Experiences of imagery in obsessive-compulsive disorder: An interpretative phenomenological analysis

Mental imagery is a defining criterion within current OCD diagnoses, and yet little has been written about how this is experienced. This study aimed to investigate how people with a diagnosis of OCD experience imagery, to better understand how this might contribute to the condition.

This research employed Interpretative Phenomenological Analysis (IPA) and used semi-structured interviews. An expert-by-experience was involved in the study design. Eight adults with an OCD diagnosis were purposively sampled from NHS mental health services and interviewed about their experience of imagery. Interviews were transcribed and analysed in accordance with IPA guidelines. A reflexive log and audit trail were maintained during the research process to enhance quality control and to support the analytical process.

Six superordinate themes were found: Submersion in intense and multifaceted imagery; Overwhelming, uncontrollable imagery; Imagery is explosive and expansive; Imagery involves past memories and future fears; People respond to imagery as if it is real; Therapy shifts imagery.

This study highlights the intensity of OCD-related imagery experienced by people with OCD and the significance of this imagery in their everyday lives. All participants experienced imagery related to their OCD, demonstrating its importance in the phenomenology of the condition. Images relating to past experiences and images of future fears were identified. Clinicians should routinely seek to include imagery in assessment, formulation, and individual treatment plans for those with OCD.