In 2010, a new measuring scale became available that is directed more towards an analysis of the relationship between specific obsessive beliefs in a patient and the resulting symptom dimensions, than to an assessment of a single type of compulsion per se. Wheaton et al (2010) put it this way:
“To this end, the Dimensional Obsessive-Compulsive Scale (DOCS; Abramowitz et al., 2010), is a new measure that assesses the severity of the four most empirically supported OCD symptom dimensions: contamination, responsibility for harm and mistakes, symmetry/ordering, and unacceptable thoughts (e.g., Mataix-Cols et al., 2005 D. Mataix-Cols, M.C. Rosario-Campos and J.F. Leckman, A multidimensional model of obsessive-compulsive disorder, American Journal of Psychiatry 162 (2005), pp. 228–238. Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (225)[Mataix-Cols et al., 2005] and [McKay et al., 2004]). The DOCS is unique in that it affords an assessment of OCD symptoms based on function rather than form. For example, ordering rituals in response to a sense of “incompleteness” or “not just right” feelings are assessed on a separate dimension (i.e., symmetry dimension) from ordering rituals which function to reduce fears of causing (or failing to prevent) harm (i.e., responsibility for harm and mistakes dimension). Similarly, checking rituals that pertain to inspecting for contaminants are assessed on the contamination dimension, while checking locks and appliances are assessed on the responsibility for harm dimension. The DOCS also assesses multiple empirically-based parameters of severity (frequency, avoidance, distress, and functional interference; Deacon & Abramowitz, 2005) for each of the four OCD symptom dimensions. Accordingly, the DOCS may be better suited than other symptom measures for investigating the relationships between OCD symptoms and dysfunctional beliefs.”
See it as a better emphasis on function of a compulsive act over the form of it. Checking for germs belongs in the ‘contamination area’; and checking for locks in the ‘responsibility for harm’ one.
This group (Wheaton et al, 2010) used the DOCS to investigate a large group of adults seeking treatment for their OCD in a clinic. They sought to know whether there is consistency between a certain type of obsessive belief, and a corresponding symptom dimension. In other words: can a dysfunctional form of belief predict a symptom dimension ‘belonging to’ that belief (is it associated, or correlated with that belief)? If that is consistently and repeatedly the case, then it might underpin future hypothesis about a certain obsession/dimension being located in a specific brain area, for instance. A belief might be: a few hairs of a pet animal can bring me a lethal disease; and the corresponding action could be: endless cleaning and washing, and checking in the context of contamination. Brain areas then could be very specific parts of the amygdala, a brain region intensely involved in the appraisal of fear; and the basal ganglia, regions involved in carrying out particular actions.
What were the actual results of this study by Wheaton et al?
- Responsibility/threat estimation beliefs predicted contamination fear symptoms.
- Perfectionism/certainty beliefs predicted symmetry obsessions.
- Importance and control of thought beliefs predicted having unacceptable thoughts.
- Responsibility/threat estimation beliefs predicted symptoms related to being responsible for harm.
These findings are consistent with concepts about cognition and behaviour.
I will readily admit that the results may sound a bit vague; but please bear in mind that the scale is very new. As any researcher working with ‘biological material’ will tell you: it can be a tough, resistant type of job, because you deal with subjects (in this case) that are basically unique; no two specimens are completely alike. With repeated replication of this investigation, and with a growing number of patients having been tested, a no doubt more precise picture will emerge.