Sensory Processing and Intolerance in Obsessive-Compulsive Disorder

Patients with obsessive-compulsive disorder often exhibit abnormal sensitivity to sensory stimuli and a reduced ability to screen out stimuli that most do not find bothersome. This chapter reviews the literature to date investigating these sensory experiences, first describing studies examining behavioral and psychophysiological responses to external sensory stimuli (exteroception) that use neuroscience and clinical frameworks. Results from these studies suggest that patients with obsessive-compulsive disorder show greater sensory sensitivity than healthy controls. In addition to abnormal exteroception, many patients with obsessive-compulsive disorder experience abnormal sensations that appear to be “internally generated,” including not-just-right experiences, incompleteness, and physical urges. These sensations, termed “sensory phenomena,” cause significant distress and impairment in daily functioning and may require different treatments than fear-based obsessions. The chapter discusses the clinical phenomenology of these sensory phenomena and describes the literature on their epidemiology and neural correlates, concluding with a brief discussion of directions for future research that may provide further insight into the nature of sensory symptoms in obsessive-compulsive disorder as well as potential treatments.

Incompleteness, Not Just Right Experiences, and Reward Sensitivity in Obsessive-Compulsive Disorder

Incompleteness, “not just right” experiences (NJREs), and reward sensitivity are constructs that have recently been the subject of intense research investigation in the obsessive-compulsive literature. Incompleteness refers to an underlying sense that something is not finished or has not been completed to one’s personal satisfaction. NJREs are sensations of discomfort experienced in response to external triggers or stimuli related to a sense of incompleteness. Reward sensitivity relates to individual variability in labeling, pursuing, and learning from reward stimuli. This chapter reviews the nature of each construct, associated historical underpinnings, assessment, and treatment. The chapter concludes with a discussion of future directions.