Toward Improved Treatment for OCD
What is interpersonal reassurance seeking (IRS), and are people diagnosed with obsessive-compulsive disorder (OCD) more prone to it than their peers (who do not have OCD)? That is, do those with OCD more persistently seek reassurance of their worth and value from others? What is the relationship between OCD and IRS? These and related questions are what prompted a group of researchers recently to examine the relationship, if one exists, between OCD and IRS. The belief on which the investigators’ hypotheses were based (and the purpose of the study they designed) is that a better understanding of this relationship will greatly contribute to the efficacy of current treatments for OCD (Starcevic, V., Berle, D., Brakoulias, V., Sammut, P., Moses, K., Milicevic, D., & Hannan, A., 2012).
Interpersonal Reassurance Seeking
IRS can best be understood as the seeking of information from others, with the intention of soothing one’s insecurity and affirming safety from perceived threats. However, the historical interpretation of IRS by researchers is described by Starcevic et al. (2012) as a subtle compulsion in and of itself, and they note the frequency and persistency of IRS in OCD patients.
Danger in Unchecked IRS
The investigators, however, do not share the historical interpretation of IRS and rather conceptualize it as one of several coping mechanisms (including compulsions) employed by individuals with OCD to manage obsessions. The researchers justify the distinction by focusing on the unique functionality of each. The following is an example. Whereas compulsions aid clients in a direct attempt to ensure safety (e.g., lock checking, hand washing), IRS aids clients in their internal assessment of a perceived threat and reduces discomfort related to obsessions. IRS is thereby an indirect coping mechanism to reduce anxiety. Starcevic and colleagues (2012) emphasize the danger in unchecked IRS (even if it is seen as an indirect coping strategy) to effective treatment of OCD, and they note that excessive IRS allows clients to more easily maintain OCD symptoms—and thus may prevent them from making the progress of which they are capable. The detrimental effects of IRS to treatment are especially apparent in behavioral strategies aimed toward exposure and response prevention (ERP).
Symptom Assessment
The study by Starcevic et al. (2012) was conducted in Australia, and participants were recruited through newspaper advertisements and referrals from primary care doctors and mental health clinicians. Participants were required to have a primary diagnosis of OCD and were administered several self-report scales along with a psychiatric interview. The self-report measures included: Yale-Brown Obsessive-Compulsive Scale (Y-BOCS; Goodman et al., 1989), Vancouver Obsessional Compulsive Inventory (VOCI; Thordarson et al., 2004), Symptom Checklist 90-Revised (SCL-90R; Derogatis, 1994) and the Mini International Neuropsychiatric Interview (MINI; Sheehan et al., 1999).
IRS as Coping Mechanism or Reflection of Severity of Illness
The results of the researchers’ study demonstrated that almost half of the participants participated in interpersonal reassurance seeking as a coping mechanism for obsessions. Further, close to one half of the participants who reported IRS sought reassurance for harm-related obsessions dealing with such things as potential harm or damage caused in the past or in the future. Participants with obsessions surrounding contamination or perfections reported lower levels of IRS. Additionally, the researchers concluded that individuals manifesting symptoms of IRS were more ill than their counterparts, with higher levels of depression and anxiety. They propose that IRS is more often noted in OCD with stronger obsessions, as it is employed as an additional coping mechanism to compulsions. Starcevic et al. (2012) also note, in accordance with previous research, that checking behavior is often, but not always, coupled with IRS.
What It Demonstrates
The contribution to the cannon of literature available about IRS made by this research (Starcevic et al., 2012) is quite useful in the treatment of OCD, because it demonstrates that the presence of IRS may be associated with greater overall severity of OCD. It also suggests that IRS is but one of many coping strategies used to manage obsessions.
References
Derogatis, L.R. (1994). SCL-90R Administration, Scoring and Procedures Manual, 3rd ed. NCS: Pearson, Minneapolis.
Goodman, W.K., Price, L.H., Rassmussen, S.A., Mazure, C., Fleischmann, R.L., Hill, C.L., Heninger, G.R., & Charney, D.S. (1989). The Yale-Brown Obsessive-Compulsive Scale I: development, use, and reliability. Archives of General Psychiatry, 46, 1006–1011.
Sheehan, D., Janavs, J., Baker, R., Harnett-Sheehan, K., Knapp, E., Sheehan, M., Lecrubier, Y., Weiller, E., Hergueta, T., Amorim, P., Bonora, L.I., & Lepine, J.P. (1999). The Mini-International Neuropsychiatric Interview (M.I.N.I.), English version 5.0.0. DSM-IV. Journal of Clinical Psychiatry, 60(18), 39–62.
Starcevic, V., Berle, D., Brakoulias, V., Sammut, P., Moses, K., Milicevic, D., & Hannan, A. (2012). Interpersonal reassurance seeking in obsessive-compulsive disorder and its relationship with checking compulsions. Psychiatry Research, 1-8.
Thordarson, D.S., Radomsky, A.S., Rachman, S., Shafran, R., Sawchuk, C.N., & Hakistan, A.R. (2004). The Vancouver Obsessional Compulsive Inventory (VOCI). Behaviour Research and Therapy, 42, 1289–1314.
