Urged to feel certain again: The role of emotion-related impulsivity on the relationships between intolerance of uncertainty and OCD symptom severity

Abstract

Objectives: Obsessive-compulsive disorder (OCD) is a debilitating mental disorder characterized by persistent and intrusive thoughts accompanied by repetitive mental or physical acts. While both intolerance of uncertainty and emotion-related impulsivity have been consistently evidenced as cognitive risk factors of OCD, no studies have considered their joint effects. The current study examined the interaction between intolerance of uncertainty and two forms of emotion-related impulsivity-including both a behavioural and cognitive form-in predicting OCD symptoms.

Design: Cross-sectional data were collected online from community-based adult participants.

Methods: Participants (N = 673) completed a battery of self-report measures of OCD symptom severity, intolerance of uncertainty, and emotion-related impulsivity.

Results: The behavioural form of emotion-related impulsivity positively moderated the relationship between intolerance of uncertainty and OCD symptoms. Elevated levels of both factors predicted the most severe symptoms, particularly checking, washing, and obsessing. This interaction effect was not found for the cognitive form of emotion-related impulsivity, which still emerged as a unique predictor of OCD symptom severity, specifically obsessing symptoms.

Conclusions: Current findings furthered the understanding of the link between intolerance of uncertainty and OCD symptoms by highlighting the role of emotion-related impulsivity. When uncertainty triggers distress in individuals with high intolerance of uncertainty, the urge to behaviourally alleviate this distress could promote the use of maladaptive obsessions and compulsions, leading to greater OCD symptoms. Results also indicated the potentially differential effects from the behavioural versus cognitive forms of emotion-related impulsivity on different symptom domains, and the mechanistic link here is worthy of further investigation.

Keywords: aetiology; emotion‐related impulsivity; intolerance of uncertainty; obsessive–compulsive disorder; urgency.

Figure 1. Interaction of IU and Feelings Trigger Action to predict OCD symptom severity

Note. OCI-12 = Obsessive-Compulsive Inventory-12 Items; IUS-12 = Intolerance of Uncertainty Scale - Short Version; Values for Low/High Feelings Trigger Action are 1 SD/+1 SD from its mean. Feelings Trigger Action scores were continuous in analyses, and this split was done for visualization purposes only.

Figure 2. Significant interactions of IU and emotion-related impulsivity to predict different OCI-12 symptom domains:

(A)-(C) higher IU and higher Feelings Trigger Action interact to predict more severe Obsessing, Washing, and Checking symptoms; (D) higher IU and lower Pervasive Influence of Feeling interact to predict more severe Washing symptoms. Note. OCI-12 = Obsessive-Compulsive Inventory-12 Items; IUS-12 = Intolerance of Uncertainty Scale - Short Version. Values for Low/High Feelings Trigger Action and Pervasive Influence of Feelings are 1 SD/+1 SD from their means. All scores were continuous in analyses, and this split was done for visualization purposes only.