Van Schalkwyk Gerrit I, Bhalla Ish P, Griepp Matthew, Kelmendi Benjamin, Davidson Larry, Pittenger Christopher
Department of Psychiatry, Yale University, New Haven, CT, USA.
Department of Psychiatry, Yale University, New Haven, CT, USA Yale Program for Recovery and Community Health, Yale University, New Haven, CT, USA.
Aust N Z J Psychiatry. 2016 Jan;50(1):74-81. doi: 10.1177/0004867415579919. Epub 2015 Apr 8.
Current attempts at understanding the heterogeneity in obsessive-compulsive disorder have relied on quantitative methods. The results of such work point toward a dimensional structure for obsessive-compulsive disorder. Existing qualitative work in obsessive-compulsive disorder has focused on understanding specific aspects of the obsessive-compulsive disorder experience in greater depth. However, qualitative methods are also of potential value in furthering our understanding of obsessive-compulsive disorder heterogeneity by allowing for open