AYŞE BİKEM HACIÖMEROĞLU, Emrah KESER, MÜJGAN İNÖZÜ MERMERKAYA

Farklı psikopatolojilerde duyguların rolü: Tiksinme, öfke, suçluluk ve anksiyete

Amaç: Psikiyatrik bozuklukların çoğu şiddetli duygular ve duygu düzenleme zorluklarıyla karakterizedir. Bugüne kadar psikiyatrik bozuklukların duygular açısından ortak ve farklı yönleri yeterince araştırılmamıştır. Bu araştırmanın amacı suçluluk, anksiyete, tiksinme ve öfke duygularının şiddetinin majör depresif bozukluk (MDB), obsesif kompulsif bozukluk (OKB), anksiyete bozuklukları (AB) ve sağlıklı kontrol gruplarında karşılaştırılmasıdır. Yöntem: Araştırmanın klinik örneklemine Ankara Gülhane Eğitim ve Araştırma Hastanesi (GATA) Ruh Sağlığı Polikliniği'ne başvuran veya bu birimde tedavi gören, aynı zamanda katılım ölçütlerini karşılayan hastalar alınmıştır. Araştırmada MDB (s=67) OKB (s=53) ve AB (s=73) tanıları konmuş üç klinik grup ve bir sağlıklı kontrol grubu (s=110) yer almaktadır. Tanı grupları, yarı yapılandırılmış SCID-I kullanılarak oluşturulmuştur. Kontrol grubundaki katılımcılara ise Gazi Üniversitesi'nde çalışan idari personellerden uygun örnekleme yoluyla ulaşılmıştır. Tüm katılımcılara Demografik Bilgi Formu, Suçluluk Ölçeği-Sürekli Suçluluk Formu (SÖ), Durumluk-Sürekli Kaygı Envanteri - Sürekli Sürekli Kaygı Formu (DSKE-S), Tiksinme Ölçeği-Revize Edilmiş Form (TÖ) ve Durumluk-Sürekli Öfke Ölçeği (DSÖ)'nden oluşan bir ölçek seti doldurtulmuştur. Bulgular: Çoklu varyans analizi (MANOVA) ve tek yönlü varyans analizi (ANOVA) kullanılarak dört farklı grup, dört farklı duygu açısından karşılaştırılmıştır. Analiz sonuçları, OKB hastalarının diğer tüm gruplara göre anlamlı olarak daha şiddetli tiksinme duygusu yaşadığını göstermiştir. Anksiyete, suçluluk ve öfke duyguları açısından klinik gruplar arasında fark bulunmazken; bu üç duygu klinik gruplarda sağlıklı kontrol grubuna göre anlamlı düzeyde daha yüksek bulunmuştur. Sonuç: Çalışma bulguları, tiksinme duygusunun OKB'ye özgü olduğunu destekler niteliktedir. Ayrıca bulgular suçluluk, anksiyete ve öfke duygularının tanılar üstü (transdiagnostic) özellikte olduğunu ve üç duygunun şiddetinin klinik gruplarda kontrol grubuna göre yüksek olduğunu göstermiştir.

The role of emotions in different psychopathologies: the examination of disgust, anger, guilt and anxiety

Objective: Most of the psychiatric disorders are characterized by severe emotions and difficulties in emotion regulation process. However, to date, commonalities and differences of emotions in psychiatric disorders have not been sufficiently investigated. In this context, the aim of the study is to examine whether the emotions of trait guilt, trait anxiety, trait disgust and state-trait anger differentiated in the major depressive disorder (MDD), obsessive compulsive disorder (OCD), anxiety disorders (AD) and healthy control groups. Methods: The clinic samples of this study included the patients who applied to Ankara Gülhane Education and Research Hospital (GATA) Psychiatry Clinic or who received treatment at this unit and fulfilled the participation criteria. The study composed of MDD (n=67) OCD (n=53), AD (n=73) and healthy control (n=110) groups. The clinical groups were evaluated by using SCID-I. The control group were reached through convenient sample method from administrative staff of the Gazi University. The participants filled out the Demographic Information Form, Guilt Inventory- Trait Form, State Trait Anxiety Inventory-Trait Form, and Disgust Scale-Revised Form and State-Trait Anger Inventory. Results: Four groups were compared in terms of four emotions by using ANOVA and MANOVA. Results showed that trait disgust scores were significantly higher in OCD group compared to all other groups. Although the MDB, OCD and AD groups were not differentiated in terms of trait anxiety, trait guilt and state-trait anger scores, all three clinical groups scored significantly higher than healthy control group. Discussion: The results supported the specificity of trait disgust to OCD. Moreover, results showed that trait anxiety, trait guilt and state-trait anger have transdiagnostic properties and the intensity of the three emotions were higher in clinical groups compared the healthy control group.

