OCD, Delusions and the

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OCD, Delusions and the Feeling of Knowing
Reflections on Szechtman and Woody (2004)
Vaughan Bell
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Outline

• Main argument
• If we accept Szechtman and Woodys model, OCD
  and delusions can be both explained as
  pathologies of belief
• Phenomenology of OCD
• The security motivation system and the feeling
  of knowing.
• OCD as pathology of belief in the completion of
  security motivated thoughts and action.
• Belief, delusions and the feeling of knowing.

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Phenomenology of OCD

• OCD is characterised by obsessions or
  compulsions, or commonly, both.

• Kurt Gödel, one of the greatest mathematicians of
  the 20th century.
• Suffered from obsessive worries.
• Eventually starved himself to death because of
  obsessive thoughts about his food being poisoned.

Kurt Gödel 1906 - 1978
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Obsessions

• Unwanted, recurrent, intrusive thoughts, which a
  person usually tries to resist or repress.
• They are reported as being my own thoughts and
  are usually recognised as being unreasonable
  concerns.
• Akhtar et al (1975) distribution of symptomology,
  most frequent to least
• Doubts, obsessive thinking, fears, impulses,
  images
• Dirt or contamination, aggression, inanimate or
  impersonal, sex, religion

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Compulsions

• Repetitive actions or mental acts that a person
  performs in response to an obsession.
• Usually to reduce distress or prevent an imagined
  event. They may or may not be realistically
  connected to the obsession.
• Akhtar et al two main types of compulsion
• Yielding compulsion that gives expression to an
  underlying obsessive urge (e.g. washing /
  checking)
• Controlling compulsion subvert the obsession
  without expressing it (e.g. counting).

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Security Motivation System

• Examples
• Szechtman and Woody see OCD in the context of a
  security motivation system.
• Unlike other adaptive motivations (hunger, pain,
  sex, maternal, exploration) there is no natural
  stop event for security behaviours.
• SW argue for a yedasentience or feeling of
  knowing signal that is generated when a security
  based action is completed.
• Their model aims to explain adaptive and
  maladaptive (OCD) security behaviours.

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Stimuli, context, plans
Security Motivation System
Yedasentience
Appraisal of potential danger
Security related programs
Security motivation
Action
Anxiety
Safety Cues
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Stimuli, context, plans
Pathology Obsessions
Yedasentience
Appraisal of potential danger
X
Security related programs
Security motivation
Action
Anxiety
Safety Cues
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Stimuli, context, plans
Pathology Compulsions
X
Yedasentience
Appraisal of potential danger
Security related programs
Security motivation
Action
Anxiety
Safety Cues
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Feelings of Knowing

• Bruce and Young (1986) feeling of knowing to
  signify face recognition.
• A metacognitive process mediating conscious
  (recollection) and unconscious (familiarity)
  processes in memory recall (Koriat, 2000)
• Damasios (1998) somatic marker hypothesis in
  which automatic emotional responses underpin
  reasoning.
• Frijda et al (2000) influence of affect on belief.

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OCD as a pathology of belief

• By using feeling of knowing Szechtman and Woody
  are essentially arguing that OCD is a problem
  with belief formation.
• OCD appears to stem from a particular
  disturbance in subjective conviction about
  reality
• It seems, a problem with belief fixation, leading
  to pathological doubt.
• James (1890)
• In its inner nature, belief or the sense of
  reality, is a sort of feeling more allied to the
  emotions than anything else The true opposite of
  belief, psychologically considered, are doubt and
  enquiry

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Parallels with Capgras

• Capgras delusion is a delusional belief that
  (usually) close relatives have been replaced by
  identical looking impostors.
• Ellis et al (1997) showed that Capgras patients
  show a reduced automatic emotional response to
  familiar faces.
• i.e. they have a distorted feeling of knowing
  for faces.
• In both Capgras and OCD there seems to be
  impairments in feeling of knowing leading to a
  belief pathology.

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Delusions

• High prevalence (100) of safety behaviours in
  persecutory delusions (Freeman et al, 2001)
• In general are a direct representation of
  emotional concerns (Freeman and Garety, 2003)
• Emotions can awaken, intrude into, and shape
  beliefs, by creating them, by amplifying or
  altering them, and by making them resistant to
  change
• Frijda et al (2000)

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OCD, Delusions, Belief

• Delusions could be explained as an inappropriate
  or over activation of affect driven feeling of
  knowing.
• According to Szechtman and Woody, OCD is a
  pathology of belief caused by under-activation of
  affect driven feeling of knowing.
• Hence, explaining both in a unitary belief
  formation model.

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Criticisms

• Szechtman and Woodys model only seems to explain
  the most prevalent obsessive phenomena (e.g.
  Doubts, Fears / Contamination, Aggression)
• Others not necessarily security related e.g.
  inanimate-impersonal, sex, religion.
• Parallels with delusions, in that this model may
  only work for persecutory delusions.
• Security motivation may be inadequate to
  explain non-persecutory obsession, compulsions
  and delusions.

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Conclusions

• Despite the caveats, using belief formation as a
  unitary framework for explaining OCD and
  delusions may be a useful way forward.
• Security motivation may not be a complete
  explanation for all phenomenon.
• Different motivations may need to be explained
  separately to account for the prevalent themes in
  both OCD and delusions.
• Affect may be an important component in
  interfacing motivation and belief formation.