OCD, Delusions and the Feeling of Knowing:

1. OCD, Delusions and the Feeling of Knowing: Reflections on Szechtman and Woody (2004) Vaughan Bell

2. Outline • Main argument: • “If we accept Szechtman and Woody’s model, OCD and delusions can be both explained as pathologies of belief” • Phenomenology of OCD • The security motivation system and the ‘feeling of knowing’. • OCD as pathology of belief in the completion of security motivated thoughts and action. • Belief, delusions and the feeling of knowing.

3. Phenomenologyof OCD • OCD is characterised by obsessions or compulsions, or commonly, both. • Kurt Gödel, one of the greatest mathematicians of the 20th century. • Suffered from obsessive worries. • Eventually starved himself to death because of obsessive thoughts about his food being poisoned. Kurt Gödel 1906 - 1978

4. Obsessions • Unwanted, recurrent, intrusivethoughts, which a person usually tries to resist or repress. • They are reported as being ‘my own thoughts’ and are usually recognised as being unreasonable concerns. • Akhtar et al (1975) distribution of symptomology, most frequent to least: • Doubts, obsessive thinking, fears, impulses, images • Dirt or contamination, aggression, inanimate or impersonal, sex, religion

5. Compulsions • Repetitive actions or mental acts that a person performs in response to an obsession. • Usually to reduce distress or prevent an imagined event. They may or may not be realistically connected to the obsession. • Akhtar et al two main types of compulsion: • Yielding compulsion: that gives expression to an underlying obsessive urge (e.g. washing / checking) • Controlling compulsion: subvert the obsession without expressing it (e.g. counting).

6. Security Motivation System • [Examples] • Szechtman and Woody see OCD in the context of a security motivation system. • Unlike other adaptive motivations (hunger, pain, sex, maternal, exploration) there is no natural ‘stop event’ for security behaviours. • S&W argue for a ‘yedasentience’ or ‘feeling of knowing’ signal that is generated when a security based action is completed. • Their model aims to explain adaptive and maladaptive (OCD) security behaviours.

7. Stimuli, context, plans Security Motivation System Yedasentience Appraisal of potential danger Security related programs Security motivation Action Anxiety Safety Cues

9. Obsessive thought Stimuli, context, plans Pathology: Obsessions Yedasentience Appraisal of potential danger X Security related programs Security motivation Action Anxiety Safety Cues

11. Compulsive action Stimuli, context, plans Pathology: Compulsions X Yedasentience Appraisal of potential danger Security related programs Security motivation Action Anxiety Safety Cues

12. Feelings of Knowing • Bruce and Young (1986): ‘feeling of knowing’ to signify face recognition. • A metacognitive process mediating conscious (recollection) and unconscious (familiarity) processes in memory recall (Koriat, 2000) • Damasio’s (1998) somatic marker hypothesis in which automatic emotional responses underpin reasoning. • Frijda et al (2000) influence of affect on belief.

13. OCD as a pathology of belief • By using ‘feeling of knowing’ Szechtman and Woody are essentially arguing that OCD is a problem with belief formation. • “OCD appears to stem from a particular disturbance in subjective conviction about reality” • It seems, a problem with belief fixation, leading to pathological doubt. • James (1890): • “In it’s inner nature, belief or the sense of reality, is a sort of feeling more allied to the emotions than anything else… The true opposite of belief, psychologically considered, are doubt and enquiry…”

14. Parallels with Capgras • Capgras delusion is a delusional belief that (usually) close relatives have been replaced by identical looking impostors. • Ellis et al (1997) showed that Capgras patients show a reduced automatic emotional response to familiar faces. • i.e. they have a distorted ‘feeling of knowing’ for faces. • In both Capgras and OCD there seems to be impairments in ‘feeling of knowing’ leading to a belief pathology.

15. Delusions • High prevalence (100%) of safety behaviours in persecutory delusions (Freeman et al, 2001) • In general are a direct representation of emotional concerns (Freeman and Garety, 2003) • “Emotions can awaken, intrude into, and shape beliefs, by creating them, by amplifying or altering them, and by making them resistant to change” • Frijda et al (2000)

16. OCD, Delusions, Belief • Delusions could be explained as an inappropriate or over activation of affect driven ‘feeling of knowing’. • According to Szechtman and Woody, OCD is a pathology of belief caused by under-activation of affect driven ‘feeling of knowing’. • Hence, explaining both in a unitary belief formation model.

17. Criticisms • Szechtman and Woody’s model only seems to explain the most prevalent obsessive phenomena (e.g. Doubts, Fears / Contamination, Aggression) • Others not necessarily security related e.g. inanimate-impersonal, sex, religion. • Parallels with delusions, in that this model may only work for persecutory delusions. • ‘Security motivation’ may be inadequate to explain non-persecutory obsession, compulsions and delusions.

18. Conclusions • Despite the caveats, using belief formation as a unitary framework for explaining OCD and delusions may be a useful way forward. • ‘Security motivation’ may not be a complete explanation for all phenomenon. • Different motivations may need to be explained separately to account for the prevalent themes in both OCD and delusions. • Affect may be an important component in interfacing motivation and belief formation.