Adem AYDIN, MURAT BOYSAN, Şennur KIŞLAK TUTAREL, Temel KALAFAT, Yavuz SELVİ, LÜTFULLAH BEŞİROĞLU

The predictive value of interpersonal schemas, perfectionism, and thought action-fusion in obsessive compulsive disorder

Amaç: Bilişsel yatkınlık faktörlerinin obsesif-kompulsif bozukluğun etiyolojisinde önemli rol oynadığı düşünülmektedir. Obsesif-kompulsif belirtilerin ortaya çıkışında rol oynayan olası mekanizmaları daha iyi açıklayabilmek için, çeşitli belirtilere ilişkin nozolojik sınıflamalar yapılmaya çalışılmaktadır. Daha önceki dönemlerde yapılmış çalışmalar, mükemmeliyetçi tutumların ve düşünce-eylem kaynaşmasının klinik olan ve olmayan örneklemde, obsesif-kompulsif belirtilerle ilişkilerini ortaya koymuştur. Buna karşın, kişilerarası şemalar gibi, yatkınlık oluşturabilecek etkenler ve obsesif-kompulsif belirtiler arasındaki çok boyutlu ilişkilerin yeterince ele alınmadığı görülmektedir. Bu çalışmada, bilişsel yatkınlık oluşturan faktörler ve obsesif-kompulsif belirtiler arasındaki ilişkiler incelenmektedir. Yöntem: Bu çalışmaya 263 üniversite öğrencisi katılmıştır. Elde edilen veriler yapısal eşitlik modellemesiyle analiz edilmiştir. Bulgular: Bu çalışmanın sonuçları, işlevsel olmayan kişilerarası şemaların obsesif-kompulsif bozuklukta, mükemmeliyetçi tutumlar, düşünce eylem kaynaşması ve semptom şiddetini yordayıcı en önemli risk faktörü olduğunu göstermektedir. Obsesif temizlik ve kesinlik arayışı belirtilerindeki artış, kontrol etme belirtilerindeki artışa bağlıdır. Kişilerarası sınırlılık şemaları, mükemmeliyetçi tutumlar ve düşünce-eylem kaynaşması obsesif-kompulsif belirtilerin ortaya çıkmasında yatkınlık oluşturan faktörlerdir. Obsesif-kompusif belirti kategorileri içinde kontrol etme, belirti şiddetindeki artış içinde önemli bir yere sahiptir. Sonuç: Obsesif-kompulsif belirtilerin ortaya çıkması ve sürmesi, çok boyutlu bir süreçtir. Olumsuz kişilerarası inanışlar önemli bir risk faktörü gibi görünmektedir. Bulgular konuya ilişkin teorik tartışmalar ışığında ele alınmıştır.

Obsesif-kompulsif bozuklukta kişilerarası şemalar, mükemmeliyetçilik ve düşünce-eylem kaynaşmasının yordayıcı rolü

Objective: Cognitive vulnerability factors are central in the etiology of obsessive-compulsive disorder. Nosological classifications among symptom clusters have been developed to enable the understanding of possible mechanisms underlying obsessive compulsive symptoms. Previous researchers have emphasized that perfectionist attitudes and thought action-fusion link to increase in obsessive compulsive symptom severity in clinical and nonclinical samples. However, multi-dimensional relations between obsessive compulsive symptoms and vulnerability factors such as interpersonal schemas have received little attention. This study examined connections between cognitive vulnerability factors and obsessive-compulsive symptoms. Method: The data collected from 263 university students. Associations between variables were analyzed by using structural equation modeling. Results: The results of the study indicated that dysfunctional interpersonal schemas were the most hazardous factors that predict perfectionist attitudes, thought action-fusion, and symptom severity in obsessive compulsive disorder. Washing and precision were the final manifestation symptoms mediated by checking. Maladaptive interpersonal schemas, perfectionist attitudes, and thought action-fusion were all vulnerability agents in the development of obsessive compulsive symptoms. Checking played a prominent role in exacerbation of obsessive –compulsive symptoms. Conclusion: Onset and maintenance of obsessive-compulsive disorder is a multidimensional process. Negativistic interpersonal beliefs seem to be an important risk factor. Findings are discussed in the light of current theoretical considerations.

