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OCD symptoms in a sample of Turkish patients: A phenomenological picture
Depression and Anxiety
Abstract
This study aimed to investigate the clinical features of obsessive-compulsive disorder (OCD) and the possible association between obsessive-compulsive symptoms and culture-related characteristics in a sample of Turkish patients with OCD. We studied 141 patients with OCD (according to DSM-IV criteria) consecutively admitted to our outpatient clinic during the period from February 1998 to December 2003. We used the Turkish version of the Structured Clinical Interview for DSM-IV (SCID) to interview all patients, and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) to assess obsessive-compulsive symptoms and severity. The onset of OCD symptoms was earlier in males. Major depression was the most common comorbid disorder (30.5%). The most commonly occurring obsessions were contamination (56.7%), aggression (48.9%), and somatic (24.1%), followed by religious (19.9%), symmetry (18.4%), and sexual imagery (15.6%). Symmetry and sexual obsessions, and checking compulsions and rituals, tended to be more common in male patients. Dirt and contamination obsessions and washing compulsions were slightly more common in females. The vast majority of patients with religious obsessions (83%) and half of the patients with sexual obsessions had compulsions that included religious practices. Also, patients with sexual and religious obsessions had delayed seeking professional help.
... Regarding demographic and clinical correlates, the symmetry dimension has been associated with male sex [4,17,[25][26][27][28][29], early onset of obsessive-compulsive symptoms [8,27,28,[30][31][32][33][34][35], longer duration of symptoms [21,27,36], and presence of tics or tic disorders [37,38]. Additionally, associations with family history of OCD [8,[39][40][41][42], greater OCD severity and functional impairment [16,21,26,32], and suicidal behaviors [43,44] have been reported. ...
... Regarding demographic and clinical correlates, the symmetry dimension has been associated with male sex [4,17,[25][26][27][28][29], early onset of obsessive-compulsive symptoms [8,27,28,[30][31][32][33][34][35], longer duration of symptoms [21,27,36], and presence of tics or tic disorders [37,38]. Additionally, associations with family history of OCD [8,[39][40][41][42], greater OCD severity and functional impairment [16,21,26,32], and suicidal behaviors [43,44] have been reported. ...
... This inventory has 21 items investigating symptoms and attitudes related to depressive disorders, whose intensity varies from 0 to 3 (maximum score: 63). This instrument was used to evaluate the severity of depressive symptoms in the previous week, as a quantitative variable, and also in categories: absent or minimal symptoms (score from 0 to 9), mild (10-18), moderate (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29), and severe symptoms (30-63). 7. Beck Anxiety Inventory-BAI [64]. ...
Background: Obsessive-compulsive disorder (OCD) is a very heterogeneous condition that frequently includes symptoms of the "symmetry dimension" (i.e., obsessions and/or compulsions of symmetry, ordering, repetition, and counting), along with aggressive, sexual/religious, contamination/cleaning, and hoarding dimensions. Methods: This cross-sectional study aimed to investigate the prevalence, severity, and demographic and clinical correlates of the symmetry dimension among 1001 outpatients from the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders. The main assessment instruments used were the Dimensional Yale-Brown Obsessive-Compulsive Scale, the Yale-Brown Obsessive-Compulsive Scale, the USP-Sensory Phenomena Scale, the Beck Depression and Anxiety Inventories, the Brown Assessment of Beliefs Scale, and the Structured Clinical Interview for DSM-IV Axis I Disorders. Chi-square tests, Fisher's exact tests, Student's t-tests, and Mann-Whitney tests were used in the bivariate analyses to compare patients with and without symptoms of the symmetry dimension. Odds ratios (ORs) with confidence intervals and Cohen's D were also calculated as effect size measures. Finally, a logistic regression was performed to control for confounders. Results: The symmetry dimension was highly prevalent (86.8%) in this large clinical sample and, in the logistic regression, it remained associated with earlier onset of obsessive-compulsive symptoms, insidious onset of compulsions, more severe depressive symptoms, and presence of sensory phenomena. Conclusions: A deeper knowledge about specific OCD dimensions is essential for a better understanding and management of this complex and multifaceted disorder.
... Sex differences concerning symptom types have been reported in a large number of studies; however, there is much heterogeneity (Hasler et al., 2005;Karadaĝ et al., 2006;Hunt, 2020). One of the most persistent findings among OCD samples is the increased frequency of contamination and cleaning symptoms observed in females (Mataix-Cols et al., 1999;Denys et al., 2004;T€ ukel et al., 2004;Labad et al., 2008;Li et al., 2009;Masi et al., 2010;Torresan et al., 2013;Cherian et al., 2014). ...
... Similarly, subclinical contamination fears are more frequent in adult females sampled from the general population (Olatunji et al., 2005). Alternatively, males with OCD often present with a higher prevalence of forbidden thoughts (i.e., aggressive, sexual, or religious obsessions) and related checking compulsions (Sobin et al., 1999;Lochner et al., 2004;Labad et al., 2008;Mataix-Cols et al., 2008;Cherian et al., 2014;Hunt, 2020), as well as symptoms related to symmetry and ordering (Leckman et al., 1997;Mataix-Cols et al., 1999;Karadaĝ et al., 2006;Li et al., 2009;Masi et al., 2010). Differences within pediatric samples have also been reported, with males experiencing increased contamination obsessions (Masi et al., 2010). ...
... The most common comorbid conditions reported in OCD include anxiety disorders, mood disorders, impulse-control disorders, and substance use disorders (Ruscio et al., 2010). Higher rates of comorbidity with tics or Tourette's disorder (TD), as well as bipolar disorders and alcohol and substance use disorders, have been repeatedly OBSESSIVE-COMPULSIVE AND RELATED DISORDERS 371 observed in males with OCD (Mataix-Cols et al., 1999;Sobin et al., 1999;Angst et al., 2005;Karadaĝ et al., 2006;Torresan et al., 2013;Torres et al., 2016), whereas higher rates of anxiety disorders, eating disorders, and posttraumatic stress disorders are more prevalent in females (Grabe et al., 2001;Lochner et al., 2004;Angst et al., 2005;Torresan et al., 2013). Females with OCD are more likely to experience comorbid depressive disorders (Karadaĝ et al., 2006;Cherian et al., 2014), though findings have been inconsistent (Torresan et al., 2013). ...
Obsessive-compulsive and related disorders (OCRDs), sometimes referred to as obsessive-compulsive spectrum disorders, cause significant impairment and share similar features across several domains, including clinical course, risk factors, and response to treatment. Generally, individuals meeting criteria for one or more OCRDs present with symptoms focused on preoccupations and repetitive behaviors. Sex differences emerge in the clinical presentation of OCRDs, and the associated. Literature emphasizes the importance of considering sex when investigating causal factors, prognosis, and outcomes of OCRDs. Understanding sex-specific phenotypes can help clinicians and healthcare providers to screen for and recognize relevant symptoms, and to create a more tailored approach for care of males and females. In this chapter, we review sex differences in obsessive-compulsive disorder (OCD), body dysmorphic disorder (BDD), hoarding disorder, trichotillomania (hair-pulling disorder), and excoriation (skin-picking) disorder. Here, we provide an updated review on the sex differences in the prevalence, symptomatology, illness course and prognosis, comorbidity, risk factors, and treatment outcomes associated with OCRDs, and highlight gaps in the current literature on sex differences in these disorders.
... Scrupulosity affects people of different religions. In regard to the Muslim population, a number of cross-sectional studies have assessed the phenomenology of scrupulosity among patients affiliated to this religious tradition (Egrilmez, Gulseren, Gulseren, & Kultur, 1997;Ghassemzadeh et al., 2002;Karadag, Oguzhanoglu, Ozdel, Atesci, & Amuk, 2006;Mahgoub & Abdel-Hafeiz, 1991;Nazar, Haq, & Idrees, 2011;Okasha, Saad, Khalil, el Dawla, & Yehia, 1994;Shooka, al-Haddad, & Raees, 1998). The common religious obsessions among Muslims are as follows: doubt related to the perfectness of compulsory prayer (solah), ablution (wudu), ritualistic bath (ghusl) and blasphemous thoughts e.g. ...
... The basic themes of OCD are similar throughout regions but variations are present in content (Ghassemzadeh et al., 2002;Karadag et al., 2006) where religious and cultural elements play significant roles (Karadag et al., 2006;Okasha et al., 1994). Mahgoub and Abdel-Hafeiz (1991) observed that religious themes dominated OCD presentation among patients in Saudi Arabia as compared to those living in secular countries (Mahgoub & Abdel-Hafeiz, 1991). ...
... The basic themes of OCD are similar throughout regions but variations are present in content (Ghassemzadeh et al., 2002;Karadag et al., 2006) where religious and cultural elements play significant roles (Karadag et al., 2006;Okasha et al., 1994). Mahgoub and Abdel-Hafeiz (1991) observed that religious themes dominated OCD presentation among patients in Saudi Arabia as compared to those living in secular countries (Mahgoub & Abdel-Hafeiz, 1991). ...
Scrupulosity is characterized by an excessive anxiety against sinning and it is found to be common in Muslim societies. Spirituality plays a significant role in its presentation and management. The role of Islamic spirituality is examined by revealing the relevance of Islamic spiritual values e.g. acceptance (rida), patience (sabr), to the therapy. Five cases where these values are integrated into the therapy are described. Limitations on the available evidence are addressed. This study proposes the integration of these spiritual values, supports the use of psychotherapeutic discourse and contributes to the field of healthcare through practical conceptual applications in the therapy.
... In some studies, adult patients with religious obsessions are rated by clinicians as having poorer insight into their symptoms, as well as cognitive distortions such as magical thinking, overinflated sense of responsibility, perfectionism, importance of thoughts, and thought-action fusion related to morality [11][12][13][14]. Additionally, such adults presented with longer durations of illness and higher symptom severity when compared to OCD-affected adults who did not experience religious symptoms [15]. In contrast, other studies did not find differences in OCD symptom severity [16,17], although religious symptoms have been associated with having more obsessions [16]. ...
... One study found that OCD-affected adults with religious symptoms were more likely to seek pastoral counseling, but less likely to seek pharmacological treatment [17], highlighting differences in the types of treatment services obtained (although there was no difference in rates of seeking CBT). Additionally, individuals with religious OCD symptoms reported longer delays in receiving an accurate diagnosis and seeking professional help for their illness [15]. Given the barriers that already face youth with psychiatric difficulties [18,19], discussing religious symptoms, which may feel especially embarrassing or taboo, is presumed to be even more difficult [20]. ...
... We also examined the clinical profiles of youth presenting with and without religious OCD symptoms on characteristics related to OCD (insight, disorder-related impairment), psychiatric comorbidity (internalizing and externalizing disorders), as well as the family (accommodation, family environment) and the parent (parental psychopathology). We hypothesized that presence of religious OCD symptoms would be linked to higher OCD-related impairment, poorer insight, higher comorbidity [11,15,30], lower family accommodation [31], more controlled family interactions, and higher parental psychopathology. Predictions regarding the style of family interactions were drawn from related research into the effects of parenting strategies on mental pollution in OCD [32], and expectations about parental psychopathology were similarly referenced from broader literature in OCD [33]; neither of these hypotheses, however, have been tested specifically for religious OCD symptoms. ...
Background:
Childhood obsessive-compulsive disorder (OCD) is a heterogeneous psychiatric condition, with varied symptom presentations that have been differentially associated with clinical characteristics and treatment response. One OCD symptom cluster of particular interest is religious symptoms, including fears of offending religious figures/objects; patients affected by these symptoms have been characterized as having greater overall OCD severity and poorer treatment response. However, the extant literature primarily examines this symptom subtype within adults, leaving a gap in our understanding of this subtype in youth.
Method:
Consequently, this study examined whether presence of religious symptoms in OCD-affected children and adolescents (N = 215) was associated with greater clinical impairments across OCD symptoms and severity, insight, other psychiatric comorbidity, family variables, or worse treatment response.
Results:
Results found that youth with religious OCD symptoms presented with higher OCD symptom severity and exhibited more symptoms in the aggressive, sexual, somatic, and checking symptom cluster, as well as the symmetry, ordering, counting, and repeating cluster. Religious OCD symptoms were also significantly associated with poorer insight and higher family expressiveness. No differences in treatment response were observed in youths with versus without religious OCD symptoms.
