Failures of urge suppression in obsessive-compulsive disorder: Behavioral modeling using a blink suppression task

Many individuals with obsessive-compulsive disorder (OCD) report sensory-based urges (e.g. ‘not-just-right experiences’) in addition to, or instead of, concrete fear-based obsessions. These sensations may be comparable to normative “urges-for-action” (UFA), such as the urge to blink. While research has identified altered functioning of brain regions related to UFA in OCD, little is known about behavioral patterns of urge suppression in the disorder. Using an urge-to-blink task as a model for sensory-based urges, this study compared failures of urge suppression between OCD patients and controls by measuring eyeblinks during 60-s blocks of instructed blink suppression. Cox shared frailty models estimated the hazard of first blinks during each 60-s block and recurrent blinks following each initial erroneous blink. OCD patients demonstrated a higher hazard of first and recurrent blinks compared to controls, suggesting greater difficulty resisting repetitive sensory-based urges. Within OCD, relationships between task outcomes and symptom severity were inconsistent. Findings provide support for a deficit in delaying initial urge-induced actions and terminating subsequent actions in OCD, which is not clearly related to clinical heterogeneity. Elucidating the nature of behavioral resistance to urges is relevant for informing conceptualizations of obsessive-compulsive psychopathology and optimizing treatment outcomes.