When our train of thought goes off track: The different facets of out-of-context thoughts in obsessive compulsive disorder

Obsessions are often described as aversive thoughts that come out-of-nowhere. Indeed, several models of obsessive compulsive symptoms postulate that obsessions are characterized by being unrelated to several levels of context (e.g. self-concept, external stimuli). In the current study we aim to broaden this notion by presenting a multidimensional concept of out-of-context thoughts and developing a self-report instrument measuring its different facets, the Out-of-Context Thoughts Questionnaire (OCTQ). Across 3 studies (total N = 599) we demonstrate the reliability and validity of the OCTQ in predicting obsessive compulsive (OC) symptoms and more specifically, obsessions. Critically, we show that the degree to which thoughts are out-of-context is independent of these thoughts' absolute content, such that people who experience more negative out-of-context thoughts, also experience more neutral out-of-context thoughts. Furthermore, we show that OC symptoms predict elevated negative and neutral out-of-context thoughts, highlighting the often-overlooked role of the context and predictability of thought in OCD, in addition to their content and appraisals. Clinically, these results suggest that obsessions might be threatening not only because they are negative, but also because they feel unpredictable. These characteristics of thought processes in OCD might be a central, yet overlooked experience of at least some OCD patients.