Ecker Willi, Gönner Sascha
Institute of Behaviour Therapy, Kurbrunnenstrasse 21a, D-67098 Bad Dürkheim, Germany.
Behav Res Ther. 2008 Aug;46(8):895-904. doi: 10.1016/j.brat.2008.04.002. Epub 2008 Apr 10.
Incompleteness (INC) and harm avoidance (HA) are motivational core dimensions of OCD. While HA-related concepts (e.g., inflated responsibility, overestimation of threat) are a main focus of current cognitive-behavioural OCD research, there is also a renewed interest in INC feelings and "not just right experiences" with an inability to achieve "closure" concerning actions/perceptions. This study systematically examines the association of OCD symptom dimensions with INC and HA in a large clinical OCD sample (n=202). Hierarchical linear multiple regression analyses controlling for anxiety, depression and symptom severity demonstrated a unique association of symmetry/ordering and checking (but not of contamination/washing and obsessional thoughts) with INC, and of obsessional thoughts and checking with HA. Thus, in contrast with symmetry/ordering (predominantly INC-related) and obsessional thoughts (predominantly HA-related), checking was motivationally heterogeneous, i.e., associated with INC and HA to a comparable and substantial degree. Contamination/washing failed to show a unique association with HA in two of three analyses, and with INC in all three analyses. Symptom severity uniquely contributed to INC in two of three analyses, but not to HA. Clinically, our results indicate that a conceptualization of OCD as an anxiety disorder is too narrow.
不完整性（INC）和伤害回避（HA）是强迫症的动机核心维度。虽然与伤害回避相关的概念（如夸大的责任感、对威胁的高估）是当前强迫症认知行为研究的主要焦点，但人们也重新关注不完整感以及无法对行为/感知达成“结束感”的“不对劲体验”。本研究在一个大型临床强迫症样本（n = 202）中系统地检验了强迫症症状维度与不完整性和伤害回避之间的关联。控制焦虑、抑郁和症状严重程度的分层线性多元回归分析表明，对称性/排序和检查（而非污染/清洗及强迫观念）与不完整性存在独特关联，强迫观念和检查与伤害回避存在独特关联。因此，与对称性/排序（主要与不完整性相关）和强迫观念（主要与伤害回避相关）不同，检查在动机上具有异质性，即与不完整性和伤害回避的关联程度相当且显著。在三项分析中的两项里，污染/清洗未能显示出与伤害回避的独特关联，在所有三项分析中均未显示出与不完整性的独特关联。在三项分析中的两项里，症状严重程度仅对不完整性有独特贡献，而对伤害回避无此贡献。在临床上，我们的结果表明，将强迫症概念化为焦虑障碍过于狭隘。
