Seeking certainty: a grounded theory of morality in obsessive-compulsive disorder

Cleo McIntosh

Research output: ThesisDoctoral Thesis

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Morality has long been associated with obsessive-compulsive disorder (OCD) in the literature, however remains underspecified in current theoretical frameworks. Despite significant advances in research, OCD remains one of the most difficult disorders to treat (Clark, 2015), suggesting there is much about this heterogeneous disorder that is not fully understood. Recent research examining self-processes in OCD has indicated morality may play an important role in OCD and further investigation is needed. Striking parallels have also been drawn between OCD symptoms and phenomena such as moral self-regulation, and moral cleansing, in the field of moral psychology. This study aimed to understand people with OCD’s experiences of morality and to develop a theoretical model based on their qualitative accounts. Grounded theory methodology was used to inform data collection and analysis. Twelve adults with experience of OCD took part in semi-structured interviews. Analysis led to development of a theoretical model with seven overarching theoretical codes: conceptualising morality, holding rigid moral values as part of identity, experiencing moral uncertainty, seeing the world in black and white, fear factor, seeking certainty, and feeling ambivalent about OCD. A sequential structure was used to indicate process and illustrate interrelationships between theoretical codes in the model. Feedback loops and circular relationships were also identified. Experiencing moral self-uncertainty and a fragile sense of self were identified as central features of participants’ experiences. The findings indicate incorporating concepts such as moral self-uncertainty, dichotomous thinking, and fear of self and others, into current theoretical frameworks may be helpful in facilitating treatment innovation; approaches able to explore self-processes may be particularly relevant for OCD. The developed model is discussed in relation to existing theory and recent research findings. The strengths and limitations of the study are outlined along with suggestions for further research.
Original languageEnglish
Awarding Institution
  • Royal Holloway, University of London
  • Fox, John, Supervisor, External person
  • Luzon, Olga, Advisor
Award date1 Nov 2017
Publication statusUnpublished - 2017


  • OCD
  • morality
  • Grounded theory
  • qualitative research
  • obsessive-compulsive disorder

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