Decision-making in OCD: when both acting and not acting result in some harm

Individuals with OCD are found to be more likely to act to prevent harm than individuals without OCD only in scenarios relevant to their obsessional concerns. Conversely, recent moral-reasoning literature suggests that individuals with OCD are less likely than individuals without OCD to act to prevent harm when that action causes other, lesser, harm. However, this research has been criticised owing to the high-risk, nomothetic content of scenarios used. Therefore, this study asked individuals with and without OCD to consider hypothetical everyday scenarios typical of OCD concerns to address three aims. The first aim was to verify previous findings that when scenarios are described such that acting prevents harm, individuals with OCD were more likely than individuals without OCD to act to prevent harm, only in scenarios idiosyncratically rated as most-disturbing to that individual. The findings supported this hypothesis. Secondly, and of primary interest to this study, the research aimed to explore whether individuals with and without OCD differed in likelihood of acting to prevent harm when scenarios were described such that acting to prevent harm, resulted in other, lesser, harm. It was found that, when risks of acting were presented, individuals with OCD were again more likely than individuals without OCD to act to prevent harm, only in their most-disturbing scenarios. A final aim was to explore factors that contributed to decisions. General responsibility beliefs and decision-specific feelings of immorality mediated decision differences, only in scenarios where risks of acting were not presented; when risks of acting were presented, no factor explored within this study contributed to decision differences. Findings are discussed in the context of previous research into decision-making and moral reasoning in OCD. Limitations are considered and areas for future research are suggested.