The Seeking Proxies for Internal States (SPIS) Model of OCD – A Comprehensive Review of Current Findings and Implications for Future Directions

Title:The Seeking Proxies for Internal States (SPIS) Model of OCD – A Comprehensive Review of Current Findings and Implications for Future Directions

Volume: 22 Issue: 11

Author(s): Amit Lazarov*, Nira Liberman and Reuven Dar

Affiliation:

• School of Psychological Sciences, Tel Aviv University, Tel Aviv 69978, Israel

Keywords: Obsessive-compulsive disorder, obsessions, compulsions, internal states, proxies, doubt.

Abstract: The Seeking Proxies for Internal States (SPIS) model of obsessive-compulsive disorder (OCD) explains symptoms of OCD as stemming from attenuated access to internal states, which is compensated for by using proxies, which are indices of these states that are more discernible or less ambiguous. Internal states in the SPIS model are subjective states that are not accessible to others, encompassing physiological states, motivations, preferences, memories, and emotions. Compensatory proxies in OCD include fixed rules and rituals as well as seeking and relying on external information. In the present review, we outline the SPIS model and describe its basic tenets. We then use the SPIS conceptualization to explain two pivotal OCD-related phenomena - obsessive doubt and compulsive rituals. Next, we provide a detailed overview of current empirical evidence supporting the SPIS in several domains, including physiological states, emotions, sense of understanding, decision-making, and sense of agency. We conclude by discussing possible neural correlates of the difficulty in accessing internal states, focusing on the anterior insular cortex (AIC) and highlighting potential clinical implications of the model to the treatment of OCD.

Cite this article as:

Lazarov Amit*, Liberman Nira and Dar Reuven, The Seeking Proxies for Internal States (SPIS) Model of OCD – A Comprehensive Review of Current Findings and Implications for Future Directions, Current Neuropharmacology 2024; 22 (11) . https://dx.doi.org/10.2174/1570159X21666230920165403