Conclusion:
Ultimately, youths with religious OCD symptoms only differed from their OCD-affected counterparts without religious symptoms on a minority of clinical variables; this suggests they may be more comparable to youths without religious OCD symptoms than would be expected based on the adult OCD literature and highlights the importance of examining these symptoms within a pediatric OCD sample.
... 2 Bunlar kişinin mantığına, görüşlerine, ahlak anlayışına, inançlarına ters düşmekte ve kabul edilememektedir. 2 Kompulsiyonlar (zorlantılar) ise çoğu zaman obsesyonları uzaklaştırmak için yapılan istenç dışı yinelenen hareketler olup obsesyonların yarattığı rahatsızlığı azaltmak için başlamaktadır; ancak zamanla denetlenemez boyuta ulaşmakta ve kişiye rahatsızlık verir. 2 Epidemiyolojik çalışmalar OKB'nin yaygınlığının %1 ile %3 arasında değiştiğini göstermektedir. [3][4][5] Cinsiyete göre görülme sıklığıyla ilgili bulgulara bakıldığında, OKB'nin başlangıç yaşının erkeklerde daha erken olduğu, [6][7][8] kadınlarda kirlenme obsesyonu ve temizlik kompulsiyonunun, erkeklerde ise cinsellik ve dini içerikli obsesyonlar ile kontrol etme kompulsiyonunun daha yaygın olduğu görülmektedir. [8][9][10] OKB'nin kendine özgü, dirençli ve mantıktan uzak doğası, ruh sağlığı uzmanları için OKB'nin anlaşılmasını ve tedavi edilmesini zorlaştırmaktadır. ...
... [3][4][5] Cinsiyete göre görülme sıklığıyla ilgili bulgulara bakıldığında, OKB'nin başlangıç yaşının erkeklerde daha erken olduğu, [6][7][8] kadınlarda kirlenme obsesyonu ve temizlik kompulsiyonunun, erkeklerde ise cinsellik ve dini içerikli obsesyonlar ile kontrol etme kompulsiyonunun daha yaygın olduğu görülmektedir. [8][9][10] OKB'nin kendine özgü, dirençli ve mantıktan uzak doğası, ruh sağlığı uzmanları için OKB'nin anlaşılmasını ve tedavi edilmesini zorlaştırmaktadır. 11,12 OKB tedavi edilmediğinde kronik bir seyir izlemektedir, 13 işlevsellikte ve yaşam kalitesinde ciddi düzeyde bozulmaya yol açmaktadır. ...
Obsesif Kompulsif Bozukluk (OKB) bireyde istenmeyen düşüncelerin (obsesyonlar) ve zaman zaman bunlara eşlik eden istem dışı yineleyici davranışların (kompulsiyonlar) bulunduğu, bireyin işlevselliğini olumsuz yönde etkileyen bir rahatsızlıktır. OKB’nin tedavisinde bilişsel davranışçı terapi müdahalelerinin etkili olduğu bilinmektedir. Son yıllarda da bilişsel davranışçı terapiye alternatif olarak farklı psikoterapötik yaklaşımların OKB üzerindeki etkililiği incelenmektedir. OKB’nin gerek
toplumdaki yaygınlığı, gerekse erken başlangıçlı olması ve bireylerin yaşamında tedavi edilmediğinde kronik bir seyir izlemesi göz önünde bulundurulduğunda psikolojik tedavi yaklaşımlarının önemi belirginleşmektedir. Bu derleme çalışmasında, OKB’nin tedavisindeki güncel yaklaşımlardan olan ve son dönemde yaygınlaşan farkındalık temelli terapilerin, kabul ve kararlılık terapisinin ve metakognitif
terapinin OKB’ye bakış açısına değinilmiş ve etkililik çalışmalarına yer verilmiştir.
... De uma forma geral, existe uma relação positiva entre a POC e a religião. Esta relação foi confirmada por 13 artigos, sendo influenciada por vários fatores, tais como o tipo de obsessões, nomeadamente a escrupulosidade [1,3,10,[12][13][14][15]18], o tipo de religião [6-8, 10, 13, 14, 17], mas também aspetos cognitivos, mais propriamente, o fenómeno de fusão pensamento-ação [7,8,12,17]. Apenas um dos 14 artigos selecionados refere o contrário [14]. ...
... Assim, a religião influencia a sintomatologia da POC [2,6,7,10,13,15], mas a POC também interfere com os hábitos religiosos [1,16]. De facto, quanto mais religioso um indivíduo for maior importância confere ao conteúdo e ao controlo do pensamento e mais obsessões e compul-sões apresenta [6,7]. ...
Introdução: A relação entre perturbação obsessivo-compulsiva e religião tem vindo a ser estudada, quer na perturbação obsessivo-compulsiva com temas de religião quer nas outras formas de expressão da doença. Com este estudo pretendeu-se analisar a forma como as crenças religiosas podem influenciar as obsessões e compulsões de cada paciente, e vice-versa. Métodos: Foi efetuada uma pesquisa na PubMed seguida da aplicação de diversos critérios de acordo com as regras PRISMA para revisão sistemática. Foram selecionados 14 artigos que foram interpretados e relacionados entre si. Resultados: Verificou-se que existe uma estreita relação entre a religião e a perturbação obsessivo-compulsiva, existindo, contudo, um pequeno número de estudos que não confirma esta associação. A relação entre a religião e a perturbação obsessivo-compulsiva pode ser conceptualizada como causa ou como consequência, verificando-se que diferentes tipos de crenças têm diferentes efeitos no pensamento e, por esse meio, influenciam a apresentação clínica da doença. Discussão: Em suma, a perturbação obsessivo-compulsiva é fortemente influenciada pelas crenças religiosas dos pacientes. Futuras investigações poderão ajudar a esclarecer esta interação com vista a melhor compreender e tratar os doentes com elevados níveis de religiosidade.
... Ablution is performed five times daily before prayers, and is invalidated by passing urine or flatus. It is not uncommon for an individual to have doubts about these functions, but many become troubled with obsessional thoughts about cleanliness and compulsions (Karadaĝ et al. 2006) to repeat the ablution. These obsessional doubts may be referred to as abnormal sensations or hallucinations. ...
... Intrusive sensory percept, which is an anal or a penile sensation of something passing out either flatus or a drop of urine or other penile secretions, is often the most distressing symptom of OCD in Muslim patients (Karadaĝ et al. 2006). It could be the main presenting complaint overshadowing other symptoms. ...
Introduction
Religious obsessions and compulsive acts compromise approximately two thirds of all obsessive compulsive disorder symptomatology in Muslim patients. Imam's mosque is consulted before a psychiatrist.
Objectives
To explore the Islamic jurist's views and methods in dealing with obsessions and compulsions.
Aims
Introduction of guidelines for managing OCD in some Muslim patients.
Methods
We began studying the different opinions of scholars in defining obsessive compulsive behaviour focusing on the tight criteria required by the Maliki Jurists to consider the individual being obsessed. This was followed by a thorough review of other Islamic doctrines.
Results
The jurisprudential therapeutic approach includes:
– obsessions are satanic whispers not originating from the self, which is equivalent to “It is not me but my OCD” in modern cognitive behavioural approach;
– diverting attention from the obsessive thought rather than engaging with it;
– not to respond to the obsessional thought (response prevention);
– listing of religious permits;
– focusing attention on acts of worship;
– thought stopping.
At the end we added various jurisprudential rules to be remembered by patients such as certainty does not fade with scepticism, no defiles by doubt, there are no doubts for a man with excessive doubts.
Conclusion
Exposure and response prevention techniques are deeply rooted in Islamic jurisprudence and are practised with conviction by OCD Muslim patients. We produced specific guidelines that could be used by clinical psychologists and other mental health professionals in dealing with OCD patients top ensure their engagement in therapy.
... The frequency of sexual obsessions in clinical populations diagnosed with OCD is reported to be 6% in Saudi Arabia, 10% in Singapore, 10% in Israel, 12% in India, 19-24% in the United, 13-31% in Turkey, 32% in Bahrain, 47% in Egypt [2][3][4][5][6][7][8][9][10][11][12][13][14][15]. ...
... The frequency of sexual obsession was 15% in our clinical populations diagnosed with OCD. In other clinical populations reported to be 13-31% in Turkey, 6% in Saudi Arabia, 10% in Singapore, 10% in Israel, 12% in India, 19-24% in the United, 32% in Bahrain, 47% in Egypt [2][3][4][5][6][7][8][9][10][11][12][13][14][15]. ...
Objective: We compared the childhood trauma, the severityof sexual functions, comorbidity of axis I psychiatricdisorder, the types and severity of obsessive-compulsivedisorder (OCD) and sociodemographic data of patientswith or without sexual obsession in OCD.Methods: Eighty patients of OCD were recruited fromincluding consecutive admissions to an outpatient clinic.Primary OCD patients assessed each subject using theStructured Clinical Interview for DSM-IV Axis I Disorders(SCID-I). OCD symptoms and symptoms severity was assessedby the Yale-Brown Obsessive Compulsive Scale(YBOCS). Traumas were assessed by the ChildhoodTrauma Experiences Questionnaire. Sexual functions severitywas assessed by the Arizona Sexual ExperienceScale (ASEX). Current depressive and anxiety symptomsscore were assessed using the 17-item Hamilton RatingScale for Depression (HAM-D) and the Hamilton AnxietyScale (HAM-A).Results: The frequency of sexual obsession was 15%in our clinical populations diagnosed with OCD. Historyof emotional abuse and incest were associated with asignificantly higher rate of OCD with sexual obsessions.Religious, aggressive, hoarding obsessions and hoardingcompulsions were associated with a significantly higherrate of OCD with sexual obsessions. Comorbidity of Somatoformdisorder was associated with a significantlyhigher rate of OCD with sexual obsessions. Subjects whohave OCD with sexual obsessions did not significantly differfrom those without sexual obsessions on any ASEX scores, Y-BOCS scores, HAM-D, HAM-A and demographicfeatures.Conclusion: Sexual obsessions were related to religious,aggressive, hoarding obsessions and hoarding compulsions,the emotional abuse, incest and a comorbidy ofsomatoform disorder.Key words: sexual obsessions, childhood trauma, comorbidity
... It has been suggested that one of the reasons that could explain the inequalities in the use of services is that clinicians find it difficult to detect the symptoms of OCD in ethnic minorities (Fernández de la Cruz et al., 2014;Williams et al., 2010) due to slight differences in the phenomenological and clinical presentation of OCD in different ethnic groups (Guarnaccia, 1997;Hatch et al. 1996;Karadag, Oguzhanoglu, Ozdel, Atesci, & Amuk, 2006). Specifically, it has been reported that Black Americans may have a later age of onset (31.8 years vs. 19.5 years in the general population; Himle et al., 2008) and a different clinical presentation of the symptoms, such as greater contamination concerns (Wheaton, Berman, Fabricant, & Abramowitz, 2013;Williams, Abramowitz, & Olatunji, 2012;Williams, Turkheimer, Magee, & Guterbock, 2008;Williams, Turkheimer, Schmidt, & Oltmanns, 2005). ...
... Furthermore, it has been suggested that patients from ethnic minorities (mostly individuals from African-American backgrounds) with the most severe form of the disorder, especially those with uncommon symptoms, may be misdiagnosed as psychotic (Hollander & Cohen, 1994;Ninan & Shelton, 1993). It has also been suggested that the expression of OCD and attitudes toward the disorder may be influenced by religious beliefs and concerns, especially when referred to obsessions of religious and sexual nature (Karadag et al., 2006). ...
... These studies have shown that a significant number of participants drank water, washed their mouths or their hands, and engaged in some form of neutralization behaviors to reduce the feelings of dirtiness and anxiety after the non-consensual kiss scenario (Bilekli & Inozu, 2018;Fairbrother et al., 2005;Rachman et al., 2012). Studies on contamination-related OCD have shown that females experienced higher levels of contamination fears and washing compulsions compared to males, but males reported higher levels of sexual and religious obsessions and related compulsions than females (Bogetto et al., 1999;Clark & Inozu, 2014;Karadağ et al., 2006;Torresan et al., 2013;Tükel et al., 2004). Despite the supporting evidence for gender differences in some symptom types of OCD, a limited number of studies have investigated the mental contamination phenomena in males. ...
