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Discussion

Guy Doron

In this study, we investigated whether particular structures of self-concept are related to OC-related beliefs and OC symptom severity. Consistent with hypotheses, individuals with sensitivity in the self-domains of morality, job competence, scholastic competence, and social acceptability held higher levels of OC-related beliefs. Further, sensitivity in morality, job competence and social acceptability related to higher OC symptom severity. Finally, sensitivity in the moral and job competence domains was related to both OC-cognitions and symptom severity, even when accounting for differences in global self-worth. One interpretation of the findings is that the link between sensitivity of self and OC phenomena is not simply due to its effects on self-worth, but rather, it is related to sensitivity in specific domains of self. These results are consistent with cognitive theory and research, which has often implicated self-structure in the etiology and maintenance of OC-phenomena (e.g., Clark & Purdon, 1993; Rachman, 1997, 1998; Salkovskis, 1985) and, in particular, provide further evidence for the model of Doron and Kyrios (2005; also see chapter 2 of this thesis).

At a more finely grained level, it was predicted that sensitivity in the domain of morality would be associated with increased severity in most OC-related beliefs and symptom dimensions. Supporting this hypothesis, moral sensitivity related to higher levels of all three OC-beliefs (responsibility/overestimation of threat, perfectionism/intolerance of ambiguity, and importance of/need to control thoughts). Furthermore, only the effects of moral sensitivity on perfectionism seem to be mediated by self-worth. This finding is consistent with suggestions that perfectionism is a more general factor for psychopathology than the other two OC-related beliefs (OCCWG, 1997, 2005).

Morality was related to higher levels of all OC-symptoms, and in particular was related to checking and contamination after controlling for self-worth. The strong relationship between morality and OC-phenomena is consistent with past research linking issues of morality to OCD (Rachman & Hodgson, 1980; Ferrier & Brewin, 2005; Bhar, 2004; also see chapter 4 of this thesis). Thus, sensitivity in the moral domain may be particularly relevant to OC-related beliefs and OC-symptoms.

It was hypothesized that sensitivity in the job and scholastic competence domains would also predict an increase in OC related beliefs, in particular responsibility cognitions. Consistent with recent suggestions (e.g., Salkovskis, 1985; Salkovskis et al., 1999), sensitivity regarding job competence was associated with a higher level of most OC cognitions including responsibility and symptoms, even after controlling for global self-worth. In contrast, scholastic competence only related to higher levels of responsibility, importance/control of thoughts and one OC symptom dimension (i.e., obsessions of harm). After controlling for self-worth, scholastic competence sensitivity related only to the importance/control of thoughts. The wider and more robust relationship between job competence and OC phenomena may be reflective of the value that job competence is given in modern society and amongst university students.

Contrary to expectations, sensitivity in the domain of social acceptance was not associated with most OC cognitions and symptoms. This domain related to overall OC symptoms and cognitions, as well as, perfectionism/intolerance of ambiguity beliefs prior to controlling for self-worth, and did not relate to specific OC symptoms. This suggests that social acceptability may be a more general factor in OCD, perhaps contributing to symptoms through depression or self-worth. While social acceptability is not associated with OCD per se, specific beliefs related to social acceptability such as beliefs that others demand perfection (e.g., Bhar & Kyrios, 1999) or that others are generally unhelpful and unkind (see chapter 4 of this thesis) may be related to OC sensitivity.

Findings from the present study have implications for the psychological treatment of OCD. Examining the profile of sensitivity that individuals show across the four domains may inform the content of psychotherapy. Cognitive techniques such as cognitive restructuring can be used to identify and modify specific as well as more general distorted self perceptions. In particular, cognitive restructuring can be used to challenge perceptions of incompetence in valued domains of self and provide alternative interpretations to the triggers of such dysfunctional self perceptions (see Chapter 8 for further discussion).

The results of this study await replication. In particular, the findings relating to job competence need to be replicated in older samples, as students´┐¢ beliefs about work may differ from the general population. Further, while particular structures of self related to OC symptoms in this analogue sample, future research should study the relationship in clinical cohorts with OCD and other anxiety/depressive disorders. This would provide stronger evidence regarding whether sensitivity in particular domains of self is specific to OCD or also implicated in other psychiatric disorders. The present study was cross-sectional. Therefore, it is not possible to determine causal relations between the measured constructs. For instance, sensitive self structures may increase sensitivity to OC symptoms and beliefs, or be a result of OC symptoms and beliefs. Also, it would also be important to examine the direct relationship between sensitive self domains and intrusive thoughts for a particular content. Experimental and treatment outcome studies need to be conducted in order to examine such causal relations.

Overall, the findings from the present study suggest that a specific self-structure may be associated with increased severity of OC symptoms. Individuals who feel incompetent in important self-domains, in particular morality and job competence, may be more sensitive to OC cognitions and symptoms. This is the first study to link specific self-domains from a unified theory of self (Harter, 1998) with both OC-cognitions and symptom severity. Finally, this leads to the important question of the origin of such self-beliefs. Given the hypothesized relationship between attachment experiences and perceptions of self, the world and OC phenomena (see chapter 2 of this thesis) there is a need for an evaluation of these relationships. Chapter 6 tests several possible structural relationships between these constructs using structural equation modeling (SEM) techniques.

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