(PS7-D81) Cognitive Response Inhibition Differences Between Autogenous and Reactive Subtypes in Adults with OCD in Inpatient Programs

Obsessive Compulsive Disorder (OCD) has been conceptualized using the autogenous-reactive model which categorizes obsessions into two distinct subtypes. Autogenous obsessions (AO) intrude with unidentifiable or illogical stimuli such as taboo thoughts. Reactive obsessions (RO) contain mental intrusions that arise through identifiable/rational stimuli such as thoughts of contamination. These two subtypes have been found to utilize different control strategies, where people with AO use more cognitive strategies such as thought stopping while people with RO use more behavioral or motorized strategies such as washing (Lee & Kwon, 2003). Furthermore, AO has been strongly associated with increased difficulties in cognitive inhibition on the go/no-go paradigm compared to the RO subtype (Lee & Telch, 2010). This study examined whether the AO subtype is characterized by greater difficulty in response inhibition deficits, as measured by the flanker task paradigm (FT), compared to the RO subtype. 

This study examined baseline assessment results of 33 patients with OCD treated at partial hospitalization programs at hospitals across the Midwest. The Revised Obsessional Intrusion Inventory was used to determine the severity of AO and RO symptoms (ROII; Lee, 2004). RI deficits were measured with the FT. The FT measures cognitive RI by participants indicating the direction of a central arrow within a line of congruent or incongruent arrows. Within the FT, interference control difficulty was indexed by number of errors on congruent trials vs. incongruent trials, and the reaction time on congruent trials vs. incongruent trials. We hypothesize that interference control difficulty will predict AO symptoms when controlling for the severity of OCD symptoms (scores on the Yale-Brown Obsessive-Compulsive Scale). 

In a multiple regression analysis, YBOCS obsession and compulsion scores and flanker indices were entered to predict AO scores, error-based interference control difficulty index significantly predicted AO score on the ROII (β = 26.212, p = 0.49). It was found that RT interference (β = -0.057, p = 0.65), YBOCS obsession score (β = 1.243, p = 0.59), and YBOCS compulsion score (β = -2.380, p = 0.174) did not significantly predict AO score. Compared to other variables, the FT error-based interference index explained an additional 12% of the variance in AO scores (R2 = 0.208, F(1, 29) = 4.226, p =.049). In contrast, the identical set of multiple regression for predicting RO scores showed that FT’s interference control difficulty indices were not significant predictors of the model.  

These findings add to the literature stating AO subtype is characterized by inhibitory control deficits. This paradigm particularly reflects the difficulty in cognitive control for inhibiting adjacent distractors. In contrast, the inhibitory control deficit was not associated with the RO subtype. These findings signify the importance of creating tailored treatments for people based on their primary clinical presentation of AO vs RO. Continuing research is warranted to develop an effective intervention focused on improving cognitive inhibition among patients with OCD, especially characterized by the pronounced experience of AO.