Academic journal article International Journal of Clinical and Health Psychology

A Cross-Sectional Investigation of Autogenous and Reactive Obsessions and Associated Cognitive and Symptom Correlates in China

Academic journal article International Journal of Clinical and Health Psychology

A Cross-Sectional Investigation of Autogenous and Reactive Obsessions and Associated Cognitive and Symptom Correlates in China

Article excerpt

Obsessive-compulsive disorder (OCD) is characterized by obsessions and compulsions, the former of which refer to persistent and intrusive images, thoughts, ideas, or impulses that cause distress or impairment (American Psychiatric Association [APA], 2013). Compulsions can be either observable (e.g., checking) or mental (e.g., praying) and are intended to neutralize or alleviate the distress caused by obsessions. Factor and cluster analyses have simplified OCD symptom subtypes into three, four, or five factors (Abramowitz, Franklin, Schwartz, & Furr, 2003; Baer, 1994; Calamari, Wiegartz, & Janeck, 1999; Leckman et al., 1997; Mataix-Cols, Rauch, Manzo, Jenike, & Baer, 1999; Sans, Hernández-Martínez, Muñoz, García, & Trallero, 2012), with common factors including contamination/ washing, hoarding/collecting, doubting/checking, and aggressive, sexual, and religious obsessions. These symptom subtypes provide a straightforward way of categorizing individuals with OCD for clinical and research purposes, and this approach to subtyping has been helpful in predicting OCD severity (e.g., Moreso, Hernández-Martínez, Val, & Sans, 2013) and response to treatment (e.g., Abramowitz et al., 2003). However, another conceptualization, based on autogenous and reactive obsessions, may represent a more parsimonious approach to carving nature at its joints compared to the symptom cluster models, as well as for stimulating research on the functions of these behaviors and increasing understanding of the relation between obsessions and compulsions (Starcevic et al., 2011).

According to Lee and Kwon (2003), autogenous and reactive obsessions can be differentiated by stimuli that evoke them, how they are experienced, and their content and perceived consequences. Autogenous obsessions are not typically preceded by an identifiable stimulus and instead come into consciousness abruptly. They are experienced as "out of the blue" and often include sexual or aggressive thoughts or urges, such as killing a baby. These obsessions are also ego-dystonic in nature, meaning they are inconsistent with the self and are experienced as aversive and immoral. Common OCD manifestations associated with autogenous obsessions include ego-dystonic impulses (Lee, Lee, Kim, Kwon, & Telch, 2005; Moulding, Kyrios, Doron, & Nedeljkovic, 2007) and unwanted thoughts (Lee & Kwon, 2003).

On the other hand, reactive obsessions are more commonly evoked by an identifiable stimulus. Instead of coming into consciousness abruptly, reactive obsessions are experienced as being tied to a realistic and rational threat, such as contamination, accidents, or mistakes (Lee & Kwon, 2003). They are less ego-dystonic in nature (although not as ego-syntonic as worry [Lee et al., 2005]), meaning that the individual perceives the thoughts as more logical and reality-based compared to autogenous obsessions, although they are disruptive and persistent. Whereas a person with autogenous obsessions would consider the content of the obsessions to be aversive and not particularly rational, a person with reactive obsessions may consider the obsessions to be more rational. Common themes of reactive obsessions include contamination concerns and checking symptoms (Belloch, Morillo, & Garcia-Soriano, 2007; Lee et al., 2005; Moulding et al., 2007; but see Lee & Telch, 2010, and Lee, Yost, & Telch, 2009, for alternative findings).

An important concern has been raised about the model of autoge nous a nd reactiv e obsessions-the model may undermine the heterogeneity of obsessions within the a ut ogenous a n d r e a c t i v e categor i e s. Fo r ex a mpl e , differences between aggressive, religious, and sexual obsessions may not be as readily recognized when using the autogenous and reactive obsession model, as these obsessions would be similarly classified as autogenous (Siev, Steketee, Fama, & Wilhelm, 2011). Despite this valid concern, this model of obsessions has been supported by several studies (Belloch et al. …

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