Abstract
Fear has been assigned a central role in models of obsessive–compulsive disorder (OCD), but empirical investigations into the emotions that underpin OCD symptoms are few, especially in pediatric samples. Using validated, clinician-led structured interviews, 124 youth with OCD reported on the presence and severity of symptoms across the main symptom dimensions of OCD (aggressive, symmetry, contamination) and the degree to which fear, incompleteness, and disgust accompanied these symptoms. For comparison purposes, the degree of fear, incompleteness, and disgust during symptoms was obtained also from youth with social anxiety disorder (SAD; n = 27) and generalized anxiety disorder (GAD; n = 28). Participants with OCD reported that all three emotions were involved in their symptoms; however, fear was most strongly linked to aggressive symptoms, incompleteness to symmetry symptoms, and disgust to contamination symptoms. Incompleteness differentiated youth with OCD from those with SAD and GAD. No differences for these emotions were found for youth with OCD with versus without the tic-disorder subtype or comorbid autism. A positive association between incompleteness and self-reported hoarding emerged among youth with OCD. Further studies of the emotional architecture of pediatric OCD, and its relationship to etiology and treatment, are warranted.
Highlights
Pediatric obsessive–compulsive disorder (OCD) is a heterogeneous and disabling condition affecting 2–4% of children and adolescents [1, 2]
We moved beyond trait-level assessment of emotion and investigated the degree to which specific emotions occur during symptoms of OCD
We drew upon two previously separate programs of research, the first focusing on fear and incompleteness [16], and the second on disgust [54], to conjointly examine these emotions in youth with OCD in comparison to youth with generalized anxiety disorder (GAD) and social anxiety disorder (SAD)
Summary
Pediatric obsessive–compulsive disorder (OCD) is a heterogeneous and disabling condition affecting 2–4% of children and adolescents [1, 2]. If the individual focuses on these intrusions and appraises them such that the intrusion means the feared outcome is more likely, and the individual is responsible for preventing the feared outcome, there is an increase in fear, distress, and an urge to neutralize this thought and prevent the feared outcome. Over time, such appraisals and the resulting fear response drive the development of a wide range of neutralizing (escape) and avoidance behaviors [11]. OCD and anxiety disorders are similar in that they are driven by exaggerated fears about the probability of harm and maintained by the excessive use of idiosyncratic safety-seeking behaviors
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