Imaginative, Dissociative, and Schizotypal Processes in Obsessive-

Compulsive Symptoms
Frederick Aardema 1,2 and Kevin D. Wu 3
1
University of Montreal, Fernand-Seguin Research Center
2
Concordia University, Montreal
3
Northern Illinois University

This study investigates imaginative, dissociative, and schizotypal processes that are potentially relevant
to obsessive-compulsive (OC) symptoms. Students (n 5 377) completed questionnaires that assessed
inferential confusion, absorption, schizotypal personality, and other domains. Hierarchical regression
revealed that inferential confusion and absorption were the most consistent predictors of OC
symptoms; other content predicted variance for specific OC symptoms. For example, schizotypal
personality predicted checking and hoarding symptoms, but not cleanliness or ordering rituals.
Immersive tendencies predicted cleanliness and hoarding but not checking or ordering rituals. Results
are consistent with an inference-based model of OC, in which an overreliance on imagination during
reasoning gives rise to experiences that are inconsistent with reality. This study suggests additional
domains that may help explain why intrusive thoughts become obsessions. & 2010 Wiley Periodicals,
Inc. J Clin Psychol 67:74–81, 2011.

Keywords: obsessive-compulsive disorder; inferential confusion; dissociation; absorption; schizotypy;

depersonalization

Cognitive models of obsessive-compulsive disorder (OCD) hold that intrusive thoughts become
obsessions because of how they are appraised (Rachman, 1997). That is, interpretation of an
otherwise benign thought as important leads to distress, which increases its intensity and
frequency, resulting in obsessions, which are followed by compulsions. The appraisal model
focuses primarily on the beliefs that are thought to increase the likelihood of harmful appraisal.
However, it may be worthwhile to more closely examine the nature of the intrusions themselves.
Obsessions often are experienced with ‘‘hallucinatory vividness,’’ making them difficult to
dismiss (Guidano & Liotti, 1983). Their strong reality value suggests a low threshold for
imaginative absorption among those with OCD and recent experimental data support this
possibility: Aardema, O’Connor, Pélissier, and Lavoie (2009) found that OCD patients are affected
more strongly than nonclinicals when considering possibility-based information (i.e., that which
‘‘might be’’), suggesting that the problem may not be what actually occurs, but what they imagine.
The role of imagination in OCD is evident in bizarre symptoms. For example, a man in a
bank feared that he might have robbed it, upon which he abruptly ran away to avoid capture.
This reaction is contrary to reality, unsupported by events in the here and now. The same
process may apply to more common thoughts, such as I am contaminated. Although possible,
the justification for the obsession is inconsistent with reality. Unlike intrusions found in the
general population, those within OCD more frequently are without context or direct link to
objective observation (Julien, O’Connor, & Aardema, 2009). Imagination also is key for
delusional disorders in which beliefs deviate from reality. Overlap between OCD and delusion
has been noted; Sobin et al. (2000) found that 50% of an OCD sample (n 5 119) presented
with at least mild schizotypy symptoms. However, whereas several studies have found
OC-schizotypal relations, this association may be mediated by fantasy proneness (Muris
& Merckelbach, 2003). Other research has investigated the role of dissociation—namely,

Correspondence concerning this article should be addressed to: Frederick Aardema, Fernand-Seguin
Research Center, 7331 Hochelaga, Montréal, Québec H1N 3V2, Canada; e-mail: faardema@crfs.rtss.qc.ca

JOURNAL OF CLINICAL PSYCHOLOGY, Vol. 67(1), 74--81 (2011) & 2010 Wiley Periodicals, Inc.
Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/jclp.20729
 Imaginative Processes in OC Symptoms 75

absorption-imagination—in schizotypal symptoms (Axelrod, Grilo, Sanislow, & McGlashan,

