Harm Avoidance and Incompleteness as Motivational Dimensions of OCD: Associations with Clinical and Demographic Traits.

Purpose: Content-based models, which focus on observable symptom content, have dominated much of the literature on heterogeneity in OCD. However, alternate models emphasize the motivations underlying different symptom presentations, including harm avoidance (HA) and incompleteness (INC). To promote understanding of these motivations, we examined their associations with various content-based symptom dimensions, obsessive belief patterns, and other clinical characteristics.

Methods: We examined a large set of demographic and clinical characteristics and their associations with HA and/or INC among individuals (N = 218) receiving treatment for OCD and related disorders in a partial hospital/residential program. We also examined the extent to which HA and INC mapped onto dimensions in prevailing symptom content and obsessive belief models.

Results: Results showed that women reported more HA than men, and INC was associated with an earlier age of onset. HA and INC were not differentially associated with sexual orientation, self-view, quality of life, depression, or suicidality. HA and INC mapped onto symptom content and obsessive belief models in some, but not all the ways we expected. Notably, contamination/washing in our sample was associated with INC, but not HA.

Conclusions: Understanding motivations underlying OCD symptoms may lead to personalized care and improvement in treatment outcomes. We suggest that future research should continue to examine the motivational model, as well as ways in which presentations of each motivation may differ.