Di erences and similarities between obsessive intrusivethoughts and worry in a non-clinical population: study 1FreÂdeÂric Langloisa,*, Mark H. Freestonb, Robert LadouceuraaEÂcole de psychologie, UniversiteÂLaval, QueÂbec GlK7P4, CanadabCentre de Recherche Fernand-Seguin and UniversiteÂde MontreÂal, MontreÂal, CanadaReceived 2 December 1998; accepted 2 December 1998AbstractWorry is the central characteristic of Generalized Anxiety Disorder (GAD) and obsessions are acentral feature of Obsessive±Compulsive Disorder (OCD). There are strong similarities between thesedisorders: repetitive cognitive intrusions, negative emotions, diculty dismissing the intrusion and®nally, loss of mental control. Direct comparisons between obsessions and worries are almost non-existent in the literature but key distinctions have been proposed. The study attempted to specify thedi erences between obsessive intrusive thoughts and worry in a nonclinical population across a series ofvariables drawn from current models (appraisal, general descriptors and emotional reactions). 254students participated in the study. They ®rst identi®ed an obsession-like intrusion and a worry and thenevaluated them with the Cognitive Intrusion Questionnaire. Within-subject comparisons demonstratedsigni®cant di erences on several variables: frequency, duration, percentage of verbal and image content,interference, egodystonic nature, stimuli awareness, emotions, etc. Most of these di erences remainedsigni®cant after controlling for frequency of thought. Discriminant analysis demonstrated a lowclassi®cation error rate when using nine variables to categorize thoughts as obsessions or worries.Results generally support the di erences postulated in the literature with the exception that obsessiveintrusive thoughts are better controlled. The egodystonic/egosyntonic dimention emerged as animportant variable in understanding obsessions and worry. # 2000 Elsevier Science Ltd. All rightsreserved.Behaviour Research and Therapy 38 (2000) 157±1730005-7967/00/$ - see front matter # 2000 Elsevier Science Ltd. All rights reserved.PII: S 0005 -7 96 7( 9 9) 00 02 7- 3www.elsevier.com/locate/brat* Corresponding author. Tel.: +1-418-656-2131-4762; fax: +1-418-656-3646.E-mail address: [email protected] (F. Langlois)1. Dierences and similarities between obsessive intrusive thoughts and worry in a non-clinicalpopulation: study 1According to the DSM-IV, worry is the central characteristic of Generalized AnxietyDisorder (GAD) (APA, 1994) and obsessions are a central feature of Obsessive±CompulsiveDisorder (OCD). Even though these disorders seem relatively easy to distinguish (Brown,Moras, Zinbarg & Barlow, 1993), few studies have directly addressed the degree of overlapbetween obsessions and worry. There are strong similarities between these two disorders:repetitive cognitive intrusions, negative emotions, diculty dismissing the intrusion and®nally, loss of mental control (Freeston & Ladouceur, 1993; Turner, Beidel & Stanley, 1992).It is thus relevant to examine whether obsessive intrusive thoughts and worries are distinctprocesses. The present study aims to specify the di erences between obsessive intrusivethoughts and worry in a nonclinical population across a series of variables drawn fromcurrent models (appraisal, general descriptors and emotional reactions).Borkovec, Robinson, Pruzinsky and DePree (1983) described worry as a ``chain of thoughtsand images, negatively a ect-laden and relatively uncontrollable''. The worry process can also beconsidered as an attempt to engage in mental problem solving of real or ®ctional issues whoseoutcome is uncertain but contains the possibility of one or more negative outcomes (Borkovec etal., 1983). Worries typically concern life circumstances such as health, ®nance, family and work.According to Mathews (1990), worry may be interpreted as a way to reduce the probability offuture negative outcomes. Worry is an unpleasant experience due to its uncontrollability. Somestudies have shown that worry is predominantly experienced in a verbal form rather than inimages (Borkovec & Lyon®elds, 1993; Freeston, Dugas & Ladouceur, 1996). Finally, Borkovecand his colleagues suggest that worry is a way of controlling unpleasant physiological activationthat is associated with images (e.g. Roemer & Borkovec, 1993).According to the DSM-IV, obsessions are de®ned by four criteria: (1) recurrent andpersistent thoughts, impulses, or images that are experienced, at some time during thedisturbance, as intrusive and inappropriate and that cause marked anxiety or distress; (2) thethoughts, impulses, or images are not simply excessive worries about real-life problems; (3) theperson attempts to ignore or suppress such thoughts, impulses, or images or to neutralize themwith some other thought or action; (4) the person recognizes that the obsessional thoughts,impulses, or images are a product of his or her own mind (not imposed from without as inthought insertion) (see APA, 1994). Obsessions may concern aggression, sexuality, religion andmorality, but common forms refer to contamination and doubts about possible mistakes orcatastrophes (Turner et al., 1992).A number of theoretical models of OCD have been proposed. The most in¯uential over the lastdecade postulates that people with OCD appraise intrusive thoughts as a function of threats thatmay happen to others or oneself (Salkovskis, 1985). An excessive sense of responsibility for thethoughts or the outcome makes the person feel very uncomfortable (e.g. I could be responsible fora car crash). The person will try to neutralize the thought by seeking reassurance, checking orusing other neutralizing behaviors. Other authors propose that perfectionism as well as control ofthoughts and actions are also involved in OCD (Steketee, 1993; RheÂaume, Ladouceur, Freeston &Letarte, 1994). Finally, others have emphasized the over-importance of thoughts such as thought-F. Langlois et al. / Behaviour Research and Therapy 38 (2000) 157±173158action-fusion (Rachman, Thordarson, Shafran & Woody, 1995; Freeston, RheÂaume &Ladouceur, 1996).A strong overlap between obsessions and worries would suggest a high rate of comorbiditybetween GAD and OCD. However, studies report only a low rate of comorbidity ranging from 0to 13% (see Crino & Andrews, 1996). Moreover, people with OCD or GAD were di erentiatedon self-report measures of key characteristics of GAD and OCD
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