Mental contamination (MC) is an internal feeling of dirtiness without having any direct contact with a contaminated object/person. Evoking feelings of pollution and a strong urge to wash, MC is related to obsessive-compulsive disorder (OCD). The study examined the associations between individual vulnerability factors such as gender, disgust propensity (DP), fear of self (FOS), and MC using a self-report study (Study 1) and a laboratory induction study (Study 2). In the first study (Study 1), 312 undergraduate students were asked to complete a set of questionnaires to assess their FOS, DP, MC, and fear of contact contamination. In the second study (Study 2), after completing the same questionnaires, 65 female and 46 male undergraduate students listened to a scenario describing a non-consensual kiss and completed the MC report. The results of Study 1 and Study 2 indicated that mental contamination mediated the association between gender, FOS and DP, and contact contamination. The female participants reported higher degrees of mental contamination than the male participants. The model testing indicated that the indirect effects of FOS and DP on the urge to wash, which was mediated by Vancouver Obsessive Compulsive Inventory-Mental Contamination Scale (VOCI-MC) scores, feelings of MC, and negative emotions were statistically significant. The study underlines the importance of gender, FOS, and DP in MC-related factors. Feelings of MC induced by non-consensual kiss scenarios mediated the relationship between individual vulnerability factors and fear of contamination.
... Although we were unable to find previous studies showing links between these "social losses" and OCD, cognitive models suggest that certain life experiences may aggravate OCD symptoms through increased self-blame (Salkovskis, 1985), which could also lead to a faster progression to OCD. Further, the fact that men tend to feel certain emotional states ("sexual frustrations") (DeLecce and Weisfeld, 2016) after romantic breakups, may explain why men, who were already more likely to report sexual obsessions in previous studies Tukel et al., 2004;Karadaĝ et al., 2006;Lensi et al., 1996;Torresan et al., 2009), also describe greater severity of sexual/religious OCD symptoms after termination of romantic relationships (albeit on a trend level). ...
Background
While stressful life events increase the risk of developing a range of psychiatric disorders, including obsessive-compulsive disorder (OCD), their ability to precipitate specific obsessive-compulsive symptom dimensions is unknown. Here we aimed to evaluate the potential role of three different types of stressful life events, herein termed losses (death of a loved one, termination of a romantic relationship and severe illness) in predicting the speed of progression from subclinical to clinical OCD and the severity of specific OCD dimensions in a large multicentre OCD sample.
Methods
Nine hundred and fifty-four OCD outpatients from the Brazilian OCD Research Consortium were included in this study. Several semi-structured and structured instruments were used, including the Structured Clinical Interview for DSM-IV Axis I Disorders, the Yale-Brown Obsessive-Compulsive Scale, the Dimensional Yale-Brown Obsessive-Compulsive Scale, the Brown Assessment of Beliefs Scale, the Beck Depression Inventory, the Beck Anxiety Inventory and the Yale OCD Natural History Questionnaire. Regression models investigated the interaction between types of loss and gender to predict speed of progression from subclinical obsessive-compulsive symptoms to OCD, and the severity of five symptom dimensions.
Results
While termination of a relationship was associated with a faster speed of progression from subthreshold to clinical OCD, the death of a loved one was associated with increased severity of hoarding symptoms. There was also an interaction between gender and experiences of death, which predicted a faster speed of progression to OCD in males.
Conclusions
Stressful life events have the ability to accelerate the progression from subclinical to clinical OCD, as well as impact the severity of specific OCD dimensions. Gender also plays a role in both the progression and severity of symptoms. These findings suggest that stressful life events may represent a marker to identify individuals at risk of progressing to clinical OCD.
... Belirtilerin içeriklerine bakıldığında ise çalışmalar, kadınlarda kirlenme obsesyonları ile temizlik kompulsiyonlarının; erkeklerde ise simetri ve cinsellikle ilgili obsesyonlar ile tekrar ve kontrole ilişkin kompulsiyonların daha fazla olduğunu göstermektedir (ör. Cherian ve ark., 2014;Karadağ, Oğuzhanoğlu, Özdel, Ateşçi, ve Amuk, 2006). Öte yandan agresyon içerikli obsesyonların kadınlarda daha fazla olduğu belirtilen çalışmalara (ör. ...
The symptoms related to Obsessive Compulsive Disorder (OCD) are common in nonclinical population and may lead to significant disabling. Sexuality in relation to OCD has been underemphasized in literature; despite that it is one of the important aspects of quality of life. Although comparative studies indicate that sexual dissatisfaction and dysfunctions are prevalent in OCD patients; the nature of this relationship needs to be highlighted. Therefore, current study aimed to examine the predictive role of not only the OCD symptoms, but also disgust sensitivity and mental contamination on sexual satisfaction among men and women. The sample consisted of 453 volunteer participants having active sexual life (253 female, 200 male) in the age range between 18 and 45 years. For data collection, Padua Inventory-Washington State University Revision (PE-WSUR), Golombok–Rust Sexual Satisfaction Inventory (GRISS), Vancouver Obsessive Compulsive Inventory-Mental Contamination Scale (VOCI-MC), Disgust Sensitivity Scale-Revised Form (DS-R) were used. The results revealed that mental contamination, obsessional thoughts and urges about harm were significantly associated with sexual dissatisfaction both at men and women. In addition, disgust sensitivity was significant predictor of sexual dissatisfaction among women. The findings highlighting the similarity and difference in the relationship between OCD and sexuality between men and women may contribute to future studies and clinical interventions aimed to improve quality of sexual life.
... (Katzman et al., 2014;Simpson, 2017;Subramaniam, Soh, Vaingankar, Picco, & Chong, 2013). The contamination theme with cleaning as compulsion is the commonest OCD type seen in mostly Muslim majority countries (Egrilmez, Gulseren, Gulseren, & Kultur, 1997;Ghassemzadeh et al., 2002;Karadag, Oguzhanoglu, Ozdel, Atesci, & Amuk, 2006;Mahgoub & Abdel-Hafeiz, 1991;Okasha, Saad, Khalil, el Dawla, & Yehia, 1994;Shooka, al-Haddad, & Raees, 1998) that affects quality of life (Subramaniam et al., 2013). ...
Contamination obsession is the commonest subtype of obsessive-compulsive disorder (OCD), and has been found to be higher among Muslim populations. The presentation of clinical OCD is influenced by one’s religious belief, practice, and culture. Islamic rituals that emphasise on cleanliness or ritual purity could explain why the common contents of obsessions/compulsions among Muslim population are contamination and religion. We want to examine whether Islamic Integrated exposure response therapy (IERT) is suitable for mental pollution. We report a 27-year-old Muslim lady with an acute onset of contamination OCD, complicated with secondary depression. Her fear of contamination was strongly related to impurity and pertaining to Islamic rituals. Ten sessions of IERT were conducted. The patient improved clinically and objectively following the IERT. IERT is another variant of treatment mode that can be used to treat OCD, especially with contamination themes.
... We reflect on this below. A reasonable explanation for anxiety and depression contributing to OC cognitions would be that more anxious and depressed patients are prone to having maladaptive cognitive domains (Karadag, Oguzhanoglu, Ozdel, Ateşci, & Amuk, 2006;Shafran, Thordarson, & Rachman, 1996). Because the relationship between religiousness and OCD/OC cognitions was mediated by the severity of anxiety and depression, future studies into this relationship should control for these psychopathological symptoms. ...
Previous studies have suggested that specific features of religion such as religious denomination and level of religiosity might influence the severity of obsessive–compulsive disorder (OCD) and the occurrence of obsessive–compulsive (OC) cognitions, whereas others could not confirm these findings. The purpose of this study was to elucidate the relation between religion, OCD, and the occurrence of OC cognitions in a Dutch sample of OCD patients. Data were drawn from the baseline assessment of the Netherlands Obsessive Compulsive Disorder Association (NOCDA; Schuurmans et al., 2012) study, which is an ongoing, multicenter, 6-year, longitudinal naturalistic cohort study examining the course of OCD. Participants were 377 outpatients, age 18 years and over, with a lifetime diagnosis of OCD. Neither being religious nor religiosity critically influenced the severity of OCD or the occurrence of OC cognitions. Roman Catholic patients scored significantly higher on anxiety and depression than nonreligious patients, and Roman Catholic patients endorsed significantly more OC cognitions than nonreligious and Protestant patients. These ratings of OC cognitions were not mediated by religious denomination or level of religiosity, but by severity of anxiety and depression, as well as age. The relationship between religious denomination, level of religiosity, and clinical aspects of OCD, which have been described before in the literature, may be spurious and mediated by comorbid psychiatric symptoms, such as anxiety and depression.
... While the data on religious OCD is scant in this age group, it is reported to be relatively predominant in societies that are religious (Ciarrocchi, 1995) e.g., conservative Muslim countries and missionary schools (Greenberg, Witztum, & Pisante, 1987;Mullick & Goodman, 2005). In a few phenomenological studies which were conducted in some Muslim countries around the world, about 11-50% of subjects were reported to experience religious OCD (Eg rilmez, Gülseren, Gülseren, & Kültür, 1997;Ghassemzadeh et al., 2002;Karadaĝ, Oguzhanoglu, Özdel, Ateşci, & Amuk, 2006;Mahgoub & Abdel-Hafeiz, 1991;Nazar & Idrees, 2011;Okasha, Saad, Khalil, El Dawla, & Yehia, 1994;Shooka, Al-Haddad, & Raees, 1998). In addition, religious OCD has been shown by some studies to have a poorer treatment outcome (Rufer, Grothusen, Maß, Peter, & Hand, 2005). ...
Religious obsessive-compulsive disorder (OCD) is relatively under-reported among adolescent and carries poorer outcome. We report a 20-year-old Muslim man who was diagnosed with religious OCD when he was 14 years old. He had recurrent blasphemous intrusive thoughts upon performing religious rituals which had hindered him from practising his religion. Despite being on tablet esticalopram 10 mg and conventional cognitive–behavioural therapy, the result was to no avail. A religious-integrated therapy was introduced by incorporating some of the Islamic values, knowledge, and practice during the exposure and response prevention therapy for five consecutive days along with cognitive restructuring. A considerable amount of symptom and functional relief was achieved. He excelled in his studies and equally important was able to resume practising his religion. Religious-integrated therapy is an untapped area that should be offered as the treatment option in certain cases where religion plays an important role in illness’s phenomenology and patient’s coping.
... Cohen and Rozin (2001) proposed that one of the determinants of the moral status assigned to mental events is religion, and doctrinal differences between different religions may influence how individuals evaluate and respond to different types of mental events. For instance, Christianity, attaches higher significance on thoughts and intentions (Favier, O'Brien, & Ingersoll, 2000;Sica et al., 2002;Siev & Cohen, 2007), differs from Islam, which is primarily concerned with religious practice as indicated by many predefined behavioral requisites and rituals (Ghassemzadeh et al., 2002;Karadağ, Oğuzhanoğlu, Özdel, Ateşçi, & Amuk, 2006;Okasha, 2002;Siev & Cohen, 2007). Therefore, in the present study we aimed to examine the relationship between disgust propensity and contamination-related symptoms in terms of Islamic scrupulosity. ...
Background and objectives The present study investigated the role of scrupulosity, a rigid religious understanding characterized by fear of God and sinning, in the relationship between disgust and contamination-related OCD in a Muslim sample. Method The sample was composed of 209 university students. After an initial screening study, the high (N = 33) and low scrupulous (N = 29) groups were formed. After filling out a self-report questionnaire battery consisting of measures of disgust propensity, obsessive beliefs, and contamination-related cognitions and symptoms, participants were randomly assigned to view either 10 highly disgusting or neutral pictures while imagining themselves in the situation depicted in the picture. After the manipulation, they rated the unpleasantness of the image, emotions, urge to wash and avoid, and also their mood. In the last phase, participants performed a fear provocation task. Results The results indicated that the intensity of disgusting stimuli was positively associated with contamination-related ratings. As expected, high scrupulous participants showed higher disgust propensity and contamination-related symptoms after exposure to the disgust inducing pictures and the fear provocation task. Conclusions High disgust propensity may be a vulnerability factor for contamination based OCD symptoms in highly scrupulous Muslims.
