A preliminary investigation of the relationships between attachment insecurity, fear of compassion, and OCD severity.

Objectives: The most successful psychological treatment for obsessive-compulsive disorder (OCD) is cognitive behavioural therapy (CBT). However, treatment success remains around 50% when refusal and dropout are considered. Purdon (Journal of Behavior Therapy and Experimental, Psychiatry, 2023, 78, 101773) argued that the CBT model is under-specified, suggesting that there may be important treatment targets that are not directly addressed. Based on emerging research, she identified insecure attachment and fear of compassion (FOC) as potentially important targets. Insecure attachment and FOC are associated with OCD symptoms, and past research suggests that FOC may explain the relationship between attachment insecurity and emotional distress. We reasoned that FOC may also be an important predictor of OCD symptom severity.

Methods: We conducted two preliminary, pre-registered online survey studies with undergraduate samples to explore potential theoretical relationships between attachment, FOC, and OCD.

Results: Study one (N = 329) revealed that the indirect effect of attachment anxiety on OCD symptom severity through fear of self-compassion was significant, even when controlling for trait self-compassion. A significant indirect effect of attachment avoidance predicting OCD severity, through fear of receiving compassion, also emerged. Study two (N = 340) replicated these findings and extended this research by controlling for depression.

Conclusions: Taken together, these findings suggest that FOC could be an important variable to consider when conceptualizing OCD. Further exploration is warranted to understand the directionality of these relationships and whether attachment and FOC could be valuable targets in OCD treatment.