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Evaluating three main research questions

Guy Doron

Are perceptions of self and the world associated with OC phenomena?

It was proposed in this thesis that a particular constellation of world assumptions, coinciding with sensitivity in specific self domains, would be associated with greater OC phenomena. The results of the four studies reported in this thesis (see chapters 4, 5, 6 and 7) provided initial evidence supporting links between the constructs.

Specifically, it was proposed in this thesis (see chapter 2 and 4) that OC symptoms will be associated with low perceptions of self-deservingness, but a high propensity to act (i.e., to perceive themselves as active in the prevention of misfortune). Such self perceptions, together with views that the world is a predictable (i.e., consequences are determined by one's actions or moral deservingness) but dangerous place (i.e., social and physical threats), were hypothesized to be linked with an increased severity of OC symptoms. For instance, increased sensitivity to repugnant intrusive thoughts was hypothesized to be amplified by negative perceptions of one's own character, particularly when holding the belief that consequences in the world are determined by moral deservingness (i.e., people get what they morally deserve in the world).

The results of the first study (see chapter 4 of this thesis) generally supported these links. As expected, increased severity of OC symptoms was found to be associated with the degree to which individuals perceive (1) the world as a just place where people get what they deserve, (2) themselves as able to avoid harm in the world, (3) themselves as undeserving; and, (4) others and the world negatively. As expected, more complex relationships were also identified. For instance, the more individuals perceived the world as just, but themselves as morally undeserving, the greater their OC severity scores. Similarly, the more strongly that individuals assumed that misfortune in the world can be avoided and also held the belief that their own actions are useful in the prevention of harm, the greater their OC symptom severity. In this study, different dimensions of OC symptoms (i.e., overt vs covert symptoms) were also found to be predicted by different world view assumptions, over and above depressive symptoms and OC related cognitions (i.e., responsibility/threat, importance/control of thoughts, perfectionism/intolerance of uncertainty). Thus, this study provided general support for the hypothesis that world assumptions are associated with OC symptoms.

The second study of this thesis (see chapter 5) focused on an exploration of self concept. In particular, this study examined the proposal that individuals showing sensitivity in particular self domains (i.e., perceptions of incompetence in valued domains of self) would exhibit more severe OC symptoms and cognitions. According to Doron and Kyrios (2005), such sensitivity will result in anxiety and preoccupation with intrusive thoughts that "endanger" those domains. This results in the triggering of OC related cognitions, other views of the world; and neutralizing behaviors.

Consistent with this hypothesis, individuals showing sensitivity in the domains of morality, job and scholastic competence, and social acceptability showed higher levels of OC-related beliefs. Sensitivity in the domains of morality, job competence, and social acceptability also related to higher levels of OC symptoms. These findings were generally maintained when controlling for global self-worth. Thus, the results of this study supported the proposal that sensitivity to OC symptoms is related to particular self structures.

The third study (see chapter 6 of this thesis) investigated the link between world view assumptions, self perceptions and OC phenomena using structural equation modeling (SEM). The aim of this analysis was to examine the relationship between attachment representations, sensitive domains of self, world assumptions and OC symptoms and cognitions. This analysis also enabled the replication of some of the previous findings linking perceptions of self and the world with OC phenomena. The best fitting model indicated a direct relationship between beliefs regarding benevolence of the world (i.e., negative perceptions of people and of the physical world) and OC symptoms and cognitions. Further, perceived benevolence of the world was indirectly linked to OC symptoms via OC related cognitions. Moreover, sensitive self was directly linked to OC cognitions, but only indirectly to OC symptoms. Importantly, multi group analysis indicated this model reflected the structural relationship in two independent student cohorts equally well. Thus, the findings of this study supported the previously found association between perceptions of self and the world and OC phenomena while indicating a more complex relationship between these constructs.

The fourth study assessed the link between perceptions of self and the world (see chapter 7 of this thesis) in a clinical sample. This study aimed to replicate aspects of previous findings within a group of individuals with OCD. The results of this study suggested that within the OCD group, world assumptions were correlated with OC symptoms and cognitions in the expected direction. Consistent with the previous study (Chapter 4), overall OC symptoms were associated with perceptions of oneself as able to prevent harm in the world (i.e., self controllability) and negative perceptions of self deservingness. Also as expected, overt OC symptoms were linked with controllability related assumptions (i.e., self controllability and controllability beliefs) and covert symptoms were linked with negative self deservingness. Also, moderate correlations between world assumptions and OC belief domains were found. However, the relationship between world assumptions and OC symptom dimensions showed less specificity than previously found, such that negative self deservingness and controllability beliefs showed an association with most OC symptom dimensions within the OCD group. Also, inconsistent with previous findings (see Chapter 4 and 6 of this thesis), negative perception of the world was only linked with contamination symptoms.

