Responsibility appraisals and obsessive-compulsive disorder: A critique of salkovskis's cognitive theory

Abstract

Salkovskis's cognitive theory of obsessive-compulsive disorder proposes that interpretations of the occurrence of intrusive thoughts as indicative of personal responsibility for some harmful outcome to oneself or others are causally linked to the features of the disorder. Such beliefs about responsibility are hypothesised to result in increased anxiety or discomfort, increased efforts to exert control over cognition, and the overt and covert neutralising activity which characterises the disorder. This paper presents a critical examination of this formulation, outlining its insufficiencies as an explanation of obsessional problems. These limitations include (a) its lack of any explicit motivational principle, (b) its reliance on a purely self-evident connection between the crucial responsibility beliefs and anxiety or distress, (c) its omission of a plausible account of important qualities of obsessive-compulsive phenomena, such as their compulsiveness and repetitiveness, and (d) its disregard for proximal etiological factors in the occurrence of the intrusive thoughts. The paper also discusses the need for consideration of affective components in any adequate psychological account. It argues for a psychological model of obsessional problems which incorporates not only propositions about responsibility beliefs but also statements concerning beliefs about “thought-action fusion”, self-doubt, and the ambivalent affective relationship between the individual and the object of his or her intrusive thoughts.