2001). Dissociation also has been shown to correlate with OCD symptoms, especially checking
(Watson, Wu, & Cutshall, 2004). In fact, OCD patients with elevated absorption-imagination
scores have significantly worse cognitive-behavioral treatment outcome (Rufer et al., 2006). It
should be noted, however, that many OC-dissociation studies do not control for general
distress and, so, specificity is a question.
One model is that dissociative experiences in OCD be understood from the perspective of an
inference-based approach (IBA) (O’Connor, Aardema, & Pélissier, 2005). According to IBA,
relying on remote, subjective possibilities leads to high involvement and absorption into the
obsession, which is experienced as if real. This blurring of reality is accompanied by varying
amounts of detachment and derealization. A reliance on imagination and distrust of senses, as
measured by the Inferential Confusion Questionnaire (ICQ), significantly relates to OC symptoms
that are independent of negative affect and cognitive appraisal domains (Aardema, O’Connor,
Emmelkamp, Marchand, & Todorov, 2005; Aardema, Wu, Careau, O’Connor, & Dennie, in
press; Wu, Aardema, & O’Connor, 2009). In addition, the ICQ relates significantly to schizotypal
symptoms such as fantasy proneness and perceptual disturbances (Aardema, Kleijer, Trihey,
O’Connor, & Emmelkamp, 2006). Not surprisingly, then, those with delusional disorder score as
high on the ICQ as those with OCD, and both groups score significantly higher than anxious and
nonclinical controls (Aardema et al., 2005). Yet, little is known about the unique contributions of
imaginative, schizotypal, and dissociative processes in OC symptoms. They appear to play a role,
but studies have investigated these processes separately, and not all studies have controlled for
negative affect. As such, it is unclear whether these relations are unique versus nonspecific.

The Current Study

We investigated a set of interrelated imaginative, dissociative, and schizotypal processes in OC
symptoms. Expectations were as follows: (a) imaginative, dissociative, and schizotypal
processes significantly relate to OC symptoms after controlling for negative affect and (b)
absorption and overreliance on the imagination are the strongest predictors of OC symptoms.
Research should target several continuous OC dimensions (Mataix-Cols, Rosario-Campos, &
Leckman, 2005). Beyond the conceptual advantages of this approach, a practical one is decreased
reliance on disordered-only samples. Data support that OC-relevant phenomena are common in
nonclinicals and are nontaxonic, that self-report OC measures predict OCD diagnosis, and that
subclinical OC experiences are similar in content and structure to OCD symptoms proper (Burns,
Formea, Keortge, & Sternberger, 1995; Tolin, Woods, & Abramowitz, 2003). The literature
supports using nonclinical participants for understanding these constructs; large-sample,
dimensional analyses were indicated for this study to begin to clarify purported relations.

Method
Participants
Participants were 377 undergraduate students from Northern Illinois University. Sample
characteristics were 55.6% women and mean age of 19.0 years (standard deviation [SD] 5 1.76;
range 5 18–39). Previous studies using the same broader undergraduate body showed
substantial racial diversity (65% White, 19% Black, 7% Asian, 5% Hispanic, 5% multiracial
or ‘‘other’’; Wu & Carter, 2008).

Questionnaires
Schedule of Compulsions, Obsessions, and Pathological Impulses (SCOPI;
Watson & Wu, 2005). This 47-item questionnaire has three OC (Checking, Cleanliness,
Rituals) and two additional (Pathological Impulses, Hoarding) scales. Ratings are made on a
5-point scale (strongly disagree to strongly disagree). It has shown good internal consistency
(as ranged from .82–.91) and 2-month retest reliability (range 5 .79–.82) in college students
(Watson & Wu, 2005). The OC scales distinguish OCD from nonclinical and non-OCD
76 Journal of Clinical Psychology, January 2011

clinical samples, and they relate to OCD beyond general distress (Wu & Watson, 2005). The
Pathological Impulses scale was not included for analysis in this study, because previous
research has found that those with OCD score lower on this scale than non-OCD clinical
controls and students (Aardema, Wu, Careau, O’Connor, & Dennie, in press).

