Inhibiting doubt and uncertainty: Integrating behavioral and cognitive models in obsessive-compulsive disorder

Obsessive compulsive disorder (OCD) is characterized by a vicious cycle of reoccurring intrusive, anxiety-evoking thoughts or impulses (obsessions) and repetitive behaviors (compulsions). Cognitive approaches to OCD focus on the role of cognitive biases in the onset and maintenance of this vicious cycle, with increased doubts and memory uncertainty being primary factors. Behavioral approaches, on the other hand, focus on executive dysfunctions, with inhibitory deficit being most prominent. In the current paper, we review previous literature on the presence and role of inhibitory deficits, increased doubts, and memory uncertainty in OCD, followed by evidence suggesting that these factors are highly interrelated. We propose that both inhibitory deficits and increased doubts serve as prominent components of OCD and suggest that a more integrative approach is needed in order to more fully conceptualize the etiology and maintenance cycle of OCD.