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1. Gross JJ. Emotion regulation in adulthood: Timing is everything. Curr Dir Psychol Sci 2001; 10:214- 219. 2. Gross JJ. Emotion regulation: affective, cognitive, and social consequences. Psychophysiology 2002; 39:281-91.
3. Sheppes G, Suri G, Gross JJ. Emotion regulation and psychopathology. Annu Rev Clin Psychol 2015; 11:379-405.
4. Gross JJ, Jazaieri H. Emotion, emotion regulation, and psychopathology: An affective science per-- spective. Clinical Psychology Science 2014; 2:387-401.
5. Krueger RF, Eaton NR. Transdiagnostic factors of mental disorders. Perspective 2015; 27-29.
6. Linton SJ. A transdiagnostic approach to pain and emotion. Journal of Applied Biobehavioural Research 2013; 18:82-103.
7. Nolen-Hoeksema S, Watkins ER. A heuristic for developing transdiagnostic models of psychopathology: Explaining multifinality and divergent trajectories. Perspective on Psychological Science 2011; 6(6):589-609.
8. Özdemir O. Psikiyatride boyutsal yaklaşım. Psikiyatride Güncel Yaklaşımlar 2012; 4(3):315-334.
9. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth ed., Arlington, VA: APA Press, 2013.
10. World Health Organization (WHO). International Classification of Diseases (10th revision), Geneva: World Health Organization, 1992.
11. Barrett EL, Mills KL, Teesson M. Mental health correlates of anger in the general population: Findings from the 2007 National Survey of Mental Health and Wellbeing. Aust N Z J Psychiatry 2013; 47(5):470-476.
12. Cassiello-Robbins C, Barlow DH. Anger: The unrecognized emotion in emotional disorders. Clin Psychol Sci Prac 2016; 23:66-85.
13. Basile B, Mancini F, Macaluso E, Caltagirone C, Bozzai M. Abnormal processing of deontological guilt in obsessive-compulsive disorder. Brain Struct Funct 2014; 219(4):1321-1331.
14. First MB, Spitzer RL, Gibbon M. Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) Research Version, Patient Ed. New York: Biometric Research, New York State Psychiatric Institute, 1996.
15. American Psychiatry Assocation. Diagnostic and Statistical Manual of Mental Disorders-IV (DSMIV-TR), Fourth Ed., Text Revision, Washington DC: APA Press, 2000.
16. Spielberger CD. Manual for the State-Trait Anger Expression Inventory (STAXI). Odessa FL: Psychological Assessment Resources, 1988.
17. Özer K. Sürekli Öfke (SL-Öfke) ve Öfke İfade Tarzı (Öfke-Tarz) Ölçekleri ön çalışması. Türk Psikoloji Dergisi 1994; 9(31):26-35.
18. Inozu M, Karanci AN, Clark AD. Why are religious ındividuals more obsessional? The role of mental control beliefs and guilt in Muslims and Christians. J Behav Ther Exp Psychiatry 2012; 43:959-966.
19. Haidt J, Mc Cauley C, Rozin P. Individual differences in sensitivity to disgust: A scale sampling seven domains of disgust elicitors. Pers Individ Dif 1994; 16:701-713.
20. İnözü M, Eremsoy E. Tiksinme Ölçeği ile Bulaş- ma/Kirlenme Bilişleri Ölçeği'nin Türkçe versiyonlarının psikometrik özellikleri. Türk Psikoloji Yazı- ları 2012; 16(31):1-10.
21. Öner N, Le Comte A. Durumluk-Süreklilik Kaygı Envanteri Elkitabı. İstanbul: BÜ Yayınları,1985.
22. Cougle JR, Lee HJ, Horowitz JD, Wolitzky-Taylor KB, Telch MJ. An exploration of the relationship between mental pollution and OCD symptoms. J Behav Ther Exp Psychiatry 2008; 39(3):340-353.
23. Melli G, Gremigni P, Elwood LS, Stopani E, Bulli F, Carraresi C. The relationship between trait guilt, disgust propensity, and contamination fear. Int J Cogn Ther 2015; 8:1-13.
24. Nicholson E, Barnes-Holmes D. Developing an implicit measure of disgust propensity and disgust sensitivity: Examining the role of implicit disgust propensity and sensitivity in obsessive-compulsive tendencies. J Behav Ther Exp Psychiatry 2012; 43:922-930.
