Not all intrusions are created equal: The role of context, feared-self perceptions and inferential confusion in the occurrence of abnormal intrusions

It is well-established that intrusions are universal phenomena that differ from obsessions in frequency, intensity, and distress, but otherwise are very similar in content. This understanding has guided research in obsessive-compulsive disorder (OCD) to focus on the misappraisals of intrusions, rather than the intrusions themselves. However, recent evidence suggests that other factors might distinguish intrusions from obsessions, namely the context in which they arise. Indeed, intrusions that occur without direct evidence are related to increased OCD symptoms, obsessive beliefs, and the tendency to confuse reality with the imagination, especially confusing a feared possible self with the person's actual self. However, experimental evidence supporting these findings is lacking, a gap the current study aimed to fill. Five hundred and fifty-seven undergraduate students completed a battery of questionnaires online, which included an experimental task made up of scenarios designed to gauge endorsement in specific intrusions that are either supported or not supported by direct evidence. Results showed that intrusions without direct evidence supporting them uniquely predicted OCD symptoms, whereas intrusions with evidence did not predict OCD symptoms; and that inferential confusion and feared self-perceptions predicted characteristics of the intrusions without direct evidence. Implications for cognitive-behavioural formulations of OCD are discussed.