Schizotypal Personality Questionnaire-Brief Version (SPQ-B; Raine & Benishay,

1995). This 22-item version of the SPQ (Raine, 1991) has been validated in student and clinical
samples. Subscales have as ranging from .72–.80 and good criterion validity with clinical
interviews for the cognitive perceptual and interpersonal subscales (Axelrod et al., 2001).
Reliability analyses in the current sample found lower values for Cognitive-Perceptual (a 5 .62),
Interpersonal (a 5 .68), and Disorganized (a 5 .65) subscales; consequently, only the total score
was used (a 5 .79). Scoring is dichotomous with yes/no answers and a potential range of 0–22.
Higher scores represent a greater level of schizotypal symptoms that include ideas of reference,
odd beliefs or magical thinking, odd or eccentric behavior, constricted affect, and suspicion.

Dissociative Experiences Scale (DES-II; Carlson & Putnam, 1993). This 28-item
questionnaire assesses dissociative symptoms using an 11-point scale (0–100 in 10-point
increments). Scores are calculated by dividing the total by 28, leaving a potential range from
0–100. Its construct and criterion validity has been established via moderate to strong
correlations with other dissociation measures and higher scores among individuals with
dissociative disorders (Carlson & Putnam). Reliability is supported by coefficient alphas that
range from .85–.93. In addition, factor-analytic studies have identified several cohesive
underlying constructs, measured by the scale, in both a large mixed sample of nonclinical and
clinical participants, including amnestic dissociation, absorption and imaginative involvement,
and experiences of derealisation or depersonalization (Carlson et al., 1991). Specifically,
among nonclinical samples, most of the variance can be attributed to items loading on an
absorption factor (items 12, 14, 15, 16, 17, 18, 20, 22, 23, and 24). In line with
recommendations, scores on this subscale scale were determined by calculating an average
score for all the items (adding the item scores and dividing them by the number of items in the
scale). Higher scores indicate a higher degree of dissociative experiences, which are
characterized by absorption and imaginative involvement.

Cambridge Depersonalisation Scale (CDS; Sierra & Berrios, 2000). The CDS
comprises 29 items that assess frequency, from 0 (never) to 4 (all the time), and duration, from
1 (few seconds) to 6 (more than a week), of depersonalization and derealization symptoms over
the previous 6 months. The total score is calculated by adding all the items. In a sample of
n 5 77 patients who suffer from a depersonalization disorder, an anxiety disorder, or temporal
lobe epilepsy, it showed good internal consistency (a 5 .89), convergent validity (r 5 .80) with
the DES depersonalization subscale, and discriminant validity (r 5 .25–.29) with the DES
absorption and amnesia subscales (Sierra & Berrios). A large undergraduate sample (Talbert,
2008) also yielded good reliability (a 5 .93) and convergent validity with other dissociative
measures (r 5 .62).

Immersive Tendency Questionnaire (ITQ; Witmer & Singer, 1998). The ITQ
measures a tendency toward immersion in common activities, including the ability to
concentrate and block out distractions. Studies with nonclinicals have supported good
reliability (a 5 .81). The present study used the total score, which comprises 18 items with a
potential range of 18–144. Items are answered on 8-point scales (e.g., never to often or not very
good to very good). High scores indicate a tendency towards immersion in common activities.

The Adapted Igroup Presence Questionnaire (AIPQ; Aardema, O’Connor et al.,

2009).1 This 9-item version of the IPQ (Schubert, Friedmann, & Regenbrecht, 2001) was
developed in a nonclinical sample to specifically measure sense of presence in objective

1
The IPQ and its modified version the AIPQ contains original items from previously developed questionnaries
(Carlin, Hoffman, & Weghorst, 1997; Hendrix, 1994; Slater & Usoh, 1994; Witmer & Singer, 1998).
 Imaginative Processes in OC Symptoms 77

external reality. Sense of presence is commonly described as ‘‘the feeling of being there’’ as it
applies to virtual reality environments. In addition, lack of presence as it applies to objective
reality has been found to significantly relate to dissociation. One previous study showed
satisfactory internal consistency (a 5 .73) and construct validity via lower levels of presence
being associated with higher levels of dissociation and immersive tendencies (Aardema,
O’Connor et al., 2009). Items are answered on a 7-point scale, ranging from 0–6. Higher scores
indicate a greater sense of presence in objective reality.

