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Laura J. Summerfeldt RESEARCH SUMMARY: In day-to-day life, what psychological function lies behind the common human experiences of the feeling that things are “not just right”? Over the past decade, Professor Summerfeldt and her collaborators have been investigating this issue in a program of research that originates from findings with a group of individuals who suffer from extreme manifestations of these experiences - those with obsessive-compulsive disorder (OCD). OCD has long been considered a unitary anxiety-based disorder. In recent years, however, both these issues have been the focus of debate. The clinical research literature on OCD is fraught with inconsistencies and enigmas - among them OCD's potential links with such non-anxiety-related syndromes as the Autistic Spectrum. Not surprisingly, factors involved in the cause, continuation, and treatment of OCD have remained elusive. The possibility that OCD is not, in fact, a homogeneous disorder has been posited as an important key. Attempts to identify OCD subtypes on the basis of overt symptoms (e.g., "washers" vs. "checkers") have not been fruitful. However, clinical observation suggests that the many different symptoms seen in OCD are in fact expressions of two basic underlying themes. One, showing marked similarity to other anxiety disorders, is dominated by anticipatory anxiety and the exaggerated avoidance of potential harm. The other is more unique, with the individual driven by a need to correct feelings of incompleteness and dissatisfaction regarding the need for experiences to achieve a flawless and perfect state. Professor Summerfeldt and her collaborators have been conducting research on a new dimensional model that posits two orthogonal core dimensions in OCD – “Harm Avoidance” and “Incompleteness” – which cut across overt symptoms. In combination may underlie most manifestations of this disorder, and be associated with quite different features, vulnerabilities, and causal factors. While Harm Avoidance likely constitutes a core motivation common to many anxiety disorders, Incompleteness appears unique to obsessive-compulsive phenomena. Here, the person is driven by the need to correct chronic feelings of dissatisfaction and to restore the sense that things are not “just right”, applied to a range of phenomena including cognitions, actions, and perceptions. This construct may be essential in the understanding of the origins and, particularly, perpetuation of obsessive-compulsive behaviours. The nucleus of Incompleteness appears to be a failure in the internal signal that terminates open-ended behaviours by producing a subjective “feeling of knowing” – an emotional state that lets one know when something is satisfactorily completed. At the “macro” level, OCD dominated by Incompleteness may exemplify the effects of lifelong deficits in this function. This would include a constellation of traits, behaviours, and information processing tendencies – many of them either reactive or compensatory. Importantly, dimensional models differ from the categorical models usually adopted in psychiatric nosology. They are based upon the idea of an unbroken continuum between healthy diversity and predisposition to illness. Disorder is seen as an aberration of otherwise normal functional processes. From this perspective, there is a blurring of the boundaries between personality, personality disorder, and outright illness. By this account, in individuals very high in these dimensions, with OCD, we see an extreme manifestation, but both dimensions are likely normally distributed and identifiable in nonclinical populations as well. In other words, they are part of the normal human psychological repertoire and exist in varying levels to some degree in all people. Our findings to date bear this out. Interestingly, Incompleteness is not included in existing models of normal human personality. Research conducted with both clinical and nonclinical participants supports the hypothesis that Harm Avoidance and Incompleteness are two discrete human experiences, and that the latter especially plays a key role in compulsions, and, at a broader level, the efficient termination of actions. Evidence derives from studies of several areas of psychological functioning. Incompleteness has been found to a) have a greater association with obsessive-compulsive personality traits (e.g., perfectionism, indecisiveness), b) predict pervasive and trait-like doubts about whether or not a wide range of behaviours had been satisfactorily completed, c) predict a more complex and less purely “anxiety-related” life history of comorbid disorders or conditions (e.g., depression; OC spectrum disorders), d) predict earlier onset of OC behaviours, and e) be associated in experimental studies with a particular cognitive profile, involving difficulties in the efficient completion of actions. All in all, it is likely that these two dimensions involve quite different proximal and distal causal factors. We are currently conducting research on a number of these, including differential family history, genetic correlates, and the role of Incompleteness in familial Autistic spectrum conditions. In short, research suggests that several clinical, personality, and cognitive variables long thought to be true of OC experiences in general, may in fact be associated with its Incompleteness dimension alone. CURRENT GRANTS HELD: 1. Social Sciences and Humanities Research Council of Canada (SHRRC). 2. Ontario Mental Health Foundation (OMHF) Standard Research Grant PEOPLE WORKING IN HER LAB: Candice Kavanagh (Trainee: B.Sc. Honours Candidate) RELEVANT PUBLICATIONS: Antony, M.M., Purdon, C., & Summerfeldt, L.J. (in press) (Eds.). Psychological Treatment of OCD: Beyond the Basics. Washington, DC: American Psychological Association. Summerfeldt, L.J., Kloosterman, P.H., Antony, M.M., & Parker, J.D.A. (in press). Social anxiety, emotional intelligence, and interpersonal adjustment. Journal of Psychopathology and Behavioral Assessment. Summerfeldt, L.J., Kloosterman, P.H., Antony, M.M., Richter, M.A., & Swinson, R.P. (2004). The relationship between miscellaneous symptoms and major symptom factors in obsessive-compulsive disorder. Behaviour Research and Therapy, 42, 1453-1467. Summerfeldt, L.J. ( 2004). Understanding and treating incompleteness in obsessive-compulsive disorder. Journal of Clinical Psychology , 60, 1-14. Bieling, P.J., Summerfeldt, L.J., Israeli, A.L., & Antony, M.M. (2004). Perfectionism as an explanatory construct in comorbidity among axis I disorders. Journal of Psychopathology and Behavioral Assessment, 26, 193-201. Summerfeldt, L.J., Hood, K.E., Antony, M.M., Richter, M.A., & Swinson, R.P. (2004). Impulsivity in obsessive-compulsive disorder: Comparisons with other anxiety disorders and within tic-related subgroups. Personality and Individual Differences, 36 (3), 539-553. Richter, M.A., Summerfeldt, L.J., Antony, M.M., & Swinson, R.P. (2003). Obsessive-compulsive spectrum conditions in obsessive-compulsive disorder and other anxiety disorders. Depression and Anxiety, 18, 118-127. Summerfeldt, L.J., Antony, M.M., & Swinson, R.P. (2002). Reply to Bilsbury and others. More on the phenomenology of perfectionism: "Incompleteness" [Letter to the editor]. Canadian Journal of Psychiatry, 47, 977-978. Summerfeldt, L.J., Richter, M.A., Antony, M.M., & Swinson, R.P. (1999). Symptom structure in obsessive-compulsive disorder: A confirmatory factor-analytic study. Behaviour Research and Therapy, 37, 297-311. Summerfeldt, L.J. & Endler, N.S. (1998). Examining the evidence for anxiety-related cognitive biases in obsessive-compulsive disorder. Journal of Anxiety Disorders, 12, 579-598. ___ |
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