More threads by Daniel E.

Daniel E.

What drives someone to compulsive behavior? How is our ability to identify our own internal states related?

In today’s episode, I spoke with Prof. Reuven Dar, a clinical psychologist and researcher, who studies OCD. Ruvi and his colleagues have developed a model that approaches OCD in a different way from the mainstream consensus. They’ve come up with a framework for OCD called “Seeking Proxies for Internal States”. The idea behind this is that individuals suffering from OCD have a harder time accessing their own internal states. And in order to deal with this, they seek proxies, or things that are external to them, in order to gauge what exactly their internal states are.

This is quite a different way of looking at OCD, and it shines a light on the difficulties that these individuals often experience when trying to understand what exactly they themselves are feeling. And so their ritualized and compulsive behavior become these kinds of external crutches that help them gain more certainty around their uncertain evaluations of their own internal worlds.

We talked about the different symptoms of OCD and how they can manifest on a spectrum. One of the important notes that came from this was that, like other psychological disorders, a diagnosis of OCD is only made when the symptoms are truly interfering with the individual’s life, functioning, and well-being.

Ruvi and his colleagues have done something that I particularly admire. They’ve looked at a certain accepted consensus and said “we’re not quite sure it’s accurate”. When ideas are widely accepted in any field in science, it’s hard to reopen that area of inquiry for further examination and to perhaps reevaluate certain things that were held to be true. Any endeavor that takes a second look at things with fresh eyes is a laudable step towards the pursuit of truth and is in my opinion, embodying the true spirit of science.
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Daniel E.
From two research articles by Dar et al:

Seeking proxies for internal states (SPIS): Towards a novel model of obsessive-compulsive disorder (2021)

We review the Seeking Proxies for Internal States (SPIS) model of OCD. The model postulates attenuated access to internal states as a central factor in OCD.

Attenuated access drives people with OCD to seek proxies for their internal states. Fixed rules and compulsive rituals are understood as proxies for internal states...

An emphasis on accepting and acknowledging doubt and uncertainty as an integral part of human existence can also benefit from using SPIS terminology, as SPIS asserts that no action will ever successfully eliminate the obsessive doubt...

Attenuated Access to Emotions in Obsessive-Compulsive Disorder (2022)

We believe that the SPIS model may have some potential clinical implications. Specifically, from a clinical stance, the SPIS model suggests that some of the symptoms displayed by OCD patients may be attempts to manage their difficulties in accessing their own emotional states. Therefore, therapy could benefit from using SPIS terminology to offer patients a novel way to conceptualize and interpret their symptoms, which is both more functional and more emphatic compared with the interpretations patients typically come up with.

First, therapists can use the model’s framework and concepts to discuss with their patients the difficulties they experience in trusting their own emotions. Doubts and uncertainties about the patients’ own feelings and emotions can be understood in therapy as emanating from deficient access to one’s own internal signals, and not only as excessive and irrational.

Second, as the SPIS model postulates that no action/proxy will ever successfully eliminate obsessive doubt, an emphasis on excepting [accepting] and acknowledging doubt and uncertainty as an integral part of human existence can also benefit from using SPIS terminology. Indeed, targeting doubt in achieving beneficial treatment outcome has been suggested in previous approaches to OCD (Aardema and O'Connor, 2012, Tolin et al., 2003).

Third, the present findings may also encourage using mentalization-based techniques aimed at achieving greater awareness of internal experiences, including emotions, in treating patients with OCD (Fonagy, 2002, Fonagy et al., 1991).
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Daniel E.

One of the larger problems in OCD is that people don’t trust their own judgement. This ties back to something that we’re starting to understand more about, which is that there do seem to be links between attachment issues and OCD.

There’s some really good research coming from Guy Doron, Mike Kyrios and others, looking at attachment and finding that people with OCD uniquely, and more so than people with other anxiety disorders, have anxious attachment...

They learn to find external rules to manage their own internal states.
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Daniel E.
Amazon product

From the book's description:

Living with Obsessive Compulsive Disorder can be a bewildering experience. The daily battle taking place in your brain can leave you feeling lost without a compass. But you don't have to take this journey alone. The OCD Travel Guide provides you with the strategies you need to recognize your OCD symptoms, reduce the influence these symptoms are having over your life, and prioritize your own internal compass over OCD's "Bad Directions."

Excerpts about developing trust in one's own experience rather than relying on external sources or avoidance:

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