Contextual determinants of intrusions and obsessions: The role of ego-dystonicity and the reality of obsessional thoughts

• Ego-dystonicity and the reality of intrusive cognitions were investigated.
• Clinicians rated intrusions on ego-dystonicity and evidence for their reality.
• Intrusions without direct evidence were associated with symptoms of OCD.
• Lack of evidence may be an important contextual determinant of abnormal intrusions.

The current study aimed to investigate whether lack of evidence for the potential reality of the intrusion and ego-dystonicity are contextual determinants of unwanted intrusive thoughts and clinical obsessions. To this end, a total 248 non-clinical participants were asked to report an intrusion they had experienced as well as the context in which the intrusion arose. Utilizing this information, three independent clinicians rated these intrusions on ego-dystonicity and whether the intrusion had occurred with or without any evidence for its potential reality. Results showed that ego-dystonicity and lack of evidence for the intrusions were related, but distinct constructs. In particular, intrusions that occurred without evidence were significantly associated with higher levels of self-reported OC symptoms and related cognitive domains, whereas ego-dystonicity was not related to OC symptoms. Overall, the results are consistent with the notion that abnormal intrusions occur without evidence in the here-and-now, whereas normal intrusions do not. Intrusions that have no evidence to back them up, yet occur without any apparent cause, may be particularly likely to invite further negative cognitive processing, over-interpretation and control attempts. Implications for further research and treatment are discussed.