Examining attentional biases in contamination fear and checking symptoms: An eye-tracking study

Cognitive biases are implicated in the maintenance of obsessive-compulsive disorder (OCD), yet findings from reaction-time paradigms remain mixed. Eye-tracking offers a direct window into these attentional processes. We examined symptom-specific attentional patterns in university students selected for high vs. low contamination fear (HCF n = 10, LCF n = 10) and high vs. low checking (HC n = 10, LC n = 10) from a screened sample (N = 774). Participants viewed symptom-matched (disgust or checking) and general threat pairs against neutral images. Attentional bias was indexed as vigilance (first fixation and latency), disengagement (first-fixation duration), and maintenance (fixation count and total duration). Results indicated that attentional biases were primarily evident during the maintenance stage rather than early orienting. For the contamination dimension, significant interaction emerged for maintenance. Specifically, HCF participants demonstrated significantly reduced gaze maintenance for disgust images compared to threat and neutral images, consistent with a vigilance-avoidance pattern suggestive of attentional avoidance. For the checking dimension, while significant main effects for image type indicated rapid orienting to checking cues and sustained viewing of checking and threat-related images across all participants, these effects were not significantly moderated by symptom group. Findings indicate that attentional bias in OCD is heterogeneous and partially distinct across symptom subtypes. These results underscore the value of symptom-matched stimuli and gaze metrics, support cognitive bias modification to symptom dimensions, and highlight eye-tracking as a useful tool for parsing vigilance, disengagement, and maintenance. Limitations, clinical implications, and future directions are discussed.