Vulnerability Schemas in Obsessive-Compulsive Disorder
Sookman, Debbie, Pinard, Gilbert, Beck, Aaron T., Journal of Cognitive Psychotherapy
This article elaborates on the construct of dysfunctional vulnerability schemas in Obsessive-Compulsive Disorder (OCD) (Sookman & Pinard, 1995,1999; Sookman, Pinard, & Beauchemin, 1994). These schemas are conceptualized as a central mechanism of excessive threat appraisals proposed to be the predominant cognitive problem in anxiety (Beck, 1996; Beck & Clark, 1997). Four domains of beliefs are hypothesized to comprise vulnerability in OCD: Perceived Vulnerability; View of/ Response to Unpredictability, Newness, and Change; View of Strong Affect; and Need for Control. A study carried out with 111 subjects indicated that OCD patients more strongly endorsed these beliefs compared with patients with other anxiety disorders, mood disorders, and normal controls. The discriminant function derived from these four belief domains was effective in classifying OCD patients and other subjects into their respective groups. The results support the inclusion of dysfunctional vulnerability beliefs in cognitive assessment and treatment of OCD.
The purpose of this article is to elaborate on the construct of vulnerability schemas proposed in Obsessive-Compulsive Disorder (OCD). An overall theoretical formulation/ model will be presented, followed by a study carried out to test the hypothesis that selected beliefs related to vulnerability are more characteristic of OCD as compared with other anxiety or mood disorders.
The Construct of Vulnerability
Beck and colleagues have hypothesized that the appraisal of personal vulnerability is a central characteristic both of anxiety and mood disorders (Beck, Emery, & Greenberg, 1985). They defined this construct as: "A person '^perception of himself as subject to internal or external dangers over which his control is lacking or is insufficient to afford him a sense of safety" (p. 67), which pervades "important objectives, attachments, and relationships" (p. 78). This construct encompasses (a) appraisals of inner as well as external danger, risk, or threat; (b) feared consequences; and (c) the importance of perceived coping skills. Inner danger was hypothesized to include threat to core self-esteem. External threat encompassed fears of interpersonal failure or loss. Associated fear of loss of control included loss of control over emotions.
This formulation is consistent with theoretical approaches that emphasize the importance of dysfunctional cognitive schemas, or core beliefs pertaining to the self and others, as a feature of psychological difficulties (e.g., Beck, 1996; Beck & Freeman, 1990; Guidano, 1990; Liotti, 1991; Safran, 1990a; Teasdale & Barnard, 1993; Young, 1994). In their integrative conceptual and treatment model of OCD, Sookman and Pinard focused on multidimensional core beliefs and schemas. They proposed that dysfunctional vulnerability schemas are characteristic of OCD, and that these are a central underlying mechanism of excessive threat appraisals to a variety of internal and external stimuli (Sookman & Pinard, 1995, 1997, 1999; Sookman, Pinard, & Beauchemin, 1990,1994). Vulnerability schemas are thought to be comprised of core beliefs about danger, with emotional, interpersonal, and behavioral aspects, emanating in part from significant developmental and attachment experiences. They selectively influence attention, memory, and appraisal of specific stimuli perceived/processed as threatening.
There is a distinction to be made between the construct of vulnerability schemas, addressed in this article, and what are referred to as vulnerability or risk factors related to the development of a disorder. For example, risk factors (e.g., heredity, environmental stressors) for depression have been extensively studied (Ingram, Miranda & Segal, 1998). Vulnerability schemas could indeed be one of the important factors that influences the emergence and maintenance of psychopathology. The aim of this article is to elaborate on the relevance of this construct in OCD that has already developed, rather than to examine its etiological role. …