Obsessive Compulsive and Related Disorders
The Relationship between OCD, Depression, and Interpretations of Intrusive Thoughts
Chase DuBois, B.A.
Study Coordinator
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina
Carly S. Rodriguez, B.A.
Clinical Research Coordinator
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina
Maya E. Tadross, None
Undergraduate Research Assistant
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina
Jennifer R. Persia, None
Research Assistant
UNC Chapel Hill
438 Aaron Cir., North Carolina
Christopher G. Lung, B.S.
Undergraduate Research Assistant
University of North Carolina at Chapel Hill
Charlotte, North Carolina
Samantha N. Hellberg, M.A.
Doctoral Canditate
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina
Heidi J. Ojalehto, M.A.
Doctoral Student
University of North Carolina at Chapel Hill
Durham, North Carolina
Nicholas S. Myers, M.A.
Doctoral Student
University of North Carolina at Chapel Hill
Durham, North Carolina
Lia Follet, Other
Research Assistant
Harvard University
Allston, Massachusetts
Jonathan Abramowitz, Ph.D.
Professor of Psychology
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina
Introduction: About 56% of individuals with obsessive-compulsive disorder (OCD) experience comorbid major depressive disorder (MDD; Torres et al., 2016). OCD symptoms concerning unacceptable, taboo thoughts have been linked to depressive symptoms (Hasler et al., 2005; Torres et al., 2016). However, this issue remains understudied. Maladaptive beliefs about the importance of intrusive thoughts (e.g., "having an unwanted sexual thought means I actually want to act on it") may mediate this relationship: they are associated with both unacceptable thoughts (Brakoulias et al., 2014) and depressive symptoms (Abramowitz et al., 2007). Indeed, overestimates of the significance of these intrusive thoughts may lead to negative views of oneself resembling depressive cognitions. The current study, therefore, aimed to clarify relationships between depressive and OCD symptom dimensions and examine erroneous interpretations of unacceptable thoughts as a potential cognitive mediator.
Methods: Participants were 152 outpatients who received a principal diagnosis of OCD and were seeking treatment for this condition. All participants completed self-report questionnaires, including the Dimensional Obsessive-Compulsive Scale (DOCS), Beck Depression Inventory-II (BDI-II), and Obsessive Beliefs Questionnaire (OBQ). An exploratory factor analysis (EFA) was conducted to derive the factor structure of the BDI-II. Bivariate correlations among the DOCS and BDI-II subscales and total scores were examined. A Bonferroni-corrected alpha was used to adjust for family-wise error (p < .002). PROCESS (Hayes, 2022) was used to estimate bootstrapped mediation models.
Results: The EFA suggested a 2-factor solution for the BDI-II. The model demonstrated adequate fit. The BDI-II factor structure derived was similar to Beck’s (1996) original findings. Factor 1 was conceptualized as cognitive/affective symptoms, while Factor 2 represented somatic/anhedonic symptoms of depression. The DOCS unacceptable thoughts (DOCS-UT) subscale was significantly correlated with the BDI-II cognitive/affective (r = .29) and somatic/anhedonic (r = .30) factors. The DOCS contamination, responsibility for harm, and symmetry subscales were not significantly associated with either BDI-II factor. In addition, OBQ importance/control of thoughts (OBQ-ICT) scores significantly mediated the relationship between DOCS-UT and BDI-II total scores: the indirect effect was significant (effect estimate = .256, SE = .099).
Conclusion: Interestingly, OCD symptoms concerning repugnant thoughts were uniquely associated with comorbid depressive symptoms. Indeed, unacceptable thought symptoms were moderately associated with both cognitive/affective and somatic/anhedonic depressive symptoms. Elevated beliefs about the importance and need to control intrusive thoughts had a small-to-moderate mediating effect on this relationship. Findings are limited by the cross-sectional design which cannot establish causality. Given OCD symptoms often precede comorbid depression (Abramowitz et al., 2007), prospective studies should examine whether this mediator contributes to comorbid MDD development and incorporate direct measures of negative self-beliefs.