(PS3-D78) OCD Relates to Difficulty Inhibiting Repetitive Urges

Background: Many individuals with obsessive-compulsive disorder (OCD) report sensory-based urges (e.g. ‘not just right experiences’) in addition to, or instead of, concrete fear-based obsessions.  These sensory-based urges may be comparable to everyday “urges-for-action” (UFA), such as the urge to blink. While research has demonstrated an association between OCD and altered functioning of brain regions related to UFA, little is known about behavioral patterns of urge suppression in OCD.
Methods:  An urge-to-blink task was utilized as a model for sensory-based urges where eight 60-s blink suppression (hold) blocks alternated with 30-s free-blinking (rest) blocks. Blinks were measured using eye-tracking (Eyelink 1000 Plus). The sample consisted of 86 individuals diagnosed with OCD (65.1% female, Age M = 30.53, SD= 10.92) and 49 healthy controls (HC; 61.2% female, M = 31.12, SD= 11.48).  Post-task ratings of the task-related urge-to-blink were examined using Mann-Whitney tests and Spearman’s correlations. In order to examine relations between OCD and patterns of urge suppression, cox regression models for survival data were used to examine 1) timing of first blink in hold blocks (i.e. latency to first blink), and 2) rate of subsequent blinks after first blink. Assessments included clinical and self-report scales.
Results: The OCD group reported greater self-reported difficulty resisting subsequent blinks after initiating blinking compared to HCs (U = 2648, z = -3.22, p </em>=.001), however groups did not differ on urge-to-blink intensity (U = 1820, z = -1.37, p </em>=.17). The cox proportional hazards model failed to show a relationship between group (OCD, HC), block number (1-8), or their interaction on latency to first blink. In the model examining recurrent blinks, there was a main effect of group (OCD, HC) (β₁ = 0.65, p < .001, HR=1.91) such that OCD patients demonstrated a 91% increased risk of recurrent blinks compared to the HCs. There was no significant effect of block or interactions between variables. In the OCD group, neither severity of OCD symptoms (Y-BOCS) nor sensory phenomena (SPS) related to blink measures or self-reported ratings.


Conclusions: Results from both behavioral and self-report measures demonstrate that when instructed to suppress blinks, individuals with OCD have greater difficulty resisting repetitive blinking compared to HCs. Interestingly, OCD did not relate to latency of first blink (i.e. if they started blinking earlier) or self-reported urge-to-blink intensity, and none of the outcomes related to clinical heterogeneity within OCD. Whereas the ability to delay an initial urge as well as the perceived urge intensity do not differ between OCD and HC, patients are impaired in the ability to suppress subsequent urges once an initial failure in suppression has occurred. Urge resistance is an important component of exposure and response prevention, a gold standard treatment for OCD, and therefore findings may be relevant for treatment.  Further elucidation of the temporal dynamics of urge resistance may contribute to the optimization of outcomes to existing evidence-based interventions.