Inferential Confusion Questionnaire–Expanded Version (ICQ-EV; Aardema, Wu,

et al., in press). This 30-item revision of the ICQ (Aardema, O’Connor et al., 2005) has been
validated in nonclinical and clinical samples and shows correlations with OC symptoms
beyond negative affect and other cognitive domains (Aardema, Wu et al., 2009). Its total score
possesses good internal consistency (as range from .96–.97 in three nonclinical samples). Items
are answered on a 6-point scale, ranging from 1 (strongly disagree) to 6 (strongly agree). High
scores represent an overreliance on imagination, a distrust of the senses, and a tendency to
confuse imagination with reality.

Positive and Negative Affect Schedule (PANAS; Watson & Clark, 1994). The
PANAS measures two broad dimensions of negative and positive affect using single-word
descriptors (e.g., guilty, afraid). Only the 10-item negative affect scale was used. It possesses
good reliability in nonclinical and clinical samples (as range from .85–.90) and has shown clear
convergent and discriminant validity across diverse studies and samples (Watson & Clark).
Items are answered on a 5-point scale, with higher scores reflecting increased negative affect.

Results
Descriptive Statistics and Reliability
The current group performed as expected on the questionnaires (Table 1). For example,
compared with previous groups, this sample scored within 1 standard deviation on the
following: DES-Absorption (M 5 16.70 vs. 14.40 in Ross, Joshie, & Currie, 1991); ICQ-EV
(M 5 71.51 vs. 75.92 in Wu et al., 2009); PANAS NA (M 5 22.80 vs. 22.81 in Fergus & Wu,
2010); SCOPI (M 5 97.81 vs. 95.75 in Wu et al.); and SPQ-B (M 5 6.8 vs. 9.6 in Raine &
Benishay, 1995). Regarding reliability, all scales except for the AIPQ (a 5 .70), showed good
internal consistency, with alphas ranging from .79–.96.

Pearson Correlations
Most measures correlated significantly, but none so high as to suggest redundancy (Table 1).
The ICQ-EV had the strongest correlations within the table (range was .19–.61), including its
five highest correlations with SPQ-B (r 5 .61), SCOPI total (r 5 .58), CDS (r 5 .56), SCOPI
Checking (r 5 .54), and DES Absorption (r 5 .53). However, all measures were distinct from
PANAS NA, as values were moderate and ranged from .12 (AIP-Q) to .47 (ICQ-EV).
All of the imaginative, dissociative, and schizotypal measures significantly related with
SCOPI total score, but ICQ-EV (r 5 .58), SPQ-B (r 5 .42), and DES Absorption (r 5 .41)
showed the strongest values. Many of the correlations with specific symptoms also were
significant, particularly those involving checking.

Multiple Regressions
To examine for specificity and for potential unique contributions, we performed a hierarchical
regression that predicted SCOPI total score (Table 2). In step 1, we entered PANAS NA,
which provided an R2 of .12. In step 2, we entered all the imaginative, dissociative, and
schizotypal measures. Together, they contributed significant additional variance beyond step 1
(R2 5 .18). This finding extends the Table 1 correlations and demonstrates that these measures
are associated with OC symptoms that are beyond nonspecific variance. Further, the findings
78 Journal of Clinical Psychology, January 2011

