Dynamic conceptualisations of threat in obsessive-compulsive disorder (OCD)

Obsessive-compulsive disorder (OCD) is a severe mental health problem of a heterogeneous nature. To add to discussions around defining coherent subtypes of OCD, this paper uses qualitative, cognitive linguistic analysis to show how episodes of OCD can be differentiated based on their underlying conceptualizations of threat. Spoken narratives of OCD episodes told by people with OCD were analyzed using image schema theory and cognitive approaches to deixis in discourse. Through an exploration of the participants’ subjective experiences of time, space, and uncertainty in their recounted OCD episodes, the findings demonstrate that perceptions of threats fluctuate as OCD episodes unfold, and that it is the perceived movement (or not) of the threat that induces distress. Moreover, the dynamism of the threat is conceptualized differently for different subtypes of OCD. This variation can in part be explained by the role of two image schemas in structuring OCD episodes: the SOURCE–PATH–GOAL image schema and the CONTAINER image schema. It is argued that the blanket notion of threat as often investigated in clinical models of OCD is not sensitive enough to capture these shifting perspectives. It is thus recommended that threat perception in OCD is researched as a dynamic, evolving, and highly subjective experience.