Responsibility and perfectionism in OCD: an experimentalstudyCatherine Bouchard, JoseÂe RheÂaume, Robert Ladouceur *UniversiteÂLaval, Ecole de Psychologie, Ste-Foy Quebec G1K 7P4, CanadaReceived 17 July 1998AbstractCognitive models of obsessive±compulsive disorder (OCD) suggest a number of dierent variablesthat may play a role in the development and maintenance of obsessive compulsive symptoms [Freeston,M. H., RheÂaume, J., & Ladouceur, R. (1996) Correcting faulty appraisals of obsessional thoughts.Behaviour Research and Therapy, 34, 433±446]. This study's aim was to verify the eect of perfectionismand excessive responsibility on checking behaviors and related variables. Twenty-four moderatelyperfectionistic subjects (MP) and 27 highly perfectionistic subjects (HP) were submitted to amanipulation of responsibility (low and high). After each manipulation, they had to perform aclassi®cation task during which checking behaviors were observed. Results indicate that more checkingbehaviors (hesitations, checking) occurred in the high responsibility condition than in the lowresponsibility condition for subjects of both groups. After executing the task in the high responsibilitycondition, HP subjects reported more in¯uence over and responsibility for negative consequences thanMP subjects. These results suggest that high perfectionistic tendencies could predispose individuals tooverestimate their perceived responsibility for negative events. Furthermore, perfectionism could beconceived as playing a catalytic role in the perception of responsibility. Results are discussed accordingto cognitive models of OCD. # 1999 Elsevier Science Ltd. All rights reserved.Keywords: Perfectionism; Responsibility; Obsessive±compulsive disorder; Cognitive models1. IntroductionBehavior therapy is faced with some limits for the treatment of obsessive±compulsivedisorder (OCD). Almost 25% of patients refuse this type of treatment and approximately25% do not bene®t from it (Foa, Steketee, Grayson, & Doppelt, 1983). Cognitive therapyBehaviour Research and Therapy 37 (1999) 239±2480005-7967/99/$ - see front matter # 1999 Elsevier Science Ltd. All rights reserved.PII: S 0005-7967(9 8) 00 14 1- 7BEHAVIOURRESEARCH ANDTHERAPYPERGAMON* Corresponding author. Tel.: +1-418-656-396; Fax: +1-418-656-3646; E-mail: [email protected] considered as an alternative or as a complement to traditional behavioral treatments (e.g.van Oppen & Arntz, 1994; van Oppen et al., 1995; Freeston et al., 1996). In thesecircumstances, it is important to know and understand the cognitive variables that areinvolved in OCD in order to ®nd eective ways of correcting cognitive distortions.Dysfunctional perfectionism and excessive responsibility have been identi®ed as part of the®ve main cognitive variables associated with OCD (McFall & Wollersheim, 1979; Freestonet al., 1996); the other principal variables being overestimation of the importance ofthoughts, overestimation of danger and the belief that anxiety caused by thoughts isunacceptable.Recent de®nitions of responsibility and perfectionism contribute to our understanding of therole these variables play in OCD. Excessive or in¯ated responsibility has been de®ned as thebelief which is pivotal to bring about or prevent subjectively crucial negative outcomes. Theymay be actual, that is, having consequences in the real world and/or at a moral level(Salkovskis et al., 1996). This de®nition has been empirically supported using a semi-idiographic questionnaire (e.g. RheÂaume, Ladouceur, Freeston, & Letarte, 1995) as well as withexperimental manipulations of responsibility (e.g. Ladouceur et al., 1995; Ladouceur,RheÂaume, & Aublet, 1997).The unidimensional de®nition of perfectionism used in this study is: `the belief that aperfect state exists that one should try to attain' (Pacht, 1984). According to thisperspective, which is particularly pertinent in the study of OCD (RheÂaume, Freeston,Dugas, Letarte, & Ladouceur, 1995), perfection does not exist and the attempt to attainthis perfect state would be associated with psychopathology. Hamachek (1978) points outthat perfectionism can be a positive personality trait and distinguishes between sane andpathological perfectionism. The Perfectionism Questionnaire was devised to measure thisconstruct with respect to the distinction between functional and dysfunctional perfectionism.The criterion and convergent validity of this instrument were established with questionnaire(RheÂaume, Freeston, & Ladouceur, 1995) and behavior manipulation studies (RheÂaume etal., 1995b).In the past few years, the concept of excessive responsibility has received a lot ofattention (Cottraux, 1990; Rachman, 1993; RheÂaume, Ladouceur, Freeston, & Letarte, 1994;Tallis, 1994; van Oppen & Arntz, 1994; RheÂaume et al., 1995c). Salkovskis (1985, 1989)made a great contribution to this theory by proposing a theoretical model whereby anexcessive sense of responsibility is at the core of OCD. According to this model,obsessional patients would appraise intrusive thoughts as a function of possible harm tothemselves or others. This excessive sense of responsibility would produce automaticnegative thoughts, and discomfort would arise. The individual would then attempt toreduce the anxiety through cognitive neutralization or compulsive behavior (e.g. checkingrepetitively). Many studies support this model. In a number of clinical studies, the presenceof an excessive sense of responsibility was observed in OC patients (Salkovskis, 1989; vanOppen et al., 1995; Ladouceur, LeÂger, RheÂaume, & DubeÂ, 1996). Furthermore,questionnaire studies comparing OC patients to control subjects support the existence of alink between responsibility and OC-type behaviors (Freeston, Ladouceur, Gagnon, &Thibodeau, 1992, 1993; RheÂaume et al., 1995a). Finally, two recent experimental studiesmanipulated the level of perceived responsibility. Lopatka and Rachman (1995) succeededC. Bouchard et al. / Behaviour Research and Therapy 37 (1999) 239±248240in changing the perceived responsibility for negative consequences in thirty compulsivecheckers. As expected, the lowering of responsibility was associated with a signi®cant dropin discomfort and need to check. Lastly, two studies experimentally manipulatedresponsibility in nonclinical subjects (Ladouceur et al., 1995, 1997). Results showed thatchecking behaviors were more frequent in the group receiving high
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