Phenomenology of incompleteness and harm avoidance in obsessive-compulsive disorder: An experience sampling study

This study used experience sampling methodology to explore the phenomenology of the core motivations in obsessive-compulsive disorder (OCD), harm avoidance (HA) and incompleteness (INC), and their influence on the experience of OCD. Fifty participants with a primary OCD diagnosis completed four questionnaires daily for five days about a recent obsessive-compulsive experience and its underlying motivations. A cluster analysis revealed four motivation profiles: high HA/INC, moderate HA/INC, high HA/low INC, and high INC/low HA, with most individuals endorsing a blend of both motivations. On average participants’, HA and INC were stable across the study period. However, participants varied in how their scores changed over time, suggesting potential state-level fluctuations. Both motivations were associated with the interpretation of long-lasting distress related to a particular obsessive-compulsive experience, HA predicted increased beliefs of future harm, and INC was associated with reduced beliefs that the experience meant something negative about themselves. Behaviourally, HA was associated with avoidance, reassurance seeking, and thought suppression, whereas INC was associated with compulsions and reduced likelihood of doing nothing. HA and INC both contribute to how OCD is experienced, although they appear to do so through distinct cognitive and behavioural pathways, offering potential targets for tailored interventions.