Exploring the Voice of OCD

Abstract

Critical inner dialogues are prevalent and clinically significant features of depression and eating disorders. According to the Interpersonal Circumplex (IPC), qualities of a communication can be rated on orthogonal dimensions of tone (hostile to warm) and authority (dominant to submissive), wherein qualities of a communication elicit complementary responses, with warmth eliciting warmth and dominance eliciting submission. Preliminary research by Chiang and Purdon (2020) found that obsessions are often experienced as a neutral dominant voice, however, this is the only study that has investigated the tonal qualities of obsessions. The current study is a replication and extension of these preliminary findings, exploring the phenomenology of the OCD voice and its association with OCD symptom severity and insecure attachment. Adults with a past diagnosis of OCD (N=20) were administered a semi-structured interview developed for this study. The interview included two within-participants conditions; one in which participants were asked about obsessions that evoked a compulsion and another in which the obsession did not evoke a compulsion. Well-validated measures were used to assess appraisals of the OCD voice, OCD symptoms, and attachment style. Qualitative results showed that all participants reported experiencing an internal OCD voice, and the majority (85%) engaged with it in internal dialogue. The OCD voice was predominantly rated as neutral and dominant across both obsessive-compulsive episodes. Quantitative analyses revealed that greater perceived benevolence and omnipotence of the OCD voice significantly predicted more severe OCD symptoms. These findings support the prevalence of a neutral and dominant OCD voice among a sample of adults with a past diagnosis of OCD. Appraisals of the OCD voice, particularly benevolence and omnipotence, may contribute to symptom severity. This study highlights the potential therapeutic value of targeting individuals’ relationship with the OCD voice.