Anxiety sensitivity in obsessive-compulsive disorder: a case-control study

Background: Anxiety sensitivity refers to the tendency to interpret anxiety-related bodily and cognitive sensations as harmful or threatening. It has been extensively studied as a cognitive vulnerability factor across various psychiatric disorders, especially panic, generalized anxiety, and social anxiety disorders. Although obsessive-compulsive disorder (OCD) is closely linked to anxiety-related mechanisms, the role of anxiety sensitivity in OCD remains poorly understood. Previous research has primarily focused on the relationship between anxiety sensitivity and obsessive-compulsive symptom dimensions, while direct comparisons between individuals with OCD and healthy controls have been limited. Clarifying this relationship may contribute to a better understanding of the cognitive mechanisms underlying OCD. Therefore, the present study aimed to compare anxiety sensitivity levels between individuals with OCD and healthy controls and examine the association between anxiety sensitivity and OCD symptom severity.

Methods: This cross-sectional study included 130 participants: 65 individuals diagnosed with OCD and 65 healthy controls. Anxiety sensitivity was assessed using the Anxiety Sensitivity Index-3 (ASI-3), which measures physical, cognitive, and social concerns related to anxiety symptoms. OCD symptom severity was evaluated using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). The normality of the variables was checked by examining skewness and kurtosis values (±1.5), which indicated that the data were normally distributed. Group differences in anxiety sensitivity scores were analyzed using independent-sample t-tests. In the OCD group, the association between anxiety sensitivity scores and OCD symptom severity was examined using Pearson’s correlation analysis. Statistical significance was set at P <0.05.

Results: Individuals with OCD demonstrated significantly higher ASI-3 total and subscale scores than healthy controls. The mean ASI-3 total score was markedly higher in the OCD group than in the control group (OCD: 36.26±17.65; controls: 12.91±10.11; p<0.001). Similarly, significant differences between groups were found for the ASI-3 physical (14.83±6.58 vs. 3.80±3.25), cognitive (13.26±7.50 vs. 5.68±5.04), and social (8.17±5.94 vs. 3.43±3.19) subscales (all p<0.001). The largest effect size was observed for the physical concerns dimension (Cohen’s d = 2.13), indicating a particularly strong difference between the groups. Within the OCD group, anxiety sensitivity scores were not significantly correlated with Y-BOCS obsession, compulsion, or total scores (all p>0.05).

Conclusions: The findings indicate that Anxiety sensitivity is significantly elevated in individuals with OCD compared to healthy controls. The particularly large effect size observed for the physical concerns dimension suggests that heightened interpretation of anxiety-related bodily sensations as threatening may play an important role in OCD. However, the lack of a significant link between anxiety sensitivity and OCD symptom severity indicates that anxiety sensitivity may not reflect the symptom severity. Instead, it may represent a cognitive characteristic that is independent of the current level of obsessive-compulsive symptoms. Further research with larger samples and longitudinal designs is needed to clarify the role of anxiety sensitivity in the psychopathology of OCD.

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