... I risultati mostrano una maggiore presenza dei sintomi OC nei partecipanti musulmani. Una possibile spiegazione risiede nella componente ritualistica (e.g., preghiere, abluzioni) che caratterizza l'Islam (Karadaĝ et al., 2006). L'appartenere al gruppo islamico sembra spiegare anche la maggior presenza di credenze OC. ...
Negli ultimi vent’anni è cresciuto l’interesse per le caratteristiche cliniche del disturbo ossessivo-compulsivo (DOC) nelle varie appartenenze religiose. Nel contesto italiano l’argomento appare poco studiato nonostante il continuo aumento del fenomeno dell’immigrazione che contribuisce a rendere l’Italia un paese sempre più multietnico e multireligioso. La conoscenza delle caratteristiche cliniche e dei fattori di vulnerabilità associati alla sintomatologia DOC nelle diverse appartenenze religiose può fornire informazioni utili in un’ottica di implementazione di strategie di prevenzione primaria e secondaria nei servizi. Il presente studio ha indagato le differenze nelle credenze ossessive e nella sintomatologia DOC tra soggetti di religione ebraica, cristiana e islamica. Inoltre, è stato indagato se le differenze sugli aspetti ossessivo-compulsivi potessero essere moderate dal livello di religiosità. Hanno partecipato 354 soggetti appartenenti alla popolazione generale italiana, tra i quali 97 Ebrei, 139 Cristiani, 118 Musulmani, che hanno compilato l’Obsessive Beliefs Questionnaire-87, l’Interpretation of Intrusions Inventory, il Padua Inventory, il Beck Anxiety Inventory e il Beck Depression Inventory-II. Il gruppo di religione islamica ha riportato sintomatologia e credenze ossessivo-compulsive significativamente più elevate rispetto agli altri due, anche quando è stato controllato l’effetto di ansia e depressione. Il livello di religiosità non è risultato essere un moderatore di tale relazione, né è risultato associato a credenze e sintomi DOC. Si discutono possibili interpretazioni teoriche, implicazioni cliniche e prospettive per studi futuri.
... Given doctrinal differences between Christianity and Islam, we might expect differences in how scrupulosity is expressed among the devout in these two religions. Christianity, which places higher value on individual conscience and maintaining certain beliefs (Favier, O'Brien & Ingersoll, 2000;Sica et al., 2002;Siev & Cohen, 2007), differs from Islam which is more ritualistic, having many predefined behavioral requisites, rules and rituals for adherents to follow (Ghassemzadeh, Mojtabai, Khamseh, Ebrahimkhani, Issazadegan et al., 2002;Karadağ, Oğuzhanoğlu, Özdel, Ateşçi, Amuk, 2006;Okasha, 2002;Siev & Cohen, 2007 ...
Objective:
The Penn Inventory of Scrupulosity (PIOS) was developed by Abramowitz and his colleagues (2002) to evaluate the severity of scrupulosity symptoms as a dimension of Obsessive Compulsive Disorder (OCD). The aim of the present study was to adapt the PIOS into the Turkish and evaluate its psychometric properties in a university student sample.
Method:
The sample of the present study was composed of 444 undergraduate university students whose age ranged between 18-25 years old. All participants were asked to complete a battery of self-report measures including the PIOS, Beck Depression inventory, Beck Anxiety Inventory, Clark-Beck Obsessive Compulsive Inventory and Penn State Worry Inventory. Following a period of approximately 4 weeks a sub-sample of the participants were asked to complete the questionnaires for the second time.
Results:
Consistent with the findings of the original study (Abromowitz et al., 2002), explanatory and confirmatory factor analyses supported the two-dimensional structure of the Turkish version of the PIOS. However, distribution of the items on the two factors showed some cultural differences that might be specific to our culture. The results revealed acceptable test-retest and internal consistency coefficients, and also good construct, convergent, discriminant, and criterion validity information for the Turkish version of the PIOS, which can be utilized in the Turkish culture in order to evaluate individual differences in terms of scrupulosity symptoms.
Conclusion:
The results of the present study indicated a good reliability and validity information for the Turkish version of the PIOS, supporting the cross-cultural nature of the scale.
... Excessive, ritualised, time consuming checking rituals and related obsessions are frequently experienced by people with this condition (e.g., Fullana et al., 2009;Samuels et al., 2006); they occur in approximately 80% of patients Rasmussen & Tsuang, 1986;Summerfeldt, Antony, Downie, Richter, & Swinson, 1997). Obsessions about contamination and washing/cleaning compulsions are also common features of this disorder (de Silva, 2003;Karadag, Oguzhanoglu, Ozdel, Atesci, & Amuk, 2006;. ...
Obsessive–compulsive disorder (OCD) is a relatively common condition in children and adolescents, and is associated with significant lifetime impairment. Despite the recognised need for early identification and treatment of this disorder, the clinical progression of effective intervention for child and adolescent OCD has been hampered by limited treatment accessibility. This article gives an overview of "OCD? Not Me!", a fully online OCD treatment program for young people aged 12-18 years, recently developed by researchers at Curtin University.
... In OCD, for example, it has been described that Black Americans may have a later age of onset than their White counterparts [52] and a different clinical presentation of the symptoms, such as greater contamination concerns, [53,54] although this finding is not consistent across studies [55]. It has also been suggested that the expression of OCD and attitudes toward the disorder may be influenced by religious beliefs and concerns [56]. Williams, Brown, and Sawyer [57] investigated hoarding symptoms in a sample of 75 African American adults with OCD (N = 75). ...
Hoarding Disorder (HD) is characterized by difficulty discarding and parting with possessions, resulting in the accumulation of belongings that congest and clutter active living areas and compromises their use. While HD is thought to be a universal phenomenon, the phenomenological, epidemiological, and clinical research studies published to date have mainly been conducted in Western, industrialized countries, precluding conclusions about the prevalence and phenomenological differences that may exist across cultures in the expression of HD. A systematic review of treatment studies in HD, revealed that all have been carried out in the US and have included a large majority (about 90%) of White/Caucasian individuals, making it difficult to ascertain whether existing treatments are equally effective for minority groups. There is a need to consider HD from a transcultural perspective in order to understand the expression of this disorder across different cultures and ethnic groups. We highlight areas of priority for future studies to ensure that the conception of hoarding and its study is inclusive, sensitive, and informative.
... The explanation given by the authors was that in the Muslim culture doubts or intrusive thoughts about religious practices and beliefs are often accepted as waswas, a word that refers to the temptation by evil forces as a test for faithfulness (Yorulmaz et al., 2009). Moreover, Islam is a very ritualistic religion that requires prayer ablution, ritualistic cleaning process in a specific fixed order and a specific number of times, and according to which those who do not respect rituals are considered spiritually unclean and this impure condition is punishable by God in every way, and brings bad luck (Karadaĝ, Oguzhanoglu, Özdel, Ateşci, & Amuk, 2006). However, in contrast with Yorulmaz and colleagues (2009), who showed that Muslims had more severe cognitions only on the importance/ control of thoughts domain, we found that they endorsed more dysfunctional beliefs on all the obsessive domains. ...
Growing interest has been dedicated by researchers on obsessive-compulsive disorder across different religious affiliations. Increasing migration in Italy is making the country progressively multi-religious but is a relatively new phenomenon, consequently this research area is still young. The present study aimed at examining differences on obsessive-compulsive (OC) cognitions and symptoms between Jews, Christians and Muslims living in Italy. Another purpose was to investigate whether potential differences on these OC features between groups could be moderated by the level of religiosity. Three hundred and fifty-four non-clinical individuals, including Jews (n=97), Christians (n=139) and Muslims (n=118) completed the OBQ-87, the III, the PI, the BAI, and the BDI-II. After controlling for anxiety and depression, Muslims had more severe OC symptoms and cognitions compared to Jews and Christians. Conversely, the level of religiosity did not appear to be significantly associated with OC symptoms and cognitions severity. Theoretical explanations and clinical implications are discussed.
... Laientheorien behaupten oft, dass Türken stärker "somatisieren". Tatsächlich konnte Özelsel (1990) (Karadağ, Oğuzhanoğlu, Özdel & Ateşçi, 2006;Glier, Tietz & Rodewig, 1998 (Siegrist, 1995). Buchard (1998) Dabei unterscheiden Berry (1997aBerry ( , 2005Berry ( , 2007 und Berry et al. (2002) (Berry, 1988). ...
Untersucht wurde der Zusammenhang zwischen körperlichen sowie psychischen Beschwerden und kulturellen Wertvorstellungen, Akkulturationsorientierungen, Kompetenz- und Kontrollüberzeugungen, Vertrauen in direkte Bezugspersonen und Hoffnungslosigkeit bei 172 türkischstämmigen Menschen in Deutschland im Alter von 16 bis 73 Jahren. Die deutschen Erhebungsinstrumente wurden mit Ausnahme eines Fragebogens, der bereits in türkischer Sprache vorlag, von der Autorin und einer staatlich anerkannten Dolmetscherin in die türkische Sprache übersetzt. Für die deutschen und türkischen Messinstrumente wurden anschließend Item- und Skalenanalysen durchgeführt, um sie hinsichtlich ihrer psychometrischen Tauglichkeit zu überprüfen. Weiterhin wurde die türkischstämmige Gesamtstichprobe in eine türkisch orientierte und eine deutsch orientierte Subgruppe unterteilt, zwischen denen einige Mittelwertsvergleiche berechnet wurden, um einerseits inhaltlich relevante Unterschiede explorativ zu erforschen und um andererseits zu überprüfen, ob die Variablen Nationalität, Sprache oder Geburtsort für die stärkere Symptomausprägung bei in Deutschland lebenden Türken entscheidend sind.
... Obsesif Kompülsif Bozukluk'ta (OKB), heterojen yapısından dolayı homojen bir sınıflandırma yapılamamıştır. Reaktif/otojen, epizodik/kronik, başlama yaşı, cinsiyet, eştanı, belirti farklılıkları, içgörü, genetik ve fenotipik özellikler kullanılarak homojen bir sınıflandırma yapılmaya çalışılmıştır [1][2][3][4][5][6] Yazında kadınlarda en sık eşlik eden psikiyatrik eştanılar majör depresyon, yeme bozuklukları, dürtü kontrol bozuklukları iken, erkeklerde sosyal fobi, tik bozuklukları, madde kullanım bozukluklarıydı 9,11,[13][14][15][16][17]19 . Yaptığımız araştırmada ise cinsiyetler arasında psikiyatrik eştanı açısından istatistiksel olarak anlamlı bir farklılık bulunamamıştır. ...
Purpose: A homogenous classification cannot be obtained because of Obsessive Compulsive Disorder’s (OCD) heterogeneous structure. The present study aimed to determine the relation of gender related differences with clinical features, symptom dimensions, age of onset, comorbidity in OCD patients. As distinct from the other studies we also aimed to evaluate the difference of Yale-Brown Obsessive Compulsive Scale’s (Y-BOCS) subscales (insight, avoidance, pathologic doubt and pathologic responsibility, instability, retardation) between male and female patients with OCD. Method: The present study comprised of 198 patients aged between 15 and 65 years, who met the OCD criteria of DSM-IV-TR. Detailed data on clinical and sociodemographic characteristics were recorded. The patients were divided into two groups; male (n=65) and female (n=133). The patients underwent Structured Clinical Interview for DSM-IV Inventory (SCID-I), Yale- Brown Obsessive Compulsive Scale and Check List, Beck Anxiety Inventory, Beck Depression Inventory. Scores of these inventories were statistically compared. Results: There were no statistically significant differences in mean age, marital status, education level, family history, social support, hospitalization and suicidal attempt history between the two groups. We found a high treatment seeking, earlier age onset of obsessive-compulsive (OC) symptoms and disorder in males. We did not find any symptom differences except sexual obsession and repeating compulsion between male and female patients with OCD. We also found high BAI and BDI scores in females. We did not find statistically significant differences in the proportion of comorbid psychiatric disorders and the subscales of Y-BOCS between genders. Conclusion: The present study suggests that age of onset, treatment seeking, anxiety, depression level, and some OC symptoms are different between male and female patients and gender may be used for the classification of the OCD.
