THEORY OF OBSESSIVE-COMPULSIVE
Paul M. Salkovskis
Fundamental to cognitive-behavioural theories of obsessive-compulsive disorder (OCD) is the idea that obsessional problems occur as the result of a set of reactions which both stem from and intensify otherwise normal intrusive thoughts. Such obsessional (intrusive) thoughts in people who suffer from OCD are not qualitatively different from the intrusive thoughts experienced by people who do not suffer from clinical obsessive disorders. Intrusive thoughts, which were indeed indistinguishable in terms of content from clinical obsessions, were found to occur in almost 90% of the general population (Rachman & de Silva, 1978; Salkovskis & Harrison, 1984). Although the perception of threat arising from the occurrence and/or content of intrusive cognitions will give rise to anxiety, more is needed in an account of OCD. The perception of threat related to intrusions would give rise to generalised anxiety, and indeed there is evidence that this is what occurs in generalised anxiety disorder (GAD) (Beck et al., 1985; Freeston et al., 1994). Although overestimation of danger and threat is a necessary component of obsessional problems, intrusions in OCD are misinterpreted, not only as indicating danger to themselves or other people, but that the person could be responsible for bringing about and/or preventing this danger. Cognitive theories further indicate that behavioural responses are driven by threat appraisal, and that the aim of such responses is to seek safety (Salkovskis, 1991, 1996a, 1996c). In OCD, responsibility appraisal is crucial to the motivation of a range of safety-seeking behaviours, mostly reactions intended to prevent or otherwise neutralise harm or to diminish responsibility (Salkovskis & Freeston, in press). This theory is consistent
Obsessive-Compulsive Disorder: Theory, Research and Treatment.
Edited by Ross G. Menzies and Padmal de Silva. © 2003 John Wiley & Sons, Ltd.