Medine Yazıcı GÜLEÇ, Serhat ÇITAK, Yücel Yılmaz, Özlem KAZAN KIZILKURT, Fikret Ferzan GIYNAŞ, Hüseyin GÜLEÇ

Obsesif kompulsif bozukluk hastalarında kişilik örgütlenmesi ve kişilik örgütlenmesinin işlevsellikle ilişkisi

Amaç: Bu çalışmanın amacı, obsesif kompulsif bozuklukta (OKB) kişilik örgütlenmesini araştırmak, kişilik örgütlen- me düzeylerinin işlevsellik üzerindeki etkisini belirlemek ve DSM-5’te önemli olan iç görü ile ilişkisini göstermektir. Yöntem: Çalışmaya, DSM-5’e göre OKB tanısı konmuş toplam 100 hasta alındı. Tüm katılımcılara Yale Brown Obsesif Kompulsif Bozukluk Ölçeği (Y-BOCS), Kişilik Örgütlenmesi Tanı Formu (KÖTF) ve İşlevselliğin Genel Değerlendirilmesi (İGD) ölçekleri uygulandı. Toplam iç görü puanı, kişilik örgütlenmesi boyutları ve işlevsellik düzeyi arasındaki ilişkiyi test etmek için korelasyon analizi yapıldı. Hiyerarşik lineer regresyon modelleri oluşturuldu. Diğer değişkenleri kontrol ettikten sonra, KÖTF bileşenlerinin global işlevsellik üzerindeki öngörülebilirliği değerlendirildi. Bulgular: OKB hastalarının 24%’ünün nevrotik, 62%’sinin sınır, 14%’ünün psikotik kişilik örgütlenmelerinde yer aldığı saptandı. Korelasyon analizlerinde, toplam İGD ve Y-BOCS iç görü puanlarının, KÖTF olgun savunmalar puanı ve KÖTF kimlik puanı ile pozitif korelasyon gösterdiği, ancak KÖTF ilkel savunmaları puanı ve KÖTF gerçeği değerlendirme puanı ile negatif korelasyon gösterdiği bulundu. İGD düzeyinin bağımlı değişken olarak alındığı hiye- rarşik regresyon modelinde iç görü boyutunun pozitif yönde yordayıcı olduğu, bununla birlikte iç görüden bağımsız olarak, PODF ilkel savunmalar puanı ve KÖTF gerçeği değerlendirme puanının ters yönde, KÖTF olgun savunma puanı toplam puanın doğrusal yönde yordayıcı olduğu görülmüştür. Tartışma: İç görünün ve iç görüden bağımsız olarak kişilik örgütlenmesi boyutlarının (kimlik boyutu hariç) OKB’de işlevselliği yordayabileceği sonucuna varılmış- tır. Ayrıca iç görü yapısının, gerçeği değerlendirme yapısından farklı bir kavram olabileceği desteklenmektedir. OKB hastalarında kişilik örgütlenmesinin değerlendirilmesi, işlevsellik ve kişiye özgü tedavi planlarının tasarımında iyileş- tirilebilecek alanlarının yaratılmasında önemli olabilir. (Anadolu Psikiyatri Derg 2019; 20(1):38-46)

Personality organization in patients with obsessive-compulsive disorder and its relationship with functionality

Objectives: The aim of this study is to investigate the level of personality organization in obsessive-compulsivedisorder (OCD), to determine the effect of personality organization dimensions on functioning, and to show the rela-tion with insight important in DSM-5. Methods: One hundred patients with OCD diagnosed according to DSM-5were included in the study. Yale Brown Obsessive-Compulsive Disorder Questionnaire (Y-BOCS), PersonalityOrganization Diagnosis Form (PODF) and Global Assessment of Functioning (GAF) scales were administered toall participants. Correlation analysis was performed to test the relationship between total insight score and the POdimensions with global functionality level in patients with OCD. Hierarchical linear regression models wereconducted. After controlling other variables, the predictability of PODF components on global functionality wasassessed. Results: In the neurotic personality spectrum of individuals with OCD 24%, 62% were in the spectrumof borderline personality organization, and 14% were in the spectrum of psychotic personality organization. Corre-lation analyses showed that the total GAF and Y-BOCS insight scores were positively correlated with the total scoreon the PODF mature defenses and the total PODF identity score, but negatively correlated with the total score fromthe PODF primitive defenses and the total PODF reality testing score. In the hierarchical regression model in whichfunctionality was a dependent variable, the Y-BOCS insight score, the total score from PODF primitive defenses,and the total PODF reality testing score were inverse predictors of global functioning, and the total PODF scorefrom mature defenses predicted global functioning in a linear direction. Discussion: It was concluded that dimen-sions of the PODF (with the exception of identity dimension) could be used to predict functionality, even if it was aconfounding factor with insight. The variable of insight in OCD was a concept that differs from the reality-testingdimension. Assessing the level of personality organization in patients with OCD will help to create areas that canbe remediated in the design of functionality and treatment plans. (Anatolian Journal of Psychiatry 2019; 20(1):38-46)

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