Reactions to intrusive images among individuals with either social anxiety disorder or obsessive-compulsive disorder

Abstract

Recurrent intrusive images exist across mental disorders. However, the specific content of intrusive images varies depending on disorder. According to the continuum hypothesis the process in which intrusive thoughts develop into clinical obsessions is specific to the development of obsessive-compulsive disorder (OCD) and other disorders on the OC-spectrum. We argue that this process can be generalized to other disorders as well, such as social anxiety disorder (SAD). The aim of the study was to explore how individuals with either SAD or OCD react to intrusive images, and whether they tend to react to them with one or more compulsive strategies. Participants were 60 outpatients with SAD as their primary diagnosis, 22 individuals with OCD as their primary diagnosis and 57 individuals without a psychiatric diagnosis (control group). Participants were interviewed with a semi-structured interview to assess their most significant intrusive image and how they tend to react to it. Participants in the OCD group (95.5%) were more likely than participants in the SAD group (56.7%) to have experienced intrusive images in the past six months. Almost no one in the control group (3.5%) reported recurrent intrusive images. Content analyses (performed by raters blind to group assignment) of the images revealed different themes in the OCD and SAD group, which could be linked to theoretical models of these disorders. Majority of participants who reported experiencing intrusive images in both groups (85% in the SAD group and 95% in the OCD group) reported using at least one strategy that was compulsive. This study is the first step towards establishing that obsessions and compulsions may exist in disorders that have not, historically, been placed on the OC-spectrum. Future directions and implications for theoretical models and treatment are discussed.Keywords: Obsessions, compulsions, obsessive- compulsive disorder, imagery, social anxiety disorder.