Obsessive– Compulsive Disorder 459
domains and there are important individual differences in how strongly persons with
OCD will endorse these maladaptive beliefs. Given this heterogeneity even at the sche-
matic level, it is important that a thorough case conceptualization is conducted in order
to understand the nature of each patient’s schematic activation.
Cognitive Processing Errors
In most cases of OCD maladaptive schema activation involves some belief that the
intrusion represents a significant potential harm to self or others that the person is
responsible to prevent as indicated by improved control over the obsession and a reduc-
tion in anxiety or distress. The activation of these schemas will lead to other automatic
processes, the most important being certain cognitive processing errors. O’Connor and
his colleagues have argued that the primary cognitive error in OCD is one of inferential
confusion. An inference is “a plausible proposition about a possible state of affairs,
itself arrived at by reasoning but which forms the premise for further deductive/induc-
tive reasoning” (O’Connor, Aardema, & Pélissier, 2005, p. 115). The faulty reasoning
processes involved in obsessional states leads to the confusion of an imagined possibil-
ity (e.g., thinking “Could I have contracted a deadly disease from brushing against this
dirty person”?) with actual reality so that the person responds “as if” the obsessional
fear was real (O’Connor & Robillard, 1999). O’Connor and colleagues identified a
number of inductive reasoning errors that lead to the construction of an idiosyncratic
narrative of doubt (i.e., obsessional concern). These include category errors, confusion
of comparable events, selective use of out-of- context facts, reliance on purely imagi-
nary sequences, inverse inference, and distrust of normal perception (see D. A. Clark &
table 11.2. the six belief Domains of obsessive–Compulsive Disorder proposed by the obsessive
Compulsive Cognitions Working group
Belief domain Definition
Inflated responsibility “... the belief that one has power which is pivotal to bring about or prevent
subjectively crucial negative outcomes” (OCCWG, 1997, p. 677)
Overimportance
of thoughts
“... beliefs that the mere presence of a thought indicates that it is
important” (OCCWG, 1997, p. 678)Overestimation of threat “... an exaggeration of the probability or severity of harm” (OCCWG,
1997, p. 678)
Importance of controlling
thoughts
“... the overvaluation of the importance of exerting complete control over
intrusive thoughts, images and impulses, and the belief that this is both
possible and desirable” (OCCWG, 1997, p. 678)Intolerance of uncertainty beliefs about the necessity of being certain, the personal inability to cope
with unpredictable change, and difficulty functioning in ambiguous
situations
Perfectionism “... the tendency to believe there is a perfect solution to every problem,
that doing something perfectly (i.e., mistake free) is not only possible
but also necessary, and that even minor mistakes will have serious
consequences” (OCCWG, 1997, p. 678)
Note. From D.A. Clark (2004, p. 112). Copyright 2004 by The Guilford Press. Reprinted by permission.