... Although, as already mentioned, rates of OCD across ethnicities may be similar, some reports, specifically focused in the Black minorities, suggest that their clinical presentation might be slightly different. [26][27][28] Himle et al 6 found that Black Americans were more likely to have a later age at onset (31.8 years v. 19.5 years in the general population). They also found that once Black patients met criteria for OCD, they were very unlikely to experience remission, partly because of the limited access to state-of-the-art treatments. ...
Background
Obsessive–compulsive disorder (OCD) has similar prevalence rates across ethnic groups. However, ethnic minorities are underrepresented in clinical trials of OCD. It is unclear whether this is also the case in clinical services.
Aims
To explore whether ethnic minorities with OCD are underrepresented in secondary and tertiary mental health services in the South London and Maudsley (SLaM) NHS Foundation Trust.
Method
The ethnic distribution of patients with OCD seen between 1999 and 2013 in SLaM (n = 1528) was compared with that of the general population in the catchment area using census data. A cohort of patients with depression (n = 22 716) was used for comparative purposes.
Results
Ethnic minorities with OCD were severely underrepresented across services (−57%, 95% CI −62% to −52%). The magnitude of the observed inequalities was significantly more pronounced than in depression (−29%, 95% CI −31% to −27%).
Conclusions
There is a clear need to understand the reasons behind such ethnic inequalities and implement measures to reduce them.
... ausing a sexual dimorphism (physical difference), which could possibly explain the higher level of cleaning and contamination concerns (Labad et al., 2008). The authors also mentioned that environmental differences could mediate the differences found, such as females being socialized to do a greater share of the domestic work such as housecleaning. et al.,2006; Himle et al., 2008; Ruscio et al., 2010; Reddy et al., 2005). The majority of participants in the study by Jaisoorya et al. were men, a phenomenon also noted in Girishchandra and Sumant (2001). Historically, in Western samples, there has been no difference in help-seeking between men and women with OCD (Goodwin et al., 2002; Torres et a ...
Background: The study and understanding of symptom presentation in Obsessive-Compulsive Disorder (OCD), has become increasingly important in the scientific literature. Through circumnavigation of the globe, this article details differences in OCD between Western, Middle Eastern, Jewish, Hispanic, Asian, and other cultures. Methods: The review involved a systematic search of research literature published from samples in several different countries of markedly different cultural backgrounds. Critical summaries and analyses were taken of featured texts and compiled to illustrate differences and similarities in symptom presentation cross-culturally. Results: There were a number of noticeable differences between cultures in terms of symptom expression, obsessive cognitions, cultural influences on behavior, ritualistic beliefs, and other issues. Differences included symptoms surrounding thought control, the relationship between beliefs, and cleaning and checking compulsions. Studies conducted in highly religious cultures emphasized purity, cleanliness, and religion as well as thought control, morality, and sexuality. Differences in lifetime prevalence of OCD were also found to vary from country to country from 0.30%-2.7%. Conclusion: Evidence suggests that a culturally-informed approach may be needed to best understand the relationship between culture and OCD. Future research is needed to further explain and understand differences between cultures.
... For example, more females than males will present with co-morbid anxiety, eating disorders, and depression (Labad et al. 2008;Lochner et al. 2004). Moreover, females are twice as likely to have contamination-centered obsessions (Labad et al. 2008), whereas sexual obsessions are more associated with males (Karadaĝ et al. 2006). Therefore, future studies must take into account these factors when investigating genetic association. ...
The serotonin transporter polymorphism has been implicated in obsessive-compulsive disorder (OCD). However, molecular genetic association studies have yielded inconsistent results. Variation may be due to lack of OCD subtype classification. The goal of this systematic review is to investigate the association of the S-allele of the serotonin transporter polymorphism with OCD and OCD subtypes. A total of 69 studies were initially found through a systematic search of the literature but only 13 with sufficient information to compute odds ratios were suitable for review. A total of 1991 participants with OCD and their 5-HTTLPR allele status were examined. The primary outcome measures were allele frequency and OCD diagnosis. A full meta-analysis was completed comparing the L- and S-alleles using a random effects model in RevMan 5.2.1. Further, a secondary meta-analysis stratified by sex and late-onset was conducted for S- versus L-allele frequency. In the primary meta-analysis, OCD was not associated with the S-allele of the 5-HTTLPR polymorphism (Z = 0.07, p = 0.94). Moreover, late-onset OCD was not associated with the S-allele (Z = 1.45, p = 0.15). However, when stratified by sex, there is an emerging sex-specific relationship. There was a trending association between the S-allele and OCD status in females (Z = 1.62, p = 0.10) but not in males (Z = 0.69, p = 0.49). The findings provide further support for the need of subtype classification of this heterogeneous disorder. Future studies should clearly examine sex differences and OCD age-of-onset. In particular, emphasis should be placed on the effect of female reproductive milestones on OCD onset and symptom exacerbation.
... This may be due to the emphasis on cleanliness and ritual purity, and where the sexual matters can be issues of prohibition, sin and shame (43,44). Studies of Turkish patients with OCD indicated that religious obsessions are present 11-42 % of patients, and its prevalence showed a tendency to increase eastward, reflecting the more conservative and more religious society in the East (45)(46)(47)(48). There is also a possible influence of the concept of spiritual purity on OCD phenomenology (49). ...
Psychopathology and depression in the Middle East Psychotherapy methods are mostly constructed by the Western societies and thus they might fail to address the social and cultural differences of other, non-Western societies. Different social and cultural factors account for the development of different norms in non-Western countries. Psychiatrists should take into account that there are different signs of psychological wellness and psychopathology in non-Western societies. Such social and cultural differences are considered to be underlying factors of different forms of psychopathologies that are predominantly observed in clinical settings among the Middle Eastern patients. Therefore, psychiatrists should consider administering the most appropriate therapeutic techniques based on such social and cultural differences. Authors also discuss the impact of medicalization of human suffering, reification of illness categories, and loss of moral meaning of being.
Bu çalışma OKB ile erken dönem uyum bozucu şemalar arasındaki ilişkiyi incelemek amacınıtaşımaktadır. Obsesif Kompulsif Bozukluk, bireylerin yaşamında sıkıntıya yol açan, yeti kaybınaneden olan, obsesyon ve kompulsiyonların genellikle birlikte gözlemlendiği fakat teşhis koymakiçin birinin varlığının yeterli olduğu bir beyin hastalığıdır. OKB'nin temelinde yatan etiyolojikfaktörlerin anlaşılması, kapsamlı bir değerlendirmenin ve bilişsel temelli bir yaklaşımınbenimsenmesinin gerekliliğini ortaya koymaktadır. Bu bağlamda, OKB'nin bilişsel kökenlerineodaklanan bir perspektif, erken dönem uyum bozucu şemaların rolüne dikkat çekmektedir. Erkendönem uyum bozucu şemalar, çocukluk dönemindeki olumsuz deneyimlere dayanan ve bireyinbilişsel ve duygusal işleyişini etkileyerek OKB semptomlarının gelişimine katkıda bulunan temelinançlar olarak ön plana çıkmaktadır. Litereatürde ulaşılan kaynaklar çerçevesinde, ObsesifKompulsif Bozukluk ile erken dönem uyum bozucu şemaların ve şema modlarının birbiriyle ilişkiliolduğu açıkça anlaşılmaktadır. Çalışmanın önerdiği bireyselleştirilmiş tedavi stratejileri, şematerapisi entegrasyonu, erken dönem müdahale ve destek grupları gibi önerilerin uygulanması, OKBile erken dönem uyum bozucu şemalar arasındaki ilişkinin daha etkili bir şekilde yönetilmesinekatkı sağlayabilir.
The degree of religiosity, a culturally relevant concept, has been associated with obsessive phenomena such as obsessional symptoms, the nature of unwanted intrusive thoughts, and responses to intrusive thoughts. Although previous research reported that repugnant (i.e., sexual and religious) intrusions had the lowest endorsement rates, these were also the most difficult to control and more likely to turn into obsessions. Highly religious individuals are more likely to be distressed by repugnant intrusions as the repugnant nature of intrusive thoughts critically threatens the perceived self. Thus, individuals with high religiosity may be more likely to respond to repugnant intrusions with dysfunctional strategies and thus become more vulnerable to OCD. This study presents the endorsement rates and qualitative features of sexual and religious intrusions among highly religious Canadian and Turkish samples. Highly religious participants were interviewed using the International Intrusive Thoughts Interview Schedule (IITIS). Thematic content analysis of the IITIS data was conducted with MAXQDA. Sexual intrusion themes of Forceful Sex, Gay Sex, Immoral Sex, and Sex with Undesirable People were identified in both samples. Religious intrusion themes of Questioning, How They Are Perceived by God, Violating Religious Doctrines, Punishment by God, and Worship also emerged in both samples. The percentages of these themes suggested the presence of cross-cultural qualitative similarities and differences.
Amaç: Obsesif-kompülsif bozukluğun ruminasyon ve temizlik boyutlarındaki bilişsel hata düzeyleri farklıdır. Bu çalışmada obsesif-kompülsif bozukluk-ruminasyon ve obsesif-kompülsif bozukluk-temizlik gruplarında ilaç tedavisine ek olarak uygulanan bilişsel davranışçı tedavinin bilişsel hatalar üzerine etkisi incelendi.Gereç ve Yöntemler: Çalışmaya toplamda 31 hasta (obsesif-kompülsif bozukluk-ruminasyon grubu=15; obsesif-kompülsif bozukluk-temizlik=16) dâhil edildi. Bu ileriye yönelik çalışmada obsesif-kompülsif bozukluk tanısı DSM-5’e göre konuldu. Alt boyutlar klinik ve Maudsley Obsesif Kompülsif Soru Listesinin birlikte değerlendirilmesiyle belirlendi. Bilişsel hatalar düşünce özellikleri ölçeği ile, hastanın genel durumu global değerlendirme ölçeği ile değerlendirildi. Bilişsel davranışçı tedavi seansları 3-10 gün arasındaki sıklıklarda ve toplamda sekiz seans olarak gerçekleştirildi. Maudsley Obsesif Kompülsif Soru Listesi sadece tedavi başlangıcında, düşünce özellikleri ölçeği ve global değerlendirme ölçeği hem tedavi başlangıcında hem de sekiz haftalık tedavi sonrasında uygulandı.Bulgular: Gruplar yaş ve eğitim durumu açısından benzerdi (sırasıyla p=0.345, p=0.258). Tedavi öncesinde gruplar arasında düşünce özellikleri ölçeği-IP (sosyal ilişki) açısından anlamlı farklılık vardı (p=0.025) ve bu anlamlı farklılık tedavi sonrasında da devam etti (p=0.012). Obsesif-kompülsif bozukluk-ruminasyon grubu düşünce özellikleri ölçeği-IP (p<0.001) ve düşünce özellikleri ölçeği-PA (kişisel başarı) (p=0.043) açısından bilişsel davranışçı tedaviden anlamlı olarak etkilenmişti. Obsesif-kompülsif bozukluk-temizlik grubu ise sadece düşünce özellikleri ölçeği-IP açısından bilişsel davranışçı tedaviden etkilenmişti (p=0.001).Sonuç: Bu çalışmanın en önemli sonucu bilişsel davranışçı tedavinin sosyal ilişkilerdeki bilişsel hataları kişisel başarılardaki bilişsel hatalara göre daha fazla azaltmasıdır. Ayrıca, bireysel başarı ile ilişkili bilişsel hatalar ruminasyon alt boyutunda bilişsel davranışçı tedavi ile azalırken, temizlik alt boyutunda etkilenmemektedir.
Background and objectives
The study examines the nature of OCD-related unwanted mental intrusions (UMIs) by comparing OCD, anxiety disorders (AD), and healthy control (HC) groups.
Methods
The patients with OCD (n = 50), AD (n = 59), and HC (n = 50) completed a semi-structured interview assessing UMIs, and a set of questionnaires.
Results
Our results provided evidence for the cognitive content specificity of OCD-related unwanted mental intrusions (UMIs) and appraisals. Two patient groups and non-clinical participants reported at least one OCD-related UMI and the groups did not differ from each other in terms of the forms and triggers of UMIS. However, the intrusions were more distressing and persistent in the OCD patients. The patients with OCD placed higher importance on getting UMIs out of their minds and reported higher difficulty in controlling them compared to the other two control groups. Furthermore, control appraisals showed higher relevance to the distressing features of the intrusions.
