Mild Uncertainty Promotes Checking Behavior in Subclinical Obsessive-Compulsive Disorder

Abstract

Patients with obsessive-compulsive disorder respond to clinical uncertainty with perseverative checking, which, ironically, enhances uncertainty. However, patients also display general subclinical uncertainty, which may tempt vulnerable individuals to seek reassurance by perseveration in response to mild uncertainty that is superimposed on general uncertainty. An experimental eye-tracking paradigm was developed to investigate whether mild uncertainty indeed induces checking behavior in people with high obsessive-compulsive tendencies (OC+, n = 34), compared to people with low obsessive-compulsive tendencies (OC–, n = 31). Participants were presented 50 visual search displays, and they indicated whether a target was “present” or “absent.” Decisions about target presence induced little uncertainty, but decisions about its absence were more ambiguous, because participants relied on not having overlooked the target. Results revealed no differences on target-present trials. However, in target-absent trials, OC+ participants searched longer and used more fixations. Thus, even in mildly uncertain situations, individuals with subclinical obsessive-compulsive disorder respond with more checking behavior, which has implications for treatment.