Looking for Outcomes: The Experience of Control and Sense of Agency in Obsessive-compulsive Behaviors

Obsessive-Compulsive Disorder (OCD) can be conceptualized as a disturbance of control over one’s thoughts and actions, and through them, over external events. Classically, there are two general approaches to the explanation of OCD symptoms: a cognitive account that emphasizes the important role played by dysfunctional beliefs in the exaggerated appraisals of negative outcomes (i.e., harm avoidance) and a sensory phenomena account that highlights the role of impaired action monitoring in inconsistent feelings of dissatisfaction with actual outcomes (i.e., incompleteness). In this chapter, we review the phenomenology of these two OCD manifestations in light of the sense of agency framework. We argue that harm avoidance and incompleteness should be construed as distinct forms of defective outcome processing, leading to distinct impairments of the experience of action.