PDF

___

Foa EB, Huppert JD, Leiberg S, Langner R, Kichic R, Hajcak G, Salkovskis PM. The Obsessive–Compulsive Inventory: development and validation of a short version. Psychol Assess 2002; 14:485-496.
McKay D, Abramowitz JS, Calamari JE, Kyrios M, Radomsky AS, Sookman D, Taylor S, Wilhelm S. A critical evaluation of obsessive–compulsive disorder subtypes: symptoms versus mechanisms. Clin Psychol Rev 2004; 24:283-313.
Foa EB, Kozak MJ, Salkovskis PM, Coles ME, Amir N. The validation of a new obsessive compulsive disorder scale: the Obsessive Compulsive Inventory. Psychol Assess 1998; 10:206- 214.
Leckman JF, Grice DE, Boardman J, Zhang H, Vitale A, Bondi C, Alsobrook J, Peterson BS, Cohen DJ, Rasmussen SA, Goodman WK, McDougle CJ, Pauls DL. Symptoms of obsessive– compulsive disorder. Am J Psychiatry 1997; 154:911-917.
Rachman S. A cognitive theory of obsessions: elaborations. Behav Res Ther 1998; 36:385-401.
Salkovskis PM. Obsessional–compulsive problems: a cognitivebehavioural analysis. Behav Res Ther 1985; 23:571-583.
Rachman S. Obsessions, responsibility and guilt. Behav Res Ther 1993; 31:149-154.
Bouchard C, Rhéaume J, Ladouceur R. Responsibility and perfectionism in OCD: an experimental study. Behav Res Ther 1999; 37:239-248.
Shafran R, Thordarson DS, Rachman S. Thought action-fusion in obsessive compulsive disorder. J Anxiety Disord 1996; 5:379-391.
Rachman S, Thordarson DS, Shafran R, Woody SR. Perceived responsibility: structure and significance. Behav Res Ther 1995; 33:779-784.
Shafran R, Mansell W. Perfectionism and psychopathology: a review of research and treatment. Clin Psychol Rev 2001; 21:879- 906.
Frost RO, Steketee G. Perfectionism in obsessive-compulsive disorder patients. Behav Res Ther 1997; 35:291-296.
Obsessive Compulsive Cognitions Working Group. Development and initial validation of the Obsessive Beliefs Questionnaire and the interpretation of Intrusions Inventory. Behav Res Ther 2001; 39:987-1006.
Obsessive Compulsive Cognitions Working Group. Psychometric validation of the Obsessive Beliefs Questionnaire and the interpretation of Intrusions Inventory: Part 2, factor analyses and testing of a brief version. Behav Res Ther 2005; 43:1527-1542.
Tolin DF, Worhunsky P, Maltby N. Are “obsessive” beliefs specific to OCD?: a comparison across anxiety disorders. Behav Res Ther 2006; 44:469-480.
Gershuny BS, Sher KJ. Compulsive checking and anxiety in a nonclinical sample: differences in cognition, behavior, personality and affect. J Psychopathol Behav Assess 1995; 17:19-38.
Tallis F. Compulsive washing in the absence of phobic and illness anxiety. Behav Res Ther 1996; 34:361-362. 18. Frost RO, Gross RC. The hoarding of possessions. Behav Res Ther 1993; 31:367-381.
Freeston MH, Rhéaume J, Ladouceur R. Correcting faulty appraisals of obsessional thoughts. Behav Res Ther 1996; 34:433-446.
Salkovskis PM. Cognitive behavioural factors and the persistence of intrusive thoughts in obsessional problems. Behav Res Ther 1989; 27:677-684.
Spranca M, Minsk E, Baron J. Omission and commission in judgment and choice. J Exp Soc Psychol 1991; 27:76-105.
White RW. Motivation reconsidered: the concept of competence. Psychol Rev 1959; 66:297-333.
Maslow AH. Toward a Psychology of Being. Second ed., Van Nostrand, 1968.
Beck A. Beyond belief: A theory of modes, personality, and psychopathology: In Salkovskis P (editor). Frontiers of Cognitive Therapy. New York: Guilford Press, 1996.
Boysan M, Beşiroğlu L, Kara H, Kayri M, Keskin S. Associations between the levels of depression and the sense of limitedness: a psychometric analysis. Anatolian Journal of Psychiatry 2008; 9:191-196.
Baldwin MW. Relational schemas and the processing of social information. Psychol Bull 1992; 112:461-484.