25. Olatunji BO. Changes in disgust correspond with changes in symptoms of contamination-based OCD: A prospective examination of specificity. J Anxiety Disord 2010; 24:313-317.
26. Olatunji BO, Haidt J, McKay D, David B. Core, animal reminder, and contamination disgust: Three kinds of disgust with distinct personality, behavioral, physiological, and clinical correlates. J Res Pers 2008; 42:1243-1259.
27. Olantunji BO, Lohr JM, Sawchuk CN, Westerndof DH. Using facial expressions as CSs and fear some and disgusting pictures as UCSs: affective responding and evaluative learning of fear and disgust in blood-injection-injury phobia. J Anxiety Disord 2005; 11:539-555.
28. Mitte K. Trait-disgust and fear of contamination and the judgmental bias of contamination concerns. J Behav Ther Exp Psychiatry 2008; 39:577- 586.
29. Moretz MW, McKay D. Disgust sensitivity as a predictor of obsessive-compulsive contamination symptoms and associated cognitions. J Anxiety Disord 2008; 22(4):707-715.
30. Ladouceur R, Freeston MH, Fournier S, Rheaume J, Dugas MJ, Gagnon F ve ark. Strategies used with intrusive thoughts: A comparison of OCD paients with anxious and community controls. J Abnorm Psychol 2000; 109:179-187.
31. Moritz S, Kempke S, Luyten P, Randjbar S, Jelinek L. Was Freud partly right on obsessive-compulsive disorder (OCD)? Investigation of latent aggression in OCD. Psychiatry Res 2011; 187:180- 184.
32. Salkovskis PM. Understanding and treating obsessive-compulsive disorder. Behav Res Ther 1999; 37:29-52.
33. Whiteside SP, Abramowitz JS. Obsessive-compulsive symptoms and the expression of anger. Cogn Ther Res 2004; 28(2):259-268.
34. Gould RA, Ball S, Kaspi SP, Otto MW, Pollack MH, Shektar A, et al. Prevalence and correlates of anger attacks: A two-site study. J Affect Disord 1996; 39(1):31-38.
35. Benazzi F Anger in bipolar depression. J Clin Psychiatry 2003; 64:480-481.
36. Pasquini M, Picardi A, Biondi M, Gaetano P, Morosini P. Relevance of anger and irritability in outpatients with major depressive disorder. Psychopathology 2004; 37:155-160.
37. Judd LL, Schettler PJ, Coryell W, Akiskal HS, Fiedorowicz JG. Overt irritability/anger in unipolar major depressive episodes: Past and current characteristics and implications for long-term course. JAMA Psychiatry 2013; 70:1171-1180.
38. Nutt DJ. Care of depressed patients with anxiety symptoms. J Clin Psychiatry 1999; 60(17):23-27.
39. Mancini F, Gangemi A.Fear of guilt from behaving irresponsibly in obsessive-compulsive disorder. J Behav Ther Exp Psychiatry 2004; 35:109-120.
40. Shafran R, Watkins E, Charman T. Guilt in obsessive-compulsive disorder. J Anxiety Disord 1996; 10:509-516.
41. Smith AH, Wetterneck CT, Heart JM, Short MB, Bjorgvinsson T. Differences in obsessional beliefs and emotion appraisal in obsessive compulsive symptom presentation. J Obsessive Compul Relat Disord 2012; 1:54-61.
42. Fergus TA, Valentiner DP, McGrath PB, Jencius S. Shame and guilt proneness: Relationships with anxiety disorder symptoms in a clinical sample. J Anxiety Disord 2010; 24:811-815.
43. Brown TA, Naragon-Gainey K. Evaluation of the unique and specific contributions of dimensions of the triple vulnerability model to the prediction of DSM-IV anxiety and mood disorder constructs. Behav Ther 2013; 44(2):277-292.
44. Ellard KK, Fairholme CP, Boisseau CL, Farchione TJ, Barlow DH. Unified protocol for the transdiagnostic treatment of emotional disorders: Protocol development and initial outcome data. Cogn Behav Pract 2010; 17(1):88-101.
45. Aldao A, Nolen-Hoeksema S. Specificity of cognitive emotion regulation strategies: A transdiagnostic examination. Behav Res Ther 2010; 48:974- 983.
46. Gellatly R, Beck AT. Catastrophic thinking: A transdiagnostic process across psychiatric disorders. Cogn Ther Res 2016; 40:441-452.