The Slippery Question of Control in OCD

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It’s nice to believe that you have control over your environment and your fate – that is until something bad happens that you’d rather not be responsible for. In today’s complex and interconnected world, it can be hard to figure out who or what causes various events to happen and to what degree you had a hand in shaping their outcomes. Yet in order to function, everyone has to create mental representations of causation and control. What happens when I press this button? Did my glib comment upset my friends? If I belch on the first date, will it scare her off?

People often believe they have more control over outcomes (particularly positive outcomes) than they actually do. Psychologists discovered this illusion of control in controlled experiments, but you can witness the same principle in many a living room now that March Madness is upon us. Of course, wearing your lucky underwear or sitting in your go-to La-Z-Boy isn’t going to help your team win the game, and the very idea that it might shows how easily one’s sense of personal control can become inflated. Decades ago, researchers discovered that the illusion of control is not universal. People suffering from depression tend not to fall for this illusion. That fact, along with similar findings from depression, gave rise to the term depressive realism. Two recent studies now suggest that patients with obsessive-compulsive disorder (OCD) may also represent contingency and estimate personal control differently from the norm.

OCD is something of a paradox when it comes to the concept of control. The illness has two characteristic features: obsessions based on fears or regrets that occupy a sufferer’s thoughts and make him or her anxious, and compulsions, or repetitive and unnecessary actions that may or may not relieve the anxiety. For decades, psychiatrists and psychologists have theorized that control lies at the heart of this cycle. Here’s how the NIMH website on OCD describes it (emphasis is mine):

The frequent upsetting thoughts are called obsessions. To try to control them, a person will feel an overwhelming urge to repeat certain rituals or behaviors called compulsions. People with OCD can’t control these obsessions and compulsions. Most of the time, the rituals end up controlling them.

In short, their obsessions cause them distress and they perform compulsions in an effort to regain some sense of control over their thoughts, fears, and anxieties. Yet in some cases, compulsions (like sports fans’ superstitions) seem to indicate an inflated sense of personal control. Based on this conventional model of OCD, you might predict that people with the illness will either underestimate or overestimate their personal control over events. So which did the studies find? In a word: both.

The latest study, which appeared this month in Frontiers in Psychology, used a classic experimental design to study the illusion of control. The authors tested 26 people with OCD and 26 comparison subjects. The subjects were shown an image of an unlit light bulb and told that their goal was to illuminate the light bulb as often as possible. On each trial, they could choose to either press or not press the space bar. After they made their decision, the light bulb either did or did not light up. Their job was to estimate, based on their trial-by-trial experimentation, how much control they had over the light bulb. Here’s the catch: the subjects had absolutely no control over the light bulb, which lit up or remained dark according to a fixed sequence.*

After 40 trials, subjects were asked to rate the degree of control they thought they had over the illumination of the light bulb, ranging from 0 (no control) to 100 (complete control). Estimates of control were consistently higher for the comparison subjects than for the subjects with OCD. In other words, the people with OCD believed they had less control – and since they actually had no control, that means that they were also more accurate than the comparison subjects. As the paper points out, this is a limitation of the study: it can’t tell us whether patients are generally prone to underestimating their control over events or if they’re simply more accurate that comparison subjects. To do that, it would need to have included situations in which subjects actually did have some degree of control over the outcomes.

Why wasn’t the light bulb study designed to distinguish between these alternatives? Because the authors were expecting the opposite result. They had designed their experiment to follow up on a 2008 study that found a heightened illusion of control among people with OCD. The earlier study used a different test. They showed subjects either neutral pictures of household items or disturbing pictures of distorted faces. The experimenters encouraged the subjects to try to control the presentation of images by pressing buttons on a keyboard and asked them to estimate their control over the images three times during the session. However, just like in the light bulb study, the presentation of the images was fixed in advance and could not be affected by the subjects’ button presses.

How can two studies of estimated control in OCD have opposite results? It seems that the devil is in the details. Prior studies with tasks like these have shown that healthy subjects’ control estimates depend on details like the frequency of the preferred outcome and whether the experimenter is physically in the room during testing.  Mental illness throws additional uncertainty into the mix. For example, the disturbing face images in the 2008 study might have made the subjects with OCD anxious, which could have triggered a different cognitive pattern. Still, both findings suggest that control estimation is abnormal for people with OCD, possibly in complex and situation-dependent ways.

These and other studies indicate that decision-making and representations of causality in OCD are altered in interesting and important ways. A better understanding of these differences could help us understand the illness and, in the process, might even shed light on the minor rituals and superstitions that are common to us all. Sadly, like a lucky pair of underwear, it probably won’t help your team get to the Final Four.

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Photo by Olga Reznik on Flickr, used via Creative Commons license

*The experiment also manipulated reinforcement (how often the light bulb lit up) and valence (whether the lit bulb earned them money or the unlit bulb cost them money) across different testing sections, but I don’t go into that here because the manipulations didn’t affect the results.

Gillan CM, Morein-Zamir S, Durieux AM, Fineberg NA, Sahakian BJ, & Robbins TW (2014). Obsessive-compulsive disorder patients have a reduced sense of control on the illusion of control task. Frontiers in Psychology, 5 PMID: 24659974

4 responses

  1. Pingback: ResearchBlogging.org News » Blog Archive » Editor’s Picks 3/30/2014

  2. Pingback: Did I Do That? Distinguishing Real from Imagined Actions « Garden of the Mind

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