Beşiroğlu L, Uğuz F, Sağlam M, Yılmaz E, Ağargün MY, Aşkın R. Factors associated with quality of life in obsessive compulsive disorder. Anatolian Journal of Psychiatry 2007; 8:5-13.
Grabe HJ, Meyer C, Hapke U, Rumpf HJ, Freyberger HJ, Dilling H, John U. Prevalence, quality of life and psychosocial function in obsessive compulsive disorder and subclinical obsessivecompulsive disorder in northern Germany. Eur Arch Psychiatry Clin Neurosci 2000; 250:262-268.
Hewitt PL, Flett GL. Perfectionism in the self and social contexts: conceptualization, assessment, and association with psychopathology. J Pers Soc Psychol 1991; 60:456-470.
Alden LE, Bieling PJ, Wallace ST. Perfectionism in an interpersonal context: a self-regulation analysis of dysphoria and social anxiety. Cognit Ther Res 1994; 18:297-315.
Flett GL, Hewitt PL, De Rosa T. Dimensions of perfectionism, psychosocial adjustment, and social skills. Pers Individ Dif 1995; 20:143-150.
Flett GL, Hewitt PL, Garshowitz M, Martin TR. Personality, negative social interactions and depressive symptoms. Can J Behav Sci 1997; 29:28-37.
Hewitt PL, Flett GL, Mikail SF. Perfectionism and relationship adjustment in pain patients and their spouses. J Fam Psychol 1995; 9:335-347.
Flett GL, Hewitt PL, Shapiro B, Rayman J. Perfectionism, beliefs, and adjustment in dating relationships. Curr Psychol 2001; 20:289-311.
Flett GL, Madorsky D, Hewitt PL, Heisel MJ. Perfectionism cognitions, rumination, and psychological distress. J Ration Emot Cogn Behav Ther 2002; 20:33-47.
Flett GL, Greene A, Hewitt PL. Dimensions of perfectionism and anxiety sensitivity. J Ration Emot Cogn Behav Ther 2004; 22:39- 57.
Sookman D, Pinard G, Beck AT. Vulnerability Schemas in Obsessive-Compulsive Disorder. Journal of Cognitive Psychotherapy: An International Quarterly 2001; 15:109-130.
Moulding R, Kyrios M. Desire for control, sense of control and obsessive-compulsive symptoms. Cognit Ther Res 2007; 31:759- 772.
Mor S, Day HI, Flett GL, Hewitt PL. Perfectionism, control, and components of performance anxiety in professional artists. Cognit Ther Res 1995; 19:207-225.
Tükel R, Polat A, Özdemir Ö, Aksüt D, Türksoy N. Comorbid conditions in obsessive-compulsive disorder. Compr Psychiatry 2002; 43:204-209.
Kayri M, Boysan M. Bilişsel yatkınlık ile depresyon düzeyleri ilişkisinin sınıflandırma ve regresyon ağacı analizi ile incelenmesi. Hacettepe Üniversitesi Eğitim Fakültesi Dergisi 2008; 34:168-177.
Boysan M, Beşiroğlu L, Kalafat T, Kağan M, Ateş C. Associations of dysfunctional interpersonal schemas with obsessivecompulsive and dissociative symptoms in university students. Archives of Neuropsychiatry 2010; 47:9-14.
Yorulmaz O, Yılmaz AE, Gençöz T. Psychometric properties of the Thought-Action Fusion Scale in a Turkish sample. Behav Res Ther 2004; 42:1203-1214.
Sanavio E. Obsession and compulsion: the Padua Inventory. Behav Res Ther 1988; 26:169-177.
van Oppen P, Hoekstra RJ, Emmelkamp PMG. The structure of obsessive-compulsive symptoms. Behav Res Ther 1995; 33:15- 23.
Feske U, Chambless D. A review of assessment measures for obsessive–compulsive disorder: In Goodman W, Rudorfer M, Maser J (editors). Obsessive– compulsive disorder: Contemporary issues in treatment. Mahwah, NJ: Lawrence Erlbaum Associates Publishers, 2000, 157-182.
Beşiroğlu L, Ağargün MY, Boysan M, Eryonucu B, Güleç M, Selvi Y. The assessment of obsessive-compulsive symptoms: the reliability and validity of the Padua inventory in a Turkish population. Turk Psikiyatri Derg 2005; 16:179-189.
Oral M. The relationship between dimensions of perfectionism, stressful life events and depressive symptoms in university students: a test of Diathesis-Stress Model of Depression. Thesis, Master of Science, Middle East Technical University, Ankara, 1999.
Byrne BM. Structural Equation Modeling with LISREL, PRELIS, and SIMPLIS: Basic concepts, Applications, and Programming. New Jersey: Lawrence Erbaum Associates Publisher, 1998.
