An investigation of doubt in obsessive–compulsive disorder

Jack Samuels, O. Joseph Bienvenu, Janice Krasnow, Ying Wang, Marco A. Grados, Bernadette Cullen, Fernando S. Goes, Brion Maher, Benjamin D. Greenberg, Nicole C. McLaughlin, Steven A. Rasmussen, Abby J. Fyer, James A. Knowles, Paul Nestadt, James T. McCracken, John Piacentini, Dan Geller, David L. Pauls, S. Evelyn Stewart, Dennis L. MurphyYin Yao Shugart, Vidya Kamath, Arnold Bakker, Mark A. Riddle, Gerald Nestadt

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Background Clinicians have long considered doubt to be a fundamental characteristic of obsessive–compulsive disorder (OCD). However, the clinical relevance of doubt in OCD has not been addressed. Methods Participants included 1182 adults with OCD who had participated in family and genetic studies of OCD. We used a clinical measure of the severity of doubt, categorized as none, mild, moderate, severe, or extreme. We evaluated the relationship between doubt and OCD clinical features, Axis I disorders, personality and personality disorder dimensions, impairment, and treatment response. Results The severity of doubt was inversely related to the age at onset of OCD symptoms. Doubt was strongly related to the number of checking symptoms and, to a lesser extent, to the numbers of contamination/cleaning and hoarding symptoms. Doubt also was related to the lifetime prevalence of recurrent major depression and generalized anxiety disorder; to the numbers of avoidant, dependent, and obsessive–compulsive personality disorder traits; and to neuroticism and introversion. Moreover, doubt was strongly associated with global impairment and poor response to cognitive behavioral treatment (CBT), even adjusting for OCD severity and other correlates of doubt. Conclusions Doubt is associated with important clinical features of OCD, including impairment and cognitive–behavioral treatment response.

Original languageEnglish (US)
Pages (from-to)117-124
Number of pages8
JournalComprehensive Psychiatry
StatePublished - May 1 2017

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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