001). Indeed, depressive symptoms have been previously found to relate more strongly with obsession than compulsions (e.g., Arts, Hoogduin, Schaap, & Haan, 1993; Ricciardi & McNally, 1995). Alternatively, the adequate but relatively low internal consistency of the world assumption scales may have hindered the detection of stronger effects, in particular, in the context of other measurements with higher internal consistency (e.g., PI-R and BDI).

Overall, it seems that vulnerability to particular OC symptom dimensions is linked with specific world view theories and consistent with the hypotheses that vulnerability to OC symptom dimensions may be linked with a particular view of the world.

The present findings indicate that world theories may be linked with OC symptoms and propose a broader understanding of OC phenomena with implications for its psychological treatment. In particular, questioning and challenging individuals' negative self-evaluations with respect to their own actions and moral deservingness, their views regarding the benevolence of people and their personal perceptions of the nature of the world may be useful in alleviating OC symptoms (See Chapter 8 for further discussion). In addition, expectation from self and other may be a result of early attachment experiences (Bretherton & Munholland, 1999; Guidano & Liotti, 1983; Howes, 1999; also see chapter 2 of this thesis). Therefore, therapy aimed towards attachment relationships (e.g., Bowlby, 1988; Young, 1999) may improve the efficacy of treatment, particularly for those individuals who are refractory to current treatments.

However, these findings require further replication. Although particular world assumptions appear to be related to OCD symptoms in the present nonclinical sample, the next step will be to examine clinical cohorts of OCD and anxious/depressed control patients. Analogue participants experience OC related phenomena and associated cognitions, but may differ from clinical patients in the type, severity and symptom-related impairment. Further, the cross-sectional nature of this study does not enable us to determine causal relations between the measured variables, thus care should be taken when applying these results to other cultural contexts as factors associated with OC phenomena may differ across cultures (e.g., Sica, Novara, Sanavio, Dorz, & Coradeschi, 2002).

Preexisting theories about the world may influence the development of beliefs associated with OC phenomena such as intolerance for uncertainty, perfectionism, inflated responsibility and overestimation of threat (OCCWG, 1997, 2005). A further examination of the extent and nature of these relationships using clinical samples is required. Assessing the specific relationship between perceptions of self, others and the world and OC phenomena could lead to a more precise way of detecting subtle differences among different OC presentations and other clinical groups. It may also be useful to examine the relationship between more particular aspects of self and OC phenomena (Doron & Kyrios, 2005); for instance, relating OC phenomena to domain specific appraisals of self (e.g., Harter, 1990).

In sum, in this chapter a systematic investigation of the link between world view assumptions and OC phenomena was undertaken. Results suggest that world assumptions are linked with OC severity scores and that these relationships are not accounted for by OC related beliefs and mood symptoms. The next chapter focuses on self concept and examines whether the structure of individuals' self-concept is associated with OC related cognitions and symptoms.

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