Dual Frameworks for Understanding OCD: Cognitive Misappraisals and Psychological Inflexibility in Clinical and Non-Clinical Populations

Background: OCD is a prevalent and debilitating mental disorder characterized by intrusive thoughts and repetitive behaviours. While cognitive models attribute OCD to dysfunctional beliefs and misinterpretations of intrusive thoughts, the inflexibility model emphasizes the role of experiential avoidance and cognitive fusion. This study investigates the relative predictive power of the cognitive and inflexibility frameworks in individuals with OCD compared to non-clinical controls. Methods: A total of 315 participants were recruited: 125 individuals with OCD and 190 non-clinical controls. Participants completed self-report measures of OCI-R, AAQ-II, CFQ and interpretation of intrusions (III). ANOVA and Pearson correlation analyses were conducted to examine group differences and relationships between variables. Finally, multiple stepwise regression analyses were performed to investigate the predictive power of these variables on OCD symptoms in both groups. Results: Results indicated that individuals with OCD exhibited significantly higher levels of cognitive fusion, experiential avoidance, and misinterpretation of intrusions compared to non-clinical controls. Regression analyses revealed that cognitive fusion and interpretation of intrusions were significant predictors of OCD symptoms in the non-clinical group (R-2 = 0.265***), while experiential avoidance and cognitive fusion were significant predictors in the clinical group (R-2 = 0.254***). Conclusions: This study provides evidence for a multifaceted understanding of OCD. While the interpretation of intrusions may be more relevant in subclinical experiences of OCD, experiential avoidance and cognitive fusion may be more important as severity increases. This shift in emphasis suggests that the inflexibility model may be a better predictor of OCD symptoms than the cognitive model in individuals with a long history of the disorder.