Conclusions
The results underlined the specificity of obsessive cognitive content and the importance of thought control-related appraisal in defining the distressful features of the mental intrusions seen in OCD. The results were discussed in light of the cognitive specificity model.
In this article, we argue that the cultural models approach provides a useful framework for cultural‐clinical psychology. We begin with a brief review of this approach before presenting the distinction between cultural models for normalcy and deviancy. As well, we consider how both normalcy and deviancy can be culturally valorised or devalorised. Given that mental disorders do not always neatly fit with available cultural models, we offer evidence‐based examples of unscripted as well as scripted distress. We conclude by considering key hypothesis‐generating questions and some methodological approaches that could be used to improve and extend the evidence base underpinning the cultural models approach as applied to the study of culture and mental health.
Obsessive-compulsive disorder (OCD) is a chronic, debilitating, and heterogeneous condition that affects 2–3% of the general population. Previous studies have suggested that sex plays a role in OCD phenotypic expression. This chapter aims to review the literature regarding OCD in women, exploring sex differences in (1) the prevalence of OCD/subclinical OCD in nonclinical populations; (2) age of onset, clinical course, and severity and impact of OCD symptoms; (3) onset or aggravation of OCD symptoms among women according to the time point in the reproductive cycle; (4) OCD symptom contents; (5) psychiatric comorbidity; and (6) treatment-seeking behavior and treatment response. Studies report either a slight female predominance or a similar prevalence of OCD in adults from the general population. Women are more likely than men to be married, to present later onset, and to report preceding stressful life events. Onset or worsening of OCD symptoms during pregnancy and postpartum are frequently described. Women are more likely to present contamination obsessions and/or cleaning rituals and comorbid eating and impulse-control disorders. Several interacting mechanisms are probably responsible for mediating the effects of sex/gender in the biological and psychosocial risk factors for OCD. Sex is a relevant factor that should be taken into account when evaluating OCD patients, but more studies are necessary to determine whether or not it defines a valid OCD subtype.
Background/Objective
Unwanted mental intrusions (UMIs), typically discussed in relation to Obsessive-Compulsive Disorder (OCD), are highly prevalent, regardless of the specific nationality, religion, and/or cultural context. Studies have also shown that UMIs related to Body Dysmorphic Disorder (BDD), Illness anxiety/Hypochondriasis (IA-H), and Eating Disorders (EDs) are commonly experienced. However, the influence of culture on these UMIs and their transdiagnostic nature has not been investigated.
Method
Participants were 1,473 non-clinical individuals from seven countries in Europe, the Middle-East, and South America. All the subjects completed the Questionnaire of Unpleasant Intrusive Thoughts, which assesses the occurrence and discomfort of four UMI contents related to OCD, BDD, IA-H, and EDs, and symptom questionnaires on the four disorders.
Results
Overall, 64% of the total sample reported having experienced the four UMIs. The EDs intrusions were the most frequently experienced, whereas hypochondriacal intrusions were the least frequent but the most disturbing. All the UMIs were significantly related to each other in frequency and disturbance, and all of them were associated with clinical measures of OCD, BDD, IA-H, and EDs.
Conclusions
UMIs are a common phenomenon across different cultural contexts and operate transdiagnostically across clinically different disorders.
Objective:
The aim of this review is to summarize the current knowledge of associated features of co-occurring obsessive-compulsive disorder (OCD) and tic disorders (TD) and to critically evaluate hypotheses regarding the nature of their comorbidity.
Method:
We conducted a systematic review following PRISMA guidelines. To this aim, the PubMed, PsychInfo and ISI Web of Knowledge databases were searched up to August 30, 2018. For gender and age-of-onset we additionally conducted meta-analyses.
Results:
One hundred eighty-nine studies met inclusion criteria. We substantiate some acknowledged features and report evidence for differential biological mechanisms and treatment response. In general, studies were of limited methodological quality.
Conclusions:
Several specific features are reliable associated with co-occurring OCD + TD. The field lacks methodological sound studies. The review found evidence against and in favor for different hypotheses regarding the nature of comorbidity of OCD and TD. This could indicate the existence of a stepwise model of co-morbidity, or could be an artefact of the low methodological quality of studies.
Background and objectives:
Mental contamination, which occurs in the absence of contact with a contaminant, has a moral element. Previous studies evoked feelings of mental contamination via listening to a scenario, which described a non-consensual kiss. Since mental contamination has a moral element, we tested the effects of the level of religiosity on feelings of mental contamination and related variables in an experimental design.
Methods:
Female undergraduates of high religiosity (n = 48) and low religiosity (n = 44) were randomly assigned to listen to one of two audio recordings involving a consensual or non-consensual kiss from a man described as moral.
Results:
Mental contamination feelings were evoked successfully in both groups. Effects of scenario condition and religiosity level were seen in mental contamination and related negative feelings. Participants who imagined a non-consensual kiss reported greatest feelings of mental contamination, and internal and external negative feelings. More importantly, high religiosity resulted in greater feelings of mental contamination, internal negative feelings, as well as urges to wash and actual washing behaviors.
Limitations:
The current study was conducted on non-clinical Muslim females. This limits the generalization of the findings to the wider population.
Conclusions:
Mental contamination and related feelings can be seen in different forms at different levels of religiosity.
Objective:
Despite the frequent occurrence of depressive symptoms in obsessive-compulsive disorder (OCD), little is known about the reciprocal influence between depressive and obsessive-compulsive symptoms during the course of the disease. The aim of the present study is to investigate the longitudinal relationship between obsessive-compulsive and depressive symptoms in OCD patients.
Method:
We used the baseline and 1-year follow-up data of the Netherlands Obsessive Compulsive Disorder Association (NOCDA) study. In 276 patients with a lifetime diagnosis of obsessive-compulsive disorder, depressive and obsessive-compulsive symptoms were assessed at baseline and at one-year follow-up with the Beck Depression Inventory (BDI) and the Yale-Brown Obsessive Compulsive Symptom (Y-BOCS) scale. Relations were investigated using a cross-lagged panel design.
Results:
The association between the severity of depressive symptoms at baseline and obsessive-compulsive symptoms at follow-up was significant (β=0.244, p<0.001), while the association between the severity of obsessive-compulsive symptoms at baseline and depressive symptoms at follow-up was not (β=0.097, p=0.060). Replication of the analyses in subgroups with and without current comorbid major depressive disorder (MDD) and subgroups with different sequence of onset (primary versus secondary MDD) revealed the same results.
Limitations:
There may be other factors, which affect both depressive and obsessive-compulsive symptoms that were not assessed in the present study.
Conclusion:
The present study demonstrates a relation between depressive symptoms and the course of obsessive-compulsive symptoms in OCD patients, irrespective of a current diagnosis of MDD and the sequence of onset of OCD and MDD.
Development and maintenance of obsessive-compulsive disorder (OCD) is closely associated with dysfunctional beliefs. Cognitive vulnerability to obsessive-compulsive (OC) symptoms may differ across cultures. The study examined the interrelationships between obsessive-compulsive symptoms, obsessional beliefs and stress, and compared the level of OCD symptom presentation among adolescents in Iran, Lithuania and the UK. A non-clinical sample of 165 adolescents (59 in Iran, 55 in Lithuania and 51 in the UK) between ages of 15 and 18 years were investigated. The questionnaires included the Hassle Scale for Children, the Obsessive Beliefs Questionnaire and the Obsessive-Compulsive Inventory. Findings demonstrated a positive correlation between OC symptoms and beliefs, while daily stress measures showed no significant contribution to the level of symptom presentation. Obsessive-compulsive-related differences were apparent among this culturally unique adolescent sample, where Iranian scores showed comparatively higher vulnerability towards the OCD than British and Lithuanian adolescents. Findings of this study demonstrate the importance of cross-cultural variations in obsessive-compulsive symptoms and highlighted vulnerability factors to OCD phenomena.
The objective of this study is to investigate the influence practice of the group counseling on the levels of obsessive and compulsive symptoms of the university students. Experiment and control group of the study consists of nine students. Pre-test and post-test models were used in employed in this study. Maudsley Obsessive Compulsive Scale was applied to experiment and control groups as pre-test and pst-test. Mann Whitney U test and Wilcoxon Signed Ranks test were used to determine whether the difference between pre-test and post-test of experiment and conrol groups mean scores was significant. Group counseling based upon cognitive behavioral approach reduced the level of obsessive and compulsive symptoms of the students. The students taking part group counseling sessions displayed a lower level of obsessive and compulsive symptoms in comparison with those not attending these sessions. Post-test scores of the students in the experiment group were significantly lower than pre-test scores. Findings putforward.
Contemporary opinions which are prevailing in psychiatry handle the obsessive compulsive disorder from a positivist-empiricist point of view and such attitudes cause an inconsistent and unintegrated vista about the compiling information concerned with the disorder. The importance of the culture-sensitive approaches about OCD is being neglected in contemporary researches and clinical practices. It can be asserted that, to establish a working cooperation between psychiatry and humanities, as done before with neuroscience, physiology, biochemistry and pharmacology, will procreate quite effective results in the field of OCD research. Embracement of the culturesensitive approach while handling the OCD will provide momentous contributions, not only for the endeavors about understanding the disorder entirely, but also for the treatment of the disorder.
This chapter discusses the cross-cultural understanding of the obsessive compulsive and spectrum disorders. Epidemiological studies suggest a reasonably consistent prevalence of OCD around the world. The role of other culturally influenced factors in the presentation of OCD is also considered (i.e., religiosity, superstition, and beliefs), with religion considered particularly important in the presentation of OCD, although not in its prevalence per se. Treatment effect sizes across countries and within minority cultures from Western countries are outlined. The influence of cultural factors on help-seeking behaviors, assessment, misdiagnosis, and treatment are considered. Limitations of the literature base are discussed, particularly the lack of non-Western studies of treatment effects, and the low evidence base for the spectrum disorders.
Little is known about the longitudinal course of symptoms in adult patients with obsessive-compulsive disorder (OCD), although some evidence exists regarding symptom stability in children and adolescents. This study systematically investigated the temporal stability of individual symptoms and symptom dimensions of OCD in adult patients who were followed prospectively for 2 years.
One hundred seventeen adult outpatients with OCD from three U.S. sites were administered the Yale-Brown Obsessive Compulsive Scale symptom checklist four times over a period of 2 years. Eighty-one (69%), 83 (71%), and 67 (57%) patients were available 6 months, 1 year, and 2 years after initial screening, respectively. Different analytic methods assessed the stability of OCD symptoms within and between previously identified symptom dimensions.
For the most part, patients maintained their symptoms throughout follow-up, although some symptoms were more stable than others. For the symptoms that changed, changes occurred within rather than between symptom dimensions; qualitative shifts from one dimension to another were rare. The strongest predictor of the presence of a particular symptom was having had that symptom in the past. Although most patients had received pharmacological and behavioral treatment during the follow-up period, changes within symptom dimensions could not be explained by overall clinical improvement over time.
Symptoms of adult patients with OCD might be more stable across time than previously thought, with some symptoms waxing and waning within symptom dimensions and rarely involving shifts between dimensions. Longer follow-up studies involving larger samples are needed to better understand the fluctuations of OCD symptoms across time.
Characteristic features of the obsessive-compulsive disorder (OCD) occur with remarkable consistency in different cultural settings. The content of symptoms, however, seems to vary across cultures.
To examine the content of symptoms in a sample of OCD patients from Iran.
In a sample of 135 patients recruited from three treatment settings the prevalence of symptoms with different contents were ranked and compared across genders.
Doubts and indecisiveness were the most common obsessions and washing the most common compulsion for the whole sample. Fears of impurity and contamination, obsessive thoughts about self-impurity and washing compulsions were more common in women, whereas blasphemous thoughts and orderliness compulsions were more common in men.
With minor differences, the pattern of symptoms with various contents in this sample was similar to that in Western settings.
