(No) Attentional Biases in Obsessive-Compulsive Disorder? An Eye-Tracking Study Using Idiosyncratic Stimulus Material

Cognitive-behavioural theories propose that attentional biases contribute to the development and maintenance of obsessive-compulsive disorder (OCD). However, research findings have been inconsistent, with some studies supporting vigilance (i.e., rapid orientation toward threatening material) and/or maintenance biases (i.e., difficulty disengaging from threatening material), and others showing either one or neither of these biases. These inconsistencies may be related to several limitations of previous studies (e.g., no clinical control groups, focus on subgroups of participants with OCD, use of generic OCD-related material). Therefore, this preregistered study (https://osf.io/8gkjc) aimed to clarify attentional biases in OCD using a free-viewing eye-tracking paradigm with idiosyncratic disorder-relevant stimuli. Participants included 51 individuals with OCD, 64 non-clinical controls, and 50 individuals with spider phobia as a clinical control group. Results did not support a vigilance bias in OCD, as participants with OCD were neither faster nor more likely to fixate first on OCD-relevant stimuli. Although a maintenance bias was observed, it was driven by avoidance of negative images rather than prolonged attention to OCD-relevant stimuli. In contrast, participants with spider phobia strategically avoided spider-related images, indicating different attentional patterns compared to OCD. Exploratory analyses revealed symptom-specific attentional patterns: whereas participants with OCD avoided OCD-relevant contamination-related images, a maintenance on OCD-relevant checking-related was observed. These findings highlight the importance of considering individual symptom profiles and the emotional significance of stimuli in future research. Our study suggests that attentional processes in OCD differ from those in anxiety disorders and challenges the applicability of anxiety models of attentional biases to OCD.