A systematic review of obsessive-compulsive disorder and self: self-esteem, feared self, self-ambivalence, egodystonicity, early maladaptive schemas, and self concealment

Treatment non-response, drop-out, and relapse have led researchers to examine if issues related to the “self” contribute to obsessive-compulsive disorder. The present systematic review investigated whether self-beliefs relate to obsessive-compulsive symptoms and related phenomena, and if these beliefs contribute to the concealment of personal and symptom-relevant information. Ninety-nine papers (103 studies; cumulative N = 21,701) met inclusion criteria. Self was broadly conceptualized, including self-esteem (n = 18 studies), self-concept (n = 5), self-perception (n = 2), negative self-statements (n = 2), self-ambivalence and self-concept clarity (n = 8), feared self (n = 13), self in autogenous and reactive obsessions (n = 4), self-worth (n = 8), sensitivity of self (n = 2), moral self-perceptions (n = 4), early maladaptive schemas (n = 5), egodystonicity and egosyntonicity (n = 10), self-concealment (n = 1), self-disclosure (n = 1), and symptom concealment (n = 20). Overall, while the more general experience of low self-esteem does not appear to differentiate OCD from other psychiatric conditions, self-beliefs encompassing particular egodystonic themes tend to accompany related obsessional concerns or compulsive behaviors. There is consistent evidence that a perceived morally deficient, fractured or feared self plays a role in these phenomena. Owing to methodological constraints of the included studies, the specific function of concealment behaviors in OCD is less clear. The present findings add to growing evidence suggesting the importance of understanding the idiosyncratic nature of self-beliefs in clinical presentations. Future studies should aim to clarify the conceptual overlap across the self-themes examined in this review, and the importance of self-themes for psychological treatments.