Discipline of Psychiatry, Sydney Medical School-Nepean, University of Sydney, Nepean Hospital, Penrith, Sydney, NSW 2751, Australia.
Psychiatr Q. 2011 Jun;82(2):151-61. doi: 10.1007/s11126-010-9157-8.
Beliefs are associated with most obsessions and compulsions in obsessive-compulsive disorder (OCD). The characteristics of these beliefs can vary considerably, which has led to some of them being regarded as overvalued ideas or delusions and has contributed to confusion regarding the conceptualization and classification of OCD. This article proposes that beliefs arising in the context of OCD be assessed along the following, well-defined characteristics: conviction, fixity, fluctuation, resistance (to beliefs), insight pertaining to an awareness of the inaccuracy of one's belief, and insight referring to the ability to attribute the belief to an illness. This approach to the assessment of OCD-related beliefs may allow a clearer distinction between non-delusional beliefs, overvalued ideas, and delusions. Although the characteristics of non-delusional beliefs may vary, especially on the dimension of awareness of the inaccuracy of belief, these beliefs can generally be distinguished from overvalued ideas and delusions in terms of lower levels of conviction and fixity and greater fluctuation, resistance and ability to attribute the belief to OCD. The development of an assessment tool using these well-defined characteristics will test the proposed model, which may lead to a more objective evaluation of OCD-related beliefs. This is likely to have implications for diagnostic conceptualization and subtyping of OCD.
信念与强迫症 (OCD) 中的大多数强迫观念和强迫行为有关。这些信念的特征差异很大，其中一些被认为是过度重视的想法或妄想，导致 OCD 的概念化和分类存在混淆。本文提出，在 OCD 背景下产生的信念应根据以下明确界定的特征进行评估：信念的坚定程度、固定程度、波动程度、对信念的抗拒（即改变信念的难易程度）、对信念的准确性的认识程度，以及归因于疾病的能力。这种评估 OCD 相关信念的方法可以更清楚地区分非妄想信念、过度重视的想法和妄想。虽然非妄想信念的特征可能会有所不同，特别是在对信念准确性的认识维度上，但这些信念通常可以与过度重视的想法和妄想区分开来，因为它们的信念坚定程度和固定程度较低，波动性、抗拒程度和归因于 OCD 的能力较高。使用这些明确界定的特征开发评估工具将检验所提出的模型，这可能会导致对 OCD 相关信念进行更客观的评估。这可能对 OCD 的诊断概念化和亚型划分产生影响。
