Obsessional cognitive styles in scrupulosity and contamination OCD

Scrupulosity is an understudied and challenging form of obsessive-compulsive disorder (OCD) characterized by core obsessional fears that focus on religious or moral themes. Previous research demonstrates that obsessional cognitive styles differ across OCD symptom dimensions; however, scrupulosity does not fit neatly within such dimensions. The goal of the present investigation was to compare obsessional cognitive styles among individuals with primary scrupulosity (n = 29), those with primary contamination OCD (n = 20), and healthy controls (n = 19). 68 participants were administered a diagnostic interview and measure of symptom severity, and completed self-report measures of symptoms and cognitions. Individuals with scrupulosity endorsed stronger beliefs about the importance and control of thoughts and moral thought-action fusion than did individuals with contamination OCD and healthy controls. Similarly, scrupulous individuals endorsed stronger responsibility beliefs. This, despite that the OCD groups did not differ in OCD severity. Both OCD groups reported greater intolerance of uncertainty than did healthy controls, but did not differ from each other. The results of dimensional analyses indicated that symptoms of scrupulosity were strongly associated with beliefs about the importance and control of thoughts, moral thought-action fusion, responsibility, and intolerance of uncertainty. In contrast, washing symptoms were not associated with beliefs about thoughts, and moderately associated with beliefs about responsibility and intolerance of uncertainty. More extreme obsessional thinking may be part of the reason why scrupulosity can be particularly challenging to treat. Increasing focus on cognitive targets may enhance treatment efficacy for scrupulous individuals, although this remains to be examined.