Table 1
Descriptive Statistics, Reliability, and Correlations

M SD Range a DES-A SPQ-B CDS ITQ ICQ-EV AIPQ NA

DES-A 16.70 12.81 0–90 .91

SPQ-B 6.80 4.15 0–19 .79 .38
CDS 33.48 29.13 0–181 .96 .48 .43
ITQ 81.97 16.68 35–136 .83 .28 .23 .09
ICQ-EV 71.51 26.49 30–166 .96 .53 .61 .56 .31
AIPQ 38.70 8.26 6–54 .70 .27 .13 .27 .02 .26
PANAS NA 22.80 7.33 10–44 .83 .30 .46 .34 .26 .47 .12
SCOPI-T 97.81 21.85 39–165 .92 .41 .42 .30 .24 .58 .18 .39
SCOPI-CH 33.67 9.99 13–61 .90 .37 .42 .26 .24 .54 .13 .40
SCOPI-CL 31.96 7.70 12–58 .84 .21 .10 .12 .07 .19 .05 .16
SCOPI-RI 19.02 6.65 8–40 .88 .30 .25 .23 .12 .40 .12 .24
SCOPI-H 13.17 4.43 5–25 .82 .20 .31 .11 .28 .35 .11 .20

Note. DES-A 5 Dissociative Experiences Scale-Absorption subscale; SPQ-B 5 Schizotypal Personality

Questionnaire-Brief Version; CDS 5 Cambridge Depersonalization Scale; ITQ 5 Immersive Tendencies
Questionnaire; ICQ-EV 5 Inferential Confusion Questionnaire-Expanded Version; AIPQ 5 Adapted
IGroup Presence Questionnaire; NA 5 Negative Affect Scale; SCOPI-T 5 Schedule of Compulsions,
Obsessions, and Pathological Impulses Total Score (minus Pathological Impulses); SCOPI-CH 5 Checking;
SCOPI-CL; Cleanliness; SCOPI-RI 5 Rituals; SCOPI-H 5 Hoarding N 5 377.
Correlations significant at pr.05 shown in bold font.

show the unique contribution of each independent variable controlling for all others. Examined
separately, ICQ-EV (b 5 .40) and DES Absorption (b 5 .16) significantly predicted SCOPI
total score. In addition, the CDS negatively predicted OC symptoms (b 5 .12; p 5 .036).
Finally, due to the heterogeneity of OCD symptoms, separate regressions predicted each
symptom dimension to examine for potential differences: for checking, in addition to the
ICQ-EV and DES, the CDS was a significant predictor (b 5 .13, po.05); for cleanliness, in
addition to the ICQ-EV and DES, the ITQ was a significant predictor (b 5 .18, po.001); for
rituals, no additional scales were predictors; and for hoarding, whereas the DES did not
emerge as a predictor, the ITQ (b 5 .17, po.001), SPB-Q (b 5 .17, po.01), and CDS
(b 5 .14, po.05) did. Thus, each symptom showed a somewhat unique pattern of
associations with the key constructs.

Discussion
This study supported that imaginative, dissociative, and schizotypal processes may be relevant
factors in OC symptom experience. Controlling for negative affect, regressions revealed
inferential confusion as the strongest predictor of OC symptoms. Additional variance in most
OC symptoms was explained by absorption, but each symptom showed a somewhat unique
pattern.
Interestingly, depersonalization symptoms were negative predictors of OC symptoms—
checking and hoarding in particular. The negative contribution of depersonalization in the
prediction of OC symptoms may be interpreted in terms of increased levels of detachment
from reality. Such a detachment from reality may actually lead to less compulsive behaviours
when the effects of absorption and inferential confusion are controlled. Likewise, immersive
tendencies were a negative predictor for cleanliness symptoms when controlling for the other
variables, perhaps because the ITQ emphasizes functional aspects of immersion in the here-
and-now as opposed to its more pathological aspects tapped by the other questionnaires.
Combined with previous research that supported the utility of assessing both obsessive
beliefs and inferential confusion, these results highlight additional variables that appear
relevant to OC symptoms. Whereas the current results do not comment directly on OCD
classification issues, they identify variables that are relevant to imagination and dissociation
 Imaginative Processes in OC Symptoms 79

Table 2
Hierarchical Regressions Predicting OC Symptoms

B SE DR2 b Test statistic p value

SCOPI Total
Step 1: 0.12 F(1,376) 5 52.12 o.001
Negative Affect (PANAS NA) 1.04 0.15 0.35 t(376) 5 7.22 o.001
Step 2: 0.18 F(8,368) 5 22.34 o.001
Inferential Confusion (ICQ-EV) 0.34 0.05 0.4 t(368) 5 5.99 o.001
Absorption (DES) 0.23 0.08 0.16 t(368) 5 3.02 0.003
DP/DR (CDS) 0.09 0.04 0.12 t(368) 5 .11 0.036
SCOPI Checking
Step 2: 0.19 F(7,369) 5 27.56 o.001
Inferential Confusion (ICQ-EV) 0.15 0.02 0.4 t(369) 5 6.33 o.001
Absorption (DES) 0.08 0.03 0.12 t(369) 5 2.23 0.027
Schizotypal (SPQ-B) 0.25 0.13 0.11 t(369) 5 1.89 0.059
DP/DR (CDS) 0.04 0.02 0.13 t(369) 5 2.36 0.019
SCOPI Cleanliness
Step 2: 0.09 F(7,369) 5 5.12 o.001
Absorption (DES) 0.09 0.03 0.19 t(369) 5 3.04 0.003
Inferential Confusion (ICQ-EV) 0.05 0.02 0.16 t(369) 5 2.16 0.031
Immersive Tendencies (ITQ) 0.09 0.03 0.18 t(369) 5 3.40 o.001
SCOPI Rituals
Step 2: 0.12 F(7,369) 5 11.29 o.001
Inferential Confusion (ICQ-EV) 0.09 0.02 0.34 t(369) 5 4.72 o.001
Absorption (DES) 0.06 0.03 0.13 t(369) 5 2.26 0.024
SCOPI Hoarding
Step 2: 0.14 F(7,369) 5 11.49 o.001
Inferential Confusion (ICQ-EV) 0.04 0.01 0.25 t(369) 5 3.52 o.001
Immersive Tendencies (ITQ) 0.05 0.01 0.17 t(369) 5 3.23 o.001
Schizotypal (SPQ-B) 0.18 0.07 0.17 t(369) 5 2.69 o.008
DP/DR (CDS) 0.02 0.01 0.14 t(369) 5 2.24 .026

Note. Only independent variables with po.10 are displayed. OC 5 obsessive-compulsive; SE 5 standard
error. SCOPI-Total 5 Schedule of Compulsions, Obsessions, and Pathological Impulses minus Patholo-
gical Impulses; PANAS NA 5 Positive and Negative Affect Schedule; ICQ-EV 5 Inferential Confusion
Questionnaire–Expanded Version; DES 5 Dissociative Experiences Scale; CDS 5 Cambridge Depersona-
lisation Scale; SPQ-B 5 Schizotypal Personality Questionnaire-Brief Version; ITQ 5 Immersive Tendency
Questionnaire.
N 5 377.

that may play a role in OC symptoms. Considerably more research is needed to further
articulate the relations between OCD and these constructs of the imagination, and such data
may inform broader efforts to conceptualize OCD’s relation with other forms of mental illness.
Examining these issues in a student sample provide a reasonable range of scores on the
included instruments, but clearly is a first step with notable limitations. First, replication in
broader samples is critical, including a clinical OCD sample. Second, future research also
may assess the relative contributions of factors to OC symptoms in combination with other
OC- relevant domains such as inflated responsibility and importance of thoughts. Third, this
study relied on questionnaires; subsequent studies may use other data sources, including
nonself-report measure, when possible. With these important limitations, our results provide a
framework for future investigations as to the role of imaginative processes in OCD symptoms.

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