When moral concerns become a psychological disorder: the case of Obsessive-Compulsive Disorder

Obsessive compulsive disorder (OCD) is an anxiety disorder that has been rated as a leading cause of disability by the World Health Organization. Symptoms can include morality-related worries, feelings, and cognitions, such as perceived violation of moral standards, guilt, and inflated responsibility. However, sensitivity to moral issues, by itself, is unlikely to lead to an emotional disorder. Many of us experience events or thoughts challenging our moral standards but are not flooded by negative self-evaluations, dysfunctional beliefs, and pathological preoccupations. In fact, for most people, such experiences would result in the activation of distress-regulation strategies that dissipate unwanted thoughts, reaffirm the challenged self, and restore emotional equanimity. In this chapter, we propose that dysfunctions of the attachment system, as manifested in heightened attachment anxiety, can disrupt the process of coping with morality-related concerns and therefore contribute to OCD. For people with high attachment anxiety, experiences challenging an important self-domain, such as morality, can increase the accessibility of 'feared self' cognitions (e.g., I’m bad, I'm immoral) and activate dysfunctional cognitive processes (e.g., an inflated sense of responsibility) that result in the development of obsessional preoccupations. We begin this chapter with a brief description of OCD and current cognitive models of the disorder. We then describe the role of dysfunctional self-perceptions and sensitive self-domains –- domains of the self that are extremely important for maintaining self-worth -- in OCD. Next, we review empirical findings linking attachment insecurities and obsessive compulsive phenomena and propose a diathesis-stress model whereby experiences challenging sensitive self-domains, such as morality, and attachment insecurities interact to increase vulnerability to OCD. We then focus on morality as a particularly important self-domain in OCD and present new, previously unpublished findings showing that experiences in the morality domain can lead to OCD symptoms and that this effect is moderated by attachment anxiety.