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Fear of Self in OCD The most influential cognitive-behavioural model outlining the development and maintenance of OCD is described by Stanley Rachman and Paul Salkovskis. This model posits that intrusions are experienced by almost everyone but only take on obsessional qualities (i.e., increased frequency and associated distress) and motivate neutralizing behaviours (such as washing, checking and reassurance seeking) when an individual misinterprets the personal significance of the intrusion. The content of intrusions has little to no importance in these appraisal models, as it is assumed that all intrusions are similar with regards to their content. However, most intrusions and obsessions centre on a particular theme for an individual, wherein the person experiences obsessions in one domain of life, but not in another. For example, an individual could have only contamination-related obsessions and none related to morality or responsibility. Beliefs such as responsibility are not specific to OCD, and the evidence for their proposed causal role is mixed at best. Researchers have proposed that intrusive doubts take on obsessional qualities in relation to how much these thoughts differ from an individual’s beliefs and/or morals, as well as threaten core perceptions of the self. Cognitive-behavioural models of OCD have recently focused on these vulnerable self-themes as a core feature. One such model by Frederick Aardema and Kieron O’Connor describes a “fear of self” in OCD, the fear of who one could be or become, which is an extension of Edward Tory Higgins’ self‐discrepancy theory. The authors suggest that obsessions become more believable when they originate from a distrust of the self, where the individual overinvests in a sense of self-as-could-be (feared self) rather than a sense of self-as-is (actual self). This ultimately creates discordance between the individual and their intrusions.

The feared self is hypothesized to determine the theme of obsessional doubts and the cause of compulsions, which are viewed as repetitive attempts to distance oneself from their feared self. The notion of a feared self in OCD is not entirely new, with Rachman initially noting that people with OCD, especially those with repugnant obsessions, fear the significance of intrusive thoughts as to what they may reveal of their moral character (i.e., that they are mad, bad, or dangerous). Indeed, the most common feared self themes relate to whether the individual is sane, moral, and/or good. Both feared self-perceptions and thought-action fusion are proposed to precede misinterpretations of the intrusions, although they are overlapping but distinct concepts.

Systematic empirical investigations of the relevance of the feared self in OCD started with Aardema and colleagues’ development of the Fear of Self Questionnaire (FSQ). Scores on the FSQ were significantly associated with self-reported repugnant intrusions, such as unwanted sexual/aggressive thoughts, in clinical samples of Italian and Canadian patients with OCD; however, they had weaker and non-significant associations with other major symptom domains of OCD, such as contamination and checking. These findings remained significant even after statistically controlling for self-reported obsessive beliefs proposed by traditional cognitive models of OCD.