Our knowledge of the prevalence and demographic and clinical characteristics of obsessive-compulsive disorder (OCD) has, until recently, been based almost exclusively on patient samples. The epidemiology of OCD was first described in a large United States household sample from the Epidemiologic Catchment Area (ECA) study. Since these original observations, the rates of OCD in household populations determined from diagnostic procedures similar to those used in the United States have been published from different parts of the world. Detailed comparisons of rates, sex ratios, age at onset, and demographic and clinical characteristics of OCD in these samples are now available.
This article reports on the cross-national epidemiology of OCD from seven international epidemiologic surveys, including the United States ECA study. Each survey used the Diagnostic Interview Schedule (DIS), a highly structured interview, developed for use in epidemiologic surveys, that yields Diagnostic and Statistical Manual of Mental Disorders , Third Edition (DSM-III) psychiatric diagnoses. All investigators provided the data from their study to be pooled at Columbia University, and the prevalence rates were standardized to the age and sex distribution of the five-site ECA household population so that more precise estimates and comparisons could be made.
During the past decade, there has been rapid growth in understanding the clinical features, pathophysiology, and treatment of obsessive compulsive disorder (OCD). This article reviews the current state of knowledge of the epidemiology and clinical features of OCD with a focus on the disorder's phenomenologic heterogeneity and its comorbidity with other Axis I and Axis II syndromes.
The aim of our study was to analyse the obsessions and compulsions of patients diagnosed as Obsessive-Compulsive Disorder in terms of their forms and their contents in Eastern Turkey. Forms and contents of 181 obsessions and 164 compulsions found in 108 patients were classified by using the classification system developed by Khanna and Channabasavanna. Dirt and contamination fear was the most common obsessive theme, followed by religion. Washing compulsion content was found in nearly two thirds of the patients then followed by specific activities (praying, counting and touching). Our data was concordant with previous studies except for religious obsessions in particular, second in frequency.
• The Yale-Brown Obsessive Compulsive Scale was designed to remedy the problems of existing rating scales by providing a specific measure of the severity of symptoms of obsessivecompulsive disorder that is not influenced by the type of obsessions or compulsions present. The scale is a clinician-rated, 10-item scale, each item rated from 0 (no symptoms) to 4 (extreme symptoms) (total range, 0 to 40), with separate subtotals for severity of obsessions and compulsions. In a study involving four raters and 40 patients with obsessive-compulsive disorder at various stages of treatment, interrater reliability for the total Yale-Brown Scale score and each of the 10 individual items was excellent, with a high degree of internal consistency among all item scores demonstrated with Cronbach's α coefficient. Based on pretreatment assessment of 42 patients with obsessive-compulsive disorder, each item was frequently endorsed and measured across a range of severity. These findings suggest that the Yale-Brown Scale is a reliable instrument for measuring the severity of illness in patients with obsessive-compulsive disorder with a range of severity and types of obsessive-compulsive symptoms.
Discusses clinical features and phenomenology of obsessive compulsive disorder (OCD), including its epidemiology, core syndrome recognition, developmental antecedents, phenomenological subtypes, coexisting disorders, and differential diagnosis. It is concluded that OCD's phenomenologic heterogeneity may be deceiving in that patients with different types of obsessions and compulsions share many common features with regard to demographics, course of illness, family history, and treatment response. The differential diagnosis is often complicated by the high rate of coexisting disorders. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Eighty-two obsessional neurotics were studied from a phenomenological viewpoint in order to unmask the clinical and socio-cultural determinants of symptom-choice in this disorder. The form of obsessions and compulsions seemed to be affected primarily by intrinsic factors (age, sex, I.Q.) while their content was affected equally, if not more, by extrinsic factors (religion, locality, social class). Patient's age at the onset of illness seemed to be an extremely relevant factor insofar as it affected both the form and the content of symptoms. Some socio-cultural explanations have been offered these findings. The data is important insofar as it provides a baseline for cross-cultural studies of the phenomenology of obsessional illness.
The case histories are examined of 41 patients who were admitted to hospital for the first time with a diagnosis of obsessive-compulsive neurosis. Aspects of the phenomenology are reported which presented between the first appearance of obsessive-compulsive symptoms and discharge from the first admission.
The mean age for admission was 31·6 years (SD 14·3) and 68 per cent of the sample were women. The women showed significantly higher incidences of contamination phobia and of compulsive cleaning behaviour than did the men. Cleaning behaviour and avoidance of feared stimuli were the most frequently encountered manifestations of compulsive behaviour.
During the past decade, there has been rapid growth in understanding the clinical features, pathophysiology, and treatment of obsessive compulsive disorder (OCD). This article reviews the current state of knowledge of the epidemiology and clinical features of OCD with a focus on the disorder's phenomenologic heterogeneity and its comorbidity with other Axis I and Axis II syndromes.
In 32 Muslim Saudis with obsessive-compulsive disorder, compulsive acts (78%) and doubts (66%) were the commonest forms. Religious themes predominated in both the obsessions and compulsions.
Among 307 adults with OCD, early onset (age 5-15 years) was more common in men and later onset (age 26-35 years) in women. Early onset was associated with more checking, and late onset with more washing. More women than men had a history of treated depression; 12% of the women but none of the men had a history of anorexia. More women than men were married. Gender-divergent features may reflect differential aetiological factors. Our sample resembled others in the literature in its slight overall female preponderance, low rate of marriage and low fertility, onset mainly before age 35 years, chronicity, and common present and past depression.
The Yale-Brown Obsessive Compulsive Scale was designed to remedy the problems of existing rating scales by providing a specific measure of the severity of symptoms of obsessive-compulsive disorder that is not influenced by the type of obsessions or compulsions present. The scale is a clinician-rated, 10-item scale, each item rated from 0 (no symptoms) to 4 (extreme symptoms) (total range, 0 to 40), with separate subtotals for severity of obsessions and compulsions. In a study involving four raters and 40 patients with obsessive-compulsive disorder at various stages of treatment, interrater reliability for the total Yale-Brown Scale score and each of the 10 individual items was excellent, with a high degree of internal consistency among all item scores demonstrated with Cronbach's alpha coefficient. Based on pretreatment assessment of 42 patients with obsessive-compulsive disorder, each item was frequently endorsed and measured across a range of severity. These findings suggest that the Yale-Brown Scale is a reliable instrument for measuring the severity of illness in patients with obsessive-compulsive disorder with a range of severity and types of obsessive-compulsive symptoms.
A retrospective analysis was carried out about sociodemographic data in 412 patients who had received a diagnosis of Obsessive Compulsive Neurosis in the period 1975 to 1984. The patterns which emerged have been discussed. There was a bimodel age of onset in females, the second peak occurring at 35-40 years. Students and housewives were the two largest groups observed. Obsessive compulsive neurosis (OCN) is a state in which the outstanding symptom is a feeling of subjective compulsion to carry out some action, to dwell in an idea, to recall an experience or to ruminate on an abstract topic. Work on this disorder has been limited because of its relative scarcity and studies have as a rule been done with small numbers. There has been recent interest evinced in the epidemiology of this disorder. Theories about the etiology of OCN range from the psycho-dynamic to the biological but it still presents many therapeutic challenges. There are proponents of drug therapy and behaviour therapy but failures are recognised. This study aims to look at sociodemographic data of a hospital based population of patients with OCN to try and determine patient variables in this illness. This attempt at descriptive epidemiology also seeks to compare our data with that from other studies to determine cross-cultural aspects and the homogeneity of this syndrome.
The authors present the clinical characteristics, demographic features, and family history of a clinical sample of 44 patients who met DSM-III criteria for obsessive-compulsive disorder. Their findings are consistent with those of previous epidemiologic studies completed before the introduction of DSM-III with regard to phenomenology, course, and demographic characteristics. Most of the 44 patients had concomitant or lifetime histories of a major depressive disorder or another anxiety disorder. A number of first-degree relatives of these patients had probable obsessive-compulsive disorder or obsessive traits. The findings of this study should prove useful in further epidemiologic, biologic, and behavioral studies.
Religious compulsions in four patients are presented to show the phenomenological similarities and differences between religious and compulsive rituals. The role of religious ritual observance in predisposing to obsessive-compulsive neurosis is discussed and minor modifications in the usual course of behavioral treatment are suggested. The proportion of religious compulsions among obsessive-compulsive neurotics is compared with two other populations studied.
We investigated gender differences in 219 patients with obsessive compulsive disorder consecutively referred to a centre specialising in the behavioural treatment of anxiety disorders. Females had a later mean onset-age, and were more likely to be married and to have children; they were also marginally more likely to have a past history of an eating disorder or depression, while males were more likely to have a history of anxious or meticulous personality traits. Family loading for psychiatric disorders did not differ significantly between the sexes. The results are discussed in the context of the epidemiological literature on gender differences in OCD.
Fifteen patients with DSM-III-R diagnosis of obsessive-compulsive disorder (OCD) were rated according to the Turkish version of the Yale Brown Obsessive Compulsive Scale (Y-BOCS) and the US National Institute of Mental Health Global Obsessive Compulsive Scale (NIMH-GOCS) by 7 raters independently from audiotaped interviews. Patients also completed the Maudsley Obsessive Compulsive Inventory (MOCI). Interrater reliability of Y-BOCS and NIMH-GOCS were very good as well as correlations between these two scales. The correlations of MOCI with Y-BOCS and NIMH-GOCS were not significant. We found Y-BOCS and NIMH-GOCS to be reliable and valid instruments in assessing the severity of OCD. These findings suggest that MOCI may not be a suitable instrument for assessing the severity of OCD.
Ninety patients suffering from obsessive-compulsive disorder (OCD) and diagnosed according to International Classification of Diseases (10th edition [ICD-10]) criteria attending the outpatient clinic of the Institute of Psychiatry in Cairo in 1991-1992 were assessed by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) for symptomatology and severity of symptoms. Sixty-nine percent of the patients were males, and 32% were females. The mean age of the sample was 23.7 years, with a mean duration of OCD of 3.2 years. Twenty percent of patients had a positive family history for OCD. Forty percent of patients presented with a mixture of obsessions and compulsions, whereas 29% presented with obsessions and 31% with compulsions. The most commonly occurring obsessions were religious and contamination obsessions (60%) and somatic obsessions (49%), and the most commonly occurring compulsions were repeating rituals (68%), cleaning and washing compulsions (63%), and checking compulsions (58%). Seventy-one percent of patients were rated severe on the Y-BOCS, and all of them had impaired insight; 9% were insightless. The age of patients was found to correlate positively with the total compulsive score and the total Yale BOCS score, but it correlated negatively with the total obsessive score. One third of patients had a comorbid depressive disorder. Regarding premorbid personality disorders, 14% had obsessive personality disorder, 34% had paranoid, anxious, or emotionally labile personality disorder, and 52% had no premorbid personality disorder. The role of religious upbringing has been evident in the phenomenology of OCD in Egypt, which is similar to the outcomes of studies in Jerusalem and different from results in India and Britain.(ABSTRACT TRUNCATED AT 250 WORDS)
Data on the epidemiology of psychiatric disorders from different parts of the world using similar methods and diagnostic criteria have previously not been available. This article presents data on lifetime and annual prevalence rates, age at onset, symptom profiles, and comorbidity of obsessive compulsive disorder (OCD), using DSM-III criteria, from community surveys in seven countries: the United States, Canada, Puerto Rico, Germany, Taiwan, Korea, and New Zealand. The OCD annual prevalence rates are remarkably consistent among these countries, ranging from 1.1/100 in Korea and New Zealand to 1.8/100 in Puerto Rico. The only exception is Taiwan (0.4/100), which has the lowest prevalence rates for all psychiatric disorders. The data for age at onset and comorbidity with major depression and the other anxiety disorders are also consistent among countries, but the predominance of obsessions or compulsions varies. These findings suggest the robustness of OCD as a disorder in diverse parts of the world.
Compulsive buying is infrequently described in the psychiatric literature despite suggestions that it may be prevalent. The authors investigated the demographics and phenomenology of this syndrome and assessed psychiatric comorbidity via interviews of both compulsive buyers and normal buyers.
Twenty-four compulsive buyers were compared with 24 age- and sex-matched normal buyers using (1) a semistructured interview for compulsive buying and impulse control disorders, (2) a modified version of the Structured Clinical Interview for DSM-III-R, and (3) scales measuring compulsiveness, depression, and anxiety.