Kline R. Principles and Practice of Structural Equation Modeling. New York: Guilford Press, 2005.
Bollen KA. Structural Equations with Latent Variables. Wiley Series in Probability and Mathematical Statistics. New York: Wiley, 1989.
Besiroglu L, Uguz F, Ozbebit O, Guler O, Cilli AS, Askin R. Longitudinal assessment of symptom and subtype categories in obsessive-compulsive disorder. Depress Anxiety 2007; 24:461- 466.
Shafran R, Rachman S. Thought-action fusion: a review. J Behav Ther Exp Psychiatry 2004; 35:87-107.
Abramowitz JS, Taylor S, McKay D (editors). ObsessiveCompulsive Disorder: Subtypes and Spectrum Conditions. Amsterdam: Elsevier, 2008.
Tallis, F. Obsessions, responsibility and guilt: two case reports suggesting a common and specific etiology. Behav Res Ther 1994; 32:143-145.
Mataix-Cols D, Wooderson S, Lawrence N, Brammer MJ, Speckens A, Phillips ML. Distinct neural correlates of washing, checking and hoarding symptom dimensions in obsessivecompulsive disorder. Arch Gen Psychiatry 2004; 61:564-576.
Baldwin MW, Fehr B, Keedian E, Seidel M, Thomson DW. An exploration of the relational schemata underlying attachment styles: self-report and lexical decision approaches. Pers Soc Psychol Bull 1993; 19:746-754.
Foa EB, Sacks MB, Tolin DF, Przeworski A, Amir N. Inflated perception of responsibility for harm in OCD patients with and without checking compulsions: a replication and extension. J Anxiety Disord 2002; 16:443-453.
Ashbaugh AR, Gelfand LA, Radomsky AS. Interpersonal aspects of responsibility and obsessive compulsive symptoms. Behav Cogn Psychother 2006; 34:151-163.
Wade D, Kyrios M, Jackson H. A model of obsessive-compulsive phenomena in a nonclinical sample. Aust J Psychol 1998; 50:11- 17.
Yorulmaz O, Karanci AN, Tekok-Kiliç A. What are the roles of perfectionism and responsibility in checking and cleaning compulsions? J Anxiety Disord 2006; 20:312-327.
Exner C, Martin C, Rief W. Self-focused ruminations and memory deficits in obsessive–compulsive disorder. Cognit Ther Res 2009; 33:163-174.
Rassin E, Muris P, Schmidt H, Merckelbach H. Relationships between thought-action fusion, thought suppression and obsessive-compulsive symptoms: a structural equation modeling approach. Behav Res Ther 2000; 38:889-897.
Myhr G, Sookman D, Pinard G. Attachment security and parental bonding in adults with obsessive compulsive disorder compared to depressed outpatients and healthy controls. Acta Psychiatr Scand 2004; 109:447-456.
Frost RO, Heimberg RG, Holt CS, Mattia JI, Neubauer AL. A comparison of two measures of perfectionism. Pers Individ Dif 1993; 14:119-126.
Flett GL, Hewitt PL. Positive versus negative perfectionism in psychopathology: A comment on Slade and Owens’s dual process model. Behav Modif 2006; 30:472-495.
Slade PD, Owens RG. A dual process model of perfectionism based on reinforcement theory. Behav Modif 1998; 22:372-390.
Fontenelle LF, Mendlowicz MV, Versiani M. Clinical subtypes of obsessive-compulsive disorder based on the presence of checking and washing compulsions. Rev Bras Psiquiatr 2005; 27:201-207.
Omori IM, Murata Y, Yamanishi T, Nakaaki S, Akechi T, Masahiko Mikuni M, Furukawa TA. The differential impact of executive attention dysfunction on episodic memory in obsessivecompulsive disorder patients with checking symptoms vs. those with washing symptoms. J Psychiatr Res 2007; 41:776-784.
Phillips ML, Marks IM, Senior C, Lythgoe D, O’Dwyer AM, Meehan O, Williams SC, Brammer MJ, Bullmore ET, McGuire PK. A differential neural response in obsessive-compulsive disorder patients with washing compared with checking symptoms to disgust. Psychol Med 2000; 30:1037-1050.
Gibbs NA. Nonclinical populations in research on obsessivecompulsive disorder: A critical review. Clin Psychol Rev 1996; 16:729-773.