An examination of sensitivity of self within the OCD group indicated that sensitivity of self in the domain of morality, but not job competence, was linked with more severe OC symptoms and cognitions. The effect of sensitivity in the domain of morality on OC symptoms remained when controlling for depression scores. As found previously (see chapter 5 of this thesis), sensitivity in the domain of morality increased the severity in most OC symptoms dimension and OC related beliefs.

Overall these findings suggested that the relationship between perceptions of self and world and OC phenomena is maintained within the restricted high range of OC symptoms and cognitions.

Are dysfunctional adult attachment representations linked with sensitive self, dysfunctional world view assumptions and OC phenomena?

Another aspect of the Doron and Kyrios (2005) model pertains to the influence of early experiences such as attachment relationships on the development of OC related beliefs, sensitive self structures and perceptions of other and the world. Althought attachment experiences per-se were not directly measured in this thesis and the data obtained was cross-sectional, this proposal was examined using adult attachment measures hypothesized to reflect the internalization of such attachment experiences.

In the first study examining this relationship (see chapter 6 of this thesis), the structural relationship between attachment representations, sensitive self, world assumptions and OC symptoms and cognitions was examined. As expected, a model whereby the influence of attachment was fully mediated by the proposed cognitive-affective structures and OC related cognitions was supported. Both attachment dimensions (i.e., IMWs of self and IWMs of others) directly predicted sensitive self concept. IWMs of others directly predicted world view assumptions which, in turn, directly predicted OC symptoms and cognitions. As previously mentioned, sensitive self construct directly predicted OC cognitions and indirectly (via OC related cognitions) predicted OC symptoms. A bootstrapping procedure showed that the indirect effect of IWMs of self and IWMs of other on OC symptoms was statistically significant. Thus, the findings of this study suggest that adult attachment representations are linked with sensitive self structure, world assumptions and OC related cognitions and symptoms.

Are the hypothesized relationship between attachment, self and the world perceptions specific to OCD?

The final study (see chapter 7 of this thesis) assessed whether the suggested constructs are specific to OCD (i.e., in severity or proportion) relative to other anxiety disorders and community participants. With regard to world view assumptions, the findings from this study were inconclusive. Individuals with OCD showed stronger adherence to only one world assumption, the negative self-deservingness assumption. Group diagnosis did not differentiate the control groups from the OCD group with regard to other world assumption. However, the same lack of specificity between the two clinical groups was found when comparing overall OC related belief scores, whereas larger scale studies (e.g., OCCWG, 2005) have shown such specificity. Hence, this lack of specificity may be attributed to the low statistical power due to the small sample size. Alternatively, it may be that the specific relationship between OCD and world assumptions is a more complex one (e.g., moderation effects) and the inability to examine such a complex relationships in this study hindered the detection of group differences. Thus, while the strength of adherence to world assumptions may not be specific to OCD sufferers, it is yet unclear whether the combination of particular world assumptions may prove more specific.

Finally, particular combinations of world-view assumptions were hypothesized to increase sensitivity to intrusive thoughts resulting in increased OC symptoms. However, individuals presenting with anxiety disorders in this study showed higher OC symptom severity than the community control group. Given that the anxiety group also present with a significant degree of OC phenemonolgy, it is likely that such perceptions of self and world view may be somewhat relavant to this group, thereby reducing the likelihood of identifying group differences.

With respect to sensitive self structures, the findings of this study suggested some degree of specificity to OCD, although previous comments about the nature of this sensitivity remain relevant. Consistent with expectations, the proportion of individuals in the OCD group showing sensitivity in the morality and job competence domains was higher than in the community control group. No statistically significant relationship between the anxiety group and these sensitive domains was detected. These findings support the hypothesis that OCD is associated with sensitivity in particular self domains. Such sensitivity makes individuals with OC symptoms more reactive to intrusions pertaining to the sensitive domains, eliciting dysfunctional responses such as anxiety and preoccupation with thoughts.

Finally, the degree of specificity of negative attachment representations to OCD was assessed. The results of this study indicated that a diagnosis of OCD was linked with more negative IWMs of self than was the anxiety disorder and community control groups, and that this effect remained after controlling for mood and OC related beliefs. Negative IWMs of others differentiated between the clinical groups and the community group, but not between the anxiety and OCD groups. Thus, the severity of negative IWMs of self may be specific to OCD, while the severity of IWMs of others may be linked with more general factor associated with OCD, although the caveats discussed above regarding the issue of specificity remain relevant.

Summary

The findings of this thesis are consistent with adult attachment representations playing a role in OC related phenomena. Despite some inconsistencies across groups (student and clinical samples), the link between perceptions of self, the world and OC symptoms and cognitions was also supported. In addition, initial backing for the specificity of sensitive self structure and the severity of negative IWMs of self to OCD was found.

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