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Emotion and internal experience in Obsessive Compulsive Disorder: Reviewing the role of Alexithymia, Anxiety Sensitivity and Distress Tolerance

Lookup NU author(s): Dr Lucy Robinson, Professor Mark FreestonORCiD



This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


Increasing attention has focused on the role of emotion and internal experience in obsessive compulsive disorder (OCD). This review examines three key constructs that capture different aspects of understanding, appraisal and tolerance of internal states in OCD – alexithymia, anxiety sensitivity (AS) and distress tolerance (DT). The review examines the evidence for the role each of these constructs plays in OCD and considers whether conclusions can be drawn about the implications for our understanding and treatment of OCD. There is evidence that all three are elevated in clinical cases compared to controls, but there is no evidence that any of the three shows specificity for OCD over other anxiety disorders. However, the review has highlighted significant methodological heterogeneity and consequent variation in findings that currently limits broader conclusions from being drawn. There is an indication that this is a valuable area to explore and future studies should focus on deriving greater conceptual clarity around these constructs, independently replicating findings, and establishing a common methodology to enhance the comparability of studies. Studies exploring the ways in which internal experience, cognitions and symptoms may relate to one another would be of significant value in developing models that then lead to improved treatment approaches.

Publication metadata

Author(s): Robinson LJ, Freeston MH

Publication type: Review

Publication status: Published

Journal: Clinical Psychology Review

Year: 2014

Volume: 34

Issue: 3

Pages: 256-271

Print publication date: 01/04/2014

Online publication date: 15/03/2014

Acceptance date: 07/03/2014

ISSN (print): 0272-7358

ISSN (electronic): 1873-7811


DOI: 10.1016/j.cpr.2014.03.003