When uncertainty is a symptom: intolerance of uncertainty in OCD and ‘irrational’ preferences

• Published in: Journal of medical ethics 2023-11, Vol.49 (11), p.757-758
• Main Author: Smith, Jared
• Format: Article
• Language: English
• Subjects: Attitudes; Cancer; Commentary; Decision Making; Ethics; Expected utility; Medical ethics; Mental Disorders; Neuroses; Obsessive compulsive disorder; Paternalism; Patients; Physicians; Risk Assessment
• ISSN: 0306-6800; 1473-4257
• DOI: 10.1136/jme-2023-109378

Consider one woman with OCD whose obsessions centred on contamination from interacting with people who have cancer (or places she associated with cancer) that would lead to her developing cancer herself, driving her to check her body for signs of illness and repeatedly scour it clean in an effort to reduce her risk (pp.45).2 There is the potential to mistake these compulsions as being automatic or meaningless repetitious behaviour (akin to tics) but this is incorrect. In their piece on decision-making in OCD, Croft et al point out inconsistency in results across studies examining the impact of risk; some studies indicate folks OCD are more risk averse than those without the disorder, some indicate no real difference from controls, and still others that these agents are less risk averse than controls.4 The Croft et al study, unlike previous studies, focuses on decision-making in the contexts most problematic for those with OCD: (1) ‘black swan’ outcomes that have an existing but low probability of a catastrophic loss occurring and (2) decisions involving the agent’s personal responsibility specifically for medical or health outcomes (as opposed to financial decisions). [...]these findings underscore how nuanced and complex considerations of risk may be in medical decision-making even among those who otherwise present as risk-averse and (relatively) intolerant of uncertainty.