Chapter 5 - Overestimation of Threat and Intolerance of Uncertainty in Obsessive Compulsive Disorder

Abstract

This chapter describes the overestimation of threat and intolerance of uncertainty in Obsessive Compulsive Disorder (OCD). The chapter reviews the literature of dysfunctional beliefs and information processing biases related to overestimation of threat and intolerance of uncertainty in OCD. Intolerance of uncertainty refers to the “beliefs about the necessity of being certain, about the capacity to cope with unpredictable change.” Intolerance of uncertainty may be one factor that influences estimation of threat in OCD. Studies carried out by the obsessive compulsive cognitions working group suggest that OCD patients endorse selected beliefs in the domain of intolerance of uncertainty more strongly than other anxiety disorders and normal subjects. These beliefs are significantly related to OCD symptoms even when the effect of anxiety and depression is controlled. The available evidence indicates that dysfunctional beliefs about threat and uncertainty are moderately to highly related to beliefs about importance of thoughts, control of thoughts, responsibility, and perfectionism, which also discriminate OCD from other groups. Over-estimation of threat from inner phenomena; such as thoughts is associated with exaggeration of their importance and attempts at overcontrol. Individuals who are intolerant of uncertainty may have a lower threshold for perceiving a variety of ambiguous situations as threatening. Difficulty with unpredictability, newness, and change could increase the range of situations in which “degree of danger” is overestimated and “capacity to cope” is underestimated. This chapter concludes that further research depends on the extent of overestimation of threat is a central aspect of OCD that it is a necessary condition to the development and maintenance of symptoms.