Cognitive aspects of obsessive-compulsive disorder in children and adults: the role of inflated responsibility and uncertainty

Aims Experimental work shows that inflated responsibility may be causally related with adult obsessive-compulsive disorder (OCD). The inflated responsibility model has been tested in children, but mixed results have been obtained. The current work aimed to test the role of responsibility in children. However, other cognitions such as uncertainty and intolerance to it may also be relevant for the emergence of OCD. Research testing the causal role of uncertainty in OCD is very sparse. The current work also aimed to test causal effects of inflated responsibility and uncertainty on anxiety and compulsive urges in adults. Study 1 adapted an experimental task for manipulating responsibility in children and a coding system used to assess obsessive-compulsive-like behaviours. This methodology was used in Study 2, an experiment that aimed to test the effects of inflated responsibility on anxiety, OCD-like behaviours, and experimental task speed in children. Study 3 tested the effect of inflated responsibility and uncertainty on anxiety, compulsive urges, and task duration in adults. Study 4 examined the effect of inflated responsibility, uncertainty, and checking on the same variables, also in adults. Method In study 2, responsibility was manipulated in 68 healthy children ages 9 to 12 using a sweet-sorting task. Children were randomly assigned to one of three groups: high responsibility, low responsibility, and control. Dependent variables were anxiety (immediately after the sorting, 10 minutes later, and 24 hours later), checking, hesitating, and time taken to complete the sorting. In experiments 3 and 4 adult participants (N= 64 and 74, respectively; non-clinical samples) completed a pill-sorting task which manipulated responsibility and uncertainty. In Study 3, uncertainty was manipulated via false feedback about accuracy of the sorting. Study 3 was a 2 (high responsibility, no- responsibility) X 2 COGNITIVE ASPECTS OF OBSESSIVE-COMPULSIVE DISORDER 3 (high-uncertainty, no-uncertainty) design. In Study 4, all participants had high responsibility. Uncertainty was manipulated via false feedback and by allowing or forbidding checking during sorting. Study 4 was a 2 (uncertainty, no uncertainty) X 2 (checking, no checking) design. Results The responsibility manipulation in Study 2 was not successful. Study hypotheses were not supported. In study 3 the responsibility and uncertainty manipulations were successful. Responsibility had no effect on anxiety and compulsive urges. However, participants in the high-uncertainty (i.e., negative feedback) condition reported significantly higher anxiety and urge to seek reassurance than participants in the no-uncertainty (i.e., positive feedback) condition. In Study 4 the responsibility manipulation was successful, but the feedback manipulation for uncertainty was not. However, checking behaviour significantly changed uncertainty. Checking had no effect on anxiety and compulsive urges; however, participants who received positive feedback experienced a constant decrease in anxiety over time, while those who received negative feedback experienced an increase. Also, those who received positive feedback reported a significant decrease in urge to see reassurance over time; this was not observed in participants who received negative feedback Conclusion Study 2 hypotheses were not supported, and this was due to the responsibility manipulation being unsuccessful. It is possible that the responsibility manipulation was not strong enough. A lack of current developmental framework for inflated responsibility may limit experimental work on this cognition in children. Study 3 and Study 4 tested the inflated responsibility model of OCD in adults, but also added uncertainty as a possible causal factor for the disorder. Results showed that confidence and uncertainty can be successfully manipulated via feedback and checking, using a pill-sorting paradigm. Surprisingly, results did not provide support for the inflated responsibility model; only feedback COGNITIVE ASPECTS OF OBSESSIVE-COMPULSIVE DISORDER 4 seemed to have an effect on anxiety and urge to seek reassurance. As these were non-clinical samples, these results show a causal relationship between low- confidence/uncertainty and compulsive urges. Overall these findings indicate that responsibility may not be sufficient or even necessary to cause the onset of OCD, and that uncertainty may be important. Future work should further test the effects of confidence/ uncertainty on anxiety and obsessivecompulsive like behaviours and urges in adults