Seminar

Obsessive-compulsive disorder (OCD) is characterized by a distinctive set of symptoms, including intrusive thoughts, heightened self-monitoring, repeated checking, and behavior guided by fixed rules and rituals. We propose that these symptoms may stem, at least in part, from attenuated access to internal states, including bodily states, feelings, emotions, wishes, and preferences. According to our Seeking Proxies for Internal States (SPIS) model, individuals with OCD compensate for this difficulty by seeking and relying on proxies—more readily discernible external or behavioral indices of internal states. I will briefly review findings that support the SPIS model and then focus on its implications for doubt and confidence in OCD. I will discuss how impaired access to internal states may undermine confidence in one’s own memories, feelings, and motivations, promoting continued information seeking, checking, and reliance on external criteria. Using clinical examples, I will illustrate how these processes affect personal and interpersonal domains in the lives of people with OCD.