Send to

Choose Destination
J Affect Disord. 2018 Jan 1;225:495-502. doi: 10.1016/j.jad.2017.08.072. Epub 2017 Aug 30.

The relationship between cognitions and symptoms in obsessive-compulsive disorder.

Author information

Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel. Electronic address:
Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, GGZ InGeest, Amsterdam, The Netherlands.
Institute of Integrated Mental Health Care "Pro Persona", Centre for Anxiety Disorders "Overwaal", Lent, The Netherlands; University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Psychiatry, Radboud University Medical Centre, Radboud University Nijmegen, Nijmegen, The Netherlands.
Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel.



The cognitive theory of obsessive-compulsive disorder (OCD) ascertains that catastrophic (mis)interpretations of normally occurring intrusive thoughts are related to the maintenance of OCD. Nonetheless, findings supporting the relationship between cognitive biases and OCD symptoms are largely inconsistent. In the present study we examined the relationship between OCD cognitions and symptoms among 382 OCD patients participating in the longitudinal Netherlands Obsessive Compulsive Disorder Association (NOCDA) study.


OCD cognitions and OC, anxiety and depressive symptoms were assessed using self-report questionnaires at baseline and at two-year follow-up. Baseline multiple regression analyses assessed the specificity of OC cognitions to OCD symptoms. Cross-lagged analyses examined whether cognitions predict OCD symptoms at two-year follow up.


Baseline analyses demonstrated significant relationships between comorbid anxiety, depressive severity and OC cognitions, adjusted for OCD symptoms (β = .283, p < .001 and β = .246, p < .001, respectively). OCD severity adjusted for comorbid symptoms was unrelated to cognitions at baseline (β = .040, p = n.s). Unique associations were found between cognitions and two OCD symptom subtypes (Impulses: β = .215, p < .001; Rumination/doubting: β = .205, p < .001). Longitudinal analyses yielded non-significant associations between OCD cognitions and symptom severity. Prospective analyses of cognitions and OCD symptom subtypes yielded significant effects for both bidirectional and unidirectional associations (β = .11-.16, p < .05).


Given the naturalistic design of the study, we did not assess therapeutic interventions between baseline and follow-up.


Results only partially concord with the predictions of the cognitive theory of OCD. Future studies should focus on mechanisms alternative to cognitions when investigating the course of OCD.


Cognitive theory; Cross-lagged design; Longitudinal; Obsessive Compulsive Cognitions; Obsessive Compulsive Disorder

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center