Academic journal article Journal of Cognitive Psychotherapy

Cognitive and Clinical Characteristics of Sexual and Religious Obsessions

Academic journal article Journal of Cognitive Psychotherapy

Cognitive and Clinical Characteristics of Sexual and Religious Obsessions

Article excerpt

Sexual and religious obsessions are often grouped together as unacceptable thoughts, symptoms of obsessive-compulsive disorder (OCD) hypothesized to be maintained by maladaptive beliefs about the importance and control of thoughts. Although there is empirical justification for this typology, there are several reasons to suspect that sexual and religious obsessions may differ with respect to associated obsessional beliefs and personality traits. In this study, we examined the associations between sexual and religious obsessions (separately) and (a) putatively obsessional cognitive styles, especially beliefs about the importance and control of thoughts, and responsibility; (b) obsessive-compulsive personality traits; and (c) schizotypal personality traits. Whereas sexual obsessions were predicted only by increased beliefs about the importance and control of thoughts, and contamination obsessions were predicted only by inflated responsibility appraisals and threat estimation, religious obsessions were independently predicted by both of these constructs. In addition, only religious obsessions were related to self-reported obsessive-compulsive personality traits. Researchers and clinicians should be cognizant of potentially important distinctions between sexual and religious obsessions, and the possibility that scrupulous OCD shares processes with both autogenous and reactive presentations.

Keywords: obsessive-compulsive disorder; obsessive-compulsive personality disorder; obsessive beliefs; autogenous obsessions; religious obsessions; sexual obsessions

Among individuals with obsessive-compulsive disorder (OCD), the presence of sexual or religious obsessions is relatively common, with nearly 25% reporting the former (e.g., Grant et al., 2006), and 10%-33% reporting the latter in Western cultures (Eisen et al., 1999; Mataix-Cols, Marks, Greist, Kobak, & Baer, 2002). Sexual and religious obsessions are experienced as particularly aversive and ego dystonic. Furthermore, they are associated with negative outcomes in several trials of cognitive-behavior therapy (CBT) and pharmacotherapy (Alonso et al., 2001; Ferrão et al., 2006; Mataix-Cols et al., 2002; Rufer, Grothusen, Mass, Peter, & Hand, 2005; but see Abramowitz, Franklin, Schwartz, & Furr, 2003). Considering the apparent difficulty in treating such obsessions, there is a notable paucity of research about characteristics associated with them.

Sexual and religious obsessions are often conceptualized together as unacceptable or repugnant thoughts, and efforts to identify nosological categories within OCD provide an empirical basis for a sexual/religious obsessional subtype (Mataix-Cols, Rauch, Manzo, Jenike, & Baer, 1999), perhaps, including aggressive obsessions as well (cf. Abramowitz et al., 2003; Bloch, Landeros-Weisenberger, Rosario, Pittenger, & Leckman, 2008; Pinto et al., 2007). Similarly, Lee and Kwon (2003) suggest that autogenous obsessions (i.e., about sex, religion, and aggression) differ fundamentally from reactive obsessions (i.e., about contamination, doubts, symmetry, etc.) experientially (internally versus externally generated), as well as in terms of associated appraisal and control strategies. Some research has supported the distinction between autogenous and reactive obsessions (e.g., Lee & Kwon, 2003; Lee, Kwon, Kwon, & Telch, 2005), but there are reasons to suspect that combining sexual, religious, and aggressive obsessions into a single category may mask differences in phenomena related to these symptoms.

First, not all studies have borne out fundamental predictions with respect to cognitions presumed to be associated with the autogenous versus reactive distinction, such as the importance and control of thoughts (cf. Lee & Kwon, 2003; Lee, Kwon, et al., 2005). This gives rise to the possibility that there are variations in such domains among individuals with autogenous symptoms, perhaps as a function of their particular obsessional concerns. …

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