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Incompleteness and Harm Avoidance in OCD 

Incompleteness and Harm Avoidance in OCD
Chapter:
Incompleteness and Harm Avoidance in OCD
Author(s):

Stefano Pallanti

, Jennifer Barnes

, Christopher Pittenger

, and Jane Eisen

DOI:
10.1093/med/9780190228163.003.0009
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date: 26 June 2022

Obsessive-compulsive disorder (OCD) has been traditionally linked with the motivational dimension of harm avoidance (HA). However, there is increasing evidence for the involvement of a second core dimension, referred to as Incompleteness (INC) or “not just right experiences” (NJREs), in a substantial fraction of patients. INC-driven compulsions are typically driven by feelings of discomfort or tension, rather than by anxiety. Appreciation of the importance of INC in OCD is one of the factors that motivated the movement of OCD out of the Anxiety Disorders chapter and into its own grouping in the latest edition of the Diagnostic and Statistical Manual (DSM-5). Both dimensions seem to contribute to OCD symptomatology, thus representing core features underlying the disorder. In this chapter, the differential roles and neural substrates of HA and INC are discussed, together with the consequent theoretical and clinical implications.

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