Intolerance of uncertainty in youth with obsessive-compulsive disorder and generalized anxiety disorder: A transdiagnostic construct with implications for phenomenology and treatment

Abstract

Obsessive-compulsive disorder (OCD) and generalized anxiety disorder (GAD) are early-onset disorders with significant overlapping phenomenology, especially in young patients who, due to developmental stage, may have difficulty recognizing obsessions and worries as unrealistic or excessive. Shared phenomenology and high rates of comorbidity between OCD and GAD raise the possibility of common underlying processes, and recent work has focused on intolerance of uncertainty (IU) as a reasonable candidate. With an emphasis on the youth literature, we review the phenomenological overlap between OCD and GAD, how symptoms may relate to IU, and how IU may be measured. We review existing psychotherapeutic treatments and discuss how understanding the role of IU may assist in the development of novel psychotherapeutic strategies to improve treatment outcomes. Neuroimaging studies of IU in OCD and GAD are also discussed and suggestions for further research are offered. We conclude that, consistent with Research Domain Criteria (RDoC), IU represents a transdiagnostic construct with a demonstrable neural basis that could be targeted to improve existing treatments for these disorders.

Keywords: Children; Cognitive behavioral therapy; Generalized anxiety disorder; Intolerance of uncertainty; Obsessive-compulsive disorder; Phenomenology.