Abstract
See Research by Jones et al., 2012, 46(3): 265–270
Recent years have seen the issue of climate change dominate the Australian political arena. Climate change represents a global environmental threat that has the potential to create emotional distress and anxiety about the future in vulnerable individuals. Hence, climate change is relevant to psychiatrists. Jones et al. (2012) reported that climate change concerns were directly related to checking compulsions in 28% of their sample. The prominence of climate change concerns in obsessive–compulsive disorder (OCD) highlights the way that sociocultural contexts can influence the expression of psychiatric disorders and calls for consideration of the potential underlying mechanisms.
Sociocultural factors have long been recognized as influencing the expression of psychiatric symptoms, including OCD symptoms (Akhtar et al., 1978). There have been a number of studies reporting increased rates of religious obsessions in more religious societies (Tek and Ulug, 2001). Similarly, reports of contamination obsessions relating to HIV infection appeared in the 1980s when HIV/AIDS first emerged and was perceived as a greater societal threat (Todd, 1989). More recently, checking compulsions related to climate change concerns have become apparent in the sociocultural context of heightened climate change concerns.
Regardless of different sociocultural determinants of OCD symptoms, it has been important to identify and understand their common underlying mechanisms. A key target of OCD research has been the heterogeneity of OCD symptoms (Heyman et al., 2006). Studies have assessed OCD symptoms with factor analysis across different cultures and indicate that OCD symptoms are commonly grouped into five major symptom dimensions (Pinto et al., 2008). These symptom dimensions are: hoarding, contamination/cleaning symptoms, symmetry/ordering symptoms, unacceptable/taboo thoughts and doubt/checking symptoms.
The study reported by Jones et al. (2012) focused only on OCD patients with checking compulsions. Checking compulsions involving climate change concerns can be understood in terms of the mechanisms that have been shown to play a role in checking compulsions in general. Checking compulsions have been associated with beliefs involving themes of increased responsibility and threat estimation (Emmelkamp and Aardema, 1999), prevention of negative consequences (Starcevic et al., 2011) and reduced memory confidence (Radomsky and Alcolado, 2010).
Increased responsibility/threat estimation refers to the underlying belief that one is more responsible for external events than they really are and that these events represent a greater threat than they actually are. Increased responsibility/threat estimation may thus predispose individuals with OCD to the development of excessive climate change concerns. The way a belief is formed is not clearly understood, but neuropsychological theories of belief formation propose that patients form an unusual hypothesis (often related to magical thinking) as a result of a perceptual distortion influenced by defences, desires and motivations (McKay et al., 2005). According to this model, excessive climate change concerns may be a result of a perceptual distortion in the OCD sufferer. For example, the hypothesis that one’s use of electrical appliances contributes to global warming may be the result of a perceptual distortion of feeling warmer when using these appliances.
Checking compulsions are frequently performed to prevent something bad or unpleasant from happening (Starcevic et al., 2011), and in accordance with this, Jones et al. (2012) described patients with climate change concerns who checked compulsively to prevent both immediate and long-term negative consequences. An example of an immediate concern related to fears that their pets would die from thirst, whereas an example of a concern about long-term consequences related to fears that their electricity use would increase carbon dioxide emissions.
Memory confidence refers to one’s confidence in their memory rather than their actual memory of an event. In the context of climate change concerns, a patient with OCD may have a heightened sense of responsibility regarding checking that the lights have been turned off, but the need to check multiple times may reflect reduced memory confidence.
The finding that a substantial proportion of OCD patients with checking compulsions have climate change concerns highlights the clinical relevance of this current societal threat. Understanding potential underlying mechanisms such as increased responsibility/threat estimation, the function that checking compulsions serve and the role of reduced memory confidence has implications for cognitive and behavioural approaches to treating patients with climate change concerns. When assessing and treating patients with OCD, it is important to consider the relevant sociocultural factors as well as the underlying mechanisms that are likely to be involved. Sociocultural factors are always changing, but the underlying mechanisms of OCD are likely to remain the same.