Sensitivity to being betrayed and betraying others in obsessive compulsive disorder and depression

Mental contamination (MC) describes subjective internal feelings of 'dirtiness', which are experienced in the absence of direct physical contact/contaminants. There is evidence of a link between MC in obsessive compulsive disorder (OCD) and the experience of past betrayals. However, it has also been noted that 'perpetrators' also experience MC. We aimed to replicate the previous finding of specificity of OCD for sensitivity to being betrayed by comparing with those suffering from depression, and to extend this by evaluating whether people with high MC OCD are also relatively more sensitive to the idea that they might betray others compared to those with low levels of MC OCD.

A cross-sectional, between-groups design was used.

Four groups, high MC OCD (N = 60), low MC OCD (N = 61), depression (N = 28), and non-clinical controls (N = 46) completed online questionnaires. Participants were recruited through the National Health Service (NHS) and social media.

Relative to all groups, the high MC OCD group had significantly higher scores both for betrayal sensitivity and sensitivity to betraying others. The depression group showed similar levels to low MC OCD in betrayal sensitivity but were significantly lower (and comparable to non-clinical controls) in sensitivity to betraying others.

Betrayal sensitivity occurs trans-diagnostically. There may be a specific link between the development of OCD and the perception of betraying others, perhaps linked to the trauma of being betrayed making those so affected more likely to worry about their own responsibility for betraying others.

Clinicians should, across diagnoses, attend to sensitivity to being betrayed and the experiences which may have led to this. Current treatments for MC OCD recommend working with historical experiences of 'betrayal'. This study suggests that people with OCD also have an increased sensitivity to the idea of being a 'perpetrator' of betrayal linked to high responsibility beliefs. Specifically for OCD, it is possible that the experience of previously being betrayed results in increased current sensitivity to being responsible for being a 'betrayer'. It may, therefore, also be useful for therapists to consider if patients with MC OCD are concerned about potentially betraying others and to consider this within the formulation. The focus of clinical work could be to redefine these difficulties by reappraising beliefs regarding experience of betrayal and the likelihood of betraying others. Elevated levels of betrayal sensitivity were found in people with depression, and this may need to be considered in treatment approaches.