The typical compulsive buyer was a 36-year-old female who had developed compulsive buying at age 17 1/2 and whose buying had resulted in adverse psychosocial consequences. Purchases were usually of clothes, shoes, jewelry, or makeup, which frequently went unused. Compared with normal buyers, compulsive buyers had a higher lifetime prevalence of anxiety disorders, substance use disorders, and eating disorders and were more depressed, anxious, and compulsive. Among compulsive buyers, 16 (66.7%) described buying that resembled obsessive compulsive disorder, whereas 23 (95.8%) described buying that resembled an impulse control disorder.
Compulsive buying is a definable clinical syndrome that can result in significant psychosocial impairment and which displays features of both obsessive compulsive disorder and the impulse control disorders.
Demographic data, family history, psychopathological features, comorbidity and course of obsessive-compulsive disorder (OCD) are investigated and data generated to support the possible existence of two subgroups with gender-related differences of a broader nature.
Two hundred and sixty-three OCD patients, consecutive admissions to the Institute of Psychiatry, University of Pisa over a period of 5 years, not excluding those with comorbid Axis I and Axis II conditions, were studied. Patients were evaluated with a specifically designed semi-structured OCD interview.
We found a significantly greater history of perinatal trauma in men who also had an earlier onset, greater likelihood of never having been married and a higher frequency of such symptoms as sexual, exactness and symmetry obsessions and odd rituals; by contrast, women suffered a later onset of the disorder, were more likely to be married, had higher rates of associated panic attacks after the onset of OCD and a higher frequency of aggressive obsessions at the onset of their illness, and were less frequently associated with bipolar disorders.
Pathophysiological mechanisms in OCD seem to differ by gender. Perinatal trauma might predispose to earlier onset in men, whereas in women there is a close association between OCD and panic disorder.
Forty-five outpatients interviewed by using the Structured Clinical Interview for DSM-III-R, Outpatient version and diagnosed as obsessive-compulsive disorder were evaluated in terms of form and content of obsessions and compulsions. Obsessive-compulsive phenomena were classified according to a system proposed by Khanna and Channabasavanna. Depressive disorder was the most common comorbid diagnosis found in 73.2% of patients. The most prevalent obsession themes were daily activities and dirt contamination themes (64.4 and 53.3%, respectively). Religious themes were infrequent (11.1%) in the sample and Muslim culture seemed not to have a prominent impact on phenomenology of the disorder.
The worldwide prevalence of obsessive-compulsive disorder (OCD) is approximately 2% of the general population. Symptoms of OCD include fear of contamination by dirt or germs; constant checking; repetitive, intrusive thoughts of a somatic, aggressive, or sexual nature; extreme slowness; and an inordinate concern with orderliness and symmetry. Differential diagnosis is sometimes complicated by the overlap between OCD and obsessive-compulsive personality disorder (OCPD). The most common complication of OCD is depression. However, while both serotonergic and nonserotonergic antidepressants are effective in treating patients with depression, only serotonergic medications are effective in treating OCD patients. Because OCD patients often attempt to conceal their symptoms, it is incumbent on clinicians to screen for OCD in every mental status examination, since appropriate treatment can often result in improved quality of life.
The aim of our study was to analyse the obsessions and compulsions of patients diagnosed as Obsessive-Compulsive Disorder in terms of their forms and their contents in Eastern Turkey. Forms and contents of 181 obsessions and 164 compulsions found in 108 patients were classified by using the classification system developed by Khanna and Channabasavanna. Dirt and contamination fear was the most common obsessive theme, followed by religion. Washing compulsion content was found in nearly two thirds of the patients then followed by specific activities (praying, counting and touching). Our data was concordant with previous studies except for religious obsessions in particular, second in frequency.
Fifty patients with a primary diagnosis of Obsessive-Compulsive Disorder (OCD) were studied during the course of the year 1994 from a phenomenological point of view in order to delineate the various forms and contents of obsessions and compulsions.
An attempt was made to highlight the frequency with which the different forms and contents occur. Six types of obsessions were identified: doubts, thoughts, fear (phobia), images, impulses and miscellaneous.
Compulsive acts were classified into two types: yielding and controlling.
The contents of obsessions could be classified into eight broad categories as relating to: dirt and contamination, germs, aggression, sex, religion, blasphemy, illness and indecisiveness. Thirty eight percent of the patients displayed obses sional thoughts related to dirt and contamination, while forty per cent showed religious and blasphemous obsessional thoughts and doubts.
Fifty six percent of the patients had compulsions of which 36% were multiple, while 20% displayed only a single compulsion.
The paper discusses these findings and emphasizes the role played by socio- cultural and religious factors in shaping the character of an obsessional thought content.
No consistent predictors of outcome have been identified for the pharmaco-therapy of obsessive-compulsive disorder (OCD). Recent factor analytic studies have identified meaningful symptom dimensions that may be related to response to serotonin reuptake inhibitors and other treatments.
A total of 354 outpatients with primary OCD were administered the Yale-Brown Obsessive Compulsive Scale Symptom Checklist, and its 13 main symptom categories were factor analyzed by using principal components analysis. The identified symptom dimensions were then entered into multiple regression models as outcome predictors of response to serotonin reuptake inhibitors and placebo response in a group of 150 nondepressed subjects who completed six double-blind, placebo-controlled trials with a serotonin reuptake inhibitor (clomipramine, fluvoxamine, fluoxetine, sertraline, and paroxetine). Eighty-four patients received a serotonin reuptake inhibitor and 66, placebo.
The principal components analysis identified five factors that explained 65.5% of variance in outcome: symmetry/ordering, hoarding, contamination/cleaning, aggressive/checking, and sexual/religious obsessions. Serotonin reuptake inhibitors were significantly superior to placebo on all outcome measures. Initial severity of OCD was related to greater posttreatment severity of OCD. Higher scores on the hoarding dimension predicted poorer outcome following treatment with serotonin reuptake inhibitors, after control for baseline severity. No predictors of placebo response were identified. Exclusion of clomipramine did not modify the overall results, suggesting a cross-serotonin reuptake inhibitor effect.
The identified symptom dimensions are largely congruent with those identified in earlier reports. Patients with OCD vary in their response to treatment with serotonin reuptake inhibitors. The presence of hoarding obsessions and compulsions is associated with poorer response to serotonin reuptake inhibitors.
The present review addresses the question of sexual dimorphism in obsessive-compulsive disorder. It enumerates examples that could be interpreted to suggest the existence of such dimorphism from the fields of epidemiology, phenomenology, pharmacology, neuropsychology, neuroimaging and genetics. We conclude that data, at this point, are too scarce to warrant a firm conclusion. On the contrary it seems that there are enough indications in the literature that hint at the possibility of sexual dimorphism to stimulate further research in the field.
This study sought to elucidate the differential effect of gender on clinical features in 40 males and 54 females who met both DSM-III-R and DSM-IV criteria for obsessive-compulsive disorder (OCD). Males had a lower rate of marriage, and a higher rate of major impairment in social or occupational functioning, whereas females were significantly more likely to involve others in their OCD symptoms, such as reassurance-seeking. Although no significant differences were detected in the distribution of OCD symptoms, cluster A personality disorders (PDs), especially schizotypal PD, were more frequently diagnosed in males, and borderline and dependent PDs tended to be more prevalent in females. Thus, gender differences in OCD subjects were prominently observed in social or interpersonal features, which might be consistent with the differential PD pathology between males and females.
One of the challenges facing modern psychiatry is to determine to what extent the diagnostic categories clinicians have represent valid constructs. Epidemiologic studies are helpful in this regard when their findings are consistent across various cultural or geographic settings or with those of clinical studies. The cross-national epidemiologic data on OCD reviewed in this article are remarkable for their consistency in rates, age at onset, and comorbidity across diverse countries, a fact which lends additional support to the validity of the diagnosis of OCD. The variability in symptom presentation across national sites suggests that cultural factors may affect the symptom expression; however, why the rates of OCD and other psychiatric disorders are so much lower in Taiwan than in other sites, including another Asian site, is unclear. Epidemiologic studies of adolescents and of adults have shown similar prevalence of OCD and substantial comorbidity with major depression and other anxiety disorders. Studies of adolescent populations indicate that OCD symptoms are fairly common among adolescents but not necessarily predictive of developing the full disorder within 1 year of follow-up. Family studies have suggested an association between OCD and TS and other CMT disorders. Clinical studies have suggested an association between Sydenham's chorea and OCD. These various studies provide a growing body of knowledge regarding the nature of OCD. Together with evidence of the substantial demand on mental health services by those afflicted with OCD, the epidemiologic data make a compelling case for additional efforts to improve the understanding and treatment of this troubling disorder.
Religion has often been thought to play a part in the genesis of some cases of obsessive-compulsive disorder (OCD). In this study, we explored the relationship between religiosity, religious obsessions, and other clinical characteristics of OCD. Forty-five outpatients with OCD were evaluated with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the Yale-Brown Obsessive-Compulsive Checklist (Y-BOCC) as well as the Religious Practices Index (RPI), which was developed for this study. On the basis of these evaluations, 42% of the patients were found to have religious obsessions. Despite differences in the frequency of religious obsessions found in this study compared with others, a factor analysis revealed the symptom dimensions to be similar to those found in other OCD samples. There was no significant difference in the overall severity of obsessions and compulsions between patients with and without religious obsessions. RPI scores did not differ significantly between groups. We failed to find a relationship between RPI scores or religious obsessions and any particular type of obsession or compulsion. A logistic regression analysis revealed that the sole predictor of the presence of religious obsessions was a higher number of types of obsessions. In conclusion, we failed to find a conclusive relationship between religiosity and any other clinical feature of OCD, including the presence of religious obsessions. On the other hand, we showed that the patients who tend to have a variety of obsessions are more likely also to have religious obsessions. Thus, religion appears to be one more arena where OCD expresses itself, rather than being a determinant of the disorder.
The objective of this study was to investigate axis I comorbidity in obsessive-compulsive disorder (OCD). A total of 147 patients diagnosed as OCD for DSM-III-R criteria were included in the study. At least one comorbid axis I disorder was present in 68.7% of the patients. Major depression was the most common comorbid disorder (39.5%). Uncomplicated (n = 46) and comorbid (n = 101) OCD groups were compared with respect to the demographic variables and the scores obtained from the Hamilton Rating Scale for Anxiety (HRSA), the Hamilton Rating Scale for Depression (HRSD) and the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). No significant difference in terms of age, sex, marital status, age at onset, or duration of illness was found between the groups. The scores on the HRSA, HRSD, and Y-BOCS were significantly higher in the comorbidity group. Our results demonstrate that at least one psychiatric disorder is present in approximately two thirds of OCD patients, the majority being depressive disorders and anxiety disorders. The fact that comorbid conditions raise not only anxiety and depression levels, but also the severity of obsessions and compulsions, is noteworthy.
Little is known about the extent and the mechanisms through which culture may affect the clinical manifestations of obsessive-compulsive disorder (OCD). In this study, our objective was to identify culture-related symptomatological patterns in OCD. We described the socio-demographic and phenomenological characteristics of 101 adult patients with OCD seen at an university clinic for anxiety and depressive disorders in Rio de Janeiro, Brazil, and compared them with those reported in 15 clinical samples from North and Latin America, Europe, Africa, and Asia identified through a systematic review in MEDLINE, PsychINFO, and LILACS. Patients with OCD were almost universally characterized by: (1) a predominance of females, (2) a relatively early age of onset, and (3) a preponderance of mixed obsessions and compulsions. In contrast, a predominance of aggressive and religious obsessions was found only in Brazilian and Middle Eastern samples, respectively. The core features of OCD are probably relatively independent of cultural variations. The sole exception to this rule seems to be the content of the obsessions, in which cultural factors may play a significant role.
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Adaptation to Turkish and reliability study of Structured Clinical Interview for Axis I disorders
- A Ozkurkc -Ugil
- O Aydemir
- M Yildiz
- Esen Danaci
- A Koroglu
Ozkurkc -ugil A, Aydemir O, Yildiz M, Esen Danaci A, Koroglu E.
1999. Adaptation to Turkish and reliability study of Structured
Clinical Interview for Axis I disorders. Ilac -ve Tedavi Dergisi 12:
233-236. (in Turkish)