Resolving Uncertainty About the Role of Uncertainty Intolerance as a Contributing Factor to Obsessive-Compulsive Disorder and Related Disorders

Comments on the article by Knowles and Olatunji (see record 2023-72909-001). Obsessive–compulsive disorder (OCD) tends to run a chronic course when not adequately treated and causes substantial functional impairment for sufferers (American Psychiatric Association [APA], 2013). The significant illness burden associated with OCD necessitates research on the factors that contribute to the development and maintenance of OCD symptoms. One candidate contributing factor to OCD is intolerance of uncertainty (IU), which has been defined as the “dispositional incapacity to endure the aversive response triggered by the perceived absence of salient, key, or sufficient information, and sustained by the associated perception of uncertainty” (Carleton, 2016, p. 31). In their article, Knowles and Olatunji (2023) provide a comprehensive review and critical appraisal of the research literature linking IU to OCD. Their article provides key criteria for evaluating the evidence supporting IU as a cognitive vulnerability for OCD. Importantly, their review shows that some criteria (e.g., robust associations between IU and OCD symptoms) have extensive empirical support, whereas others (e.g., temporal precedence of change in IU preceding change in OCD symptoms) are characterized by mixed findings. Overall, given the historical nature of the association between OCD and IU and the centrality of learning to live with doubt in OCD treatments (Grayson, 2010), it is perhaps somewhat surprising how many ambiguities and unknowns remain in the empirical literature on the relationship between IU and OCD. Knowles and Olatunji (2023) identify the relevant gaps in the literature and offer important directions for future research. Their review has substantial merit to improve the science while also acknowledging the barriers and challenges future research will face. This commentary provides support for these recommendations and also highlights additional areas for consideration for future research on IU. (PsycInfo Database Record (c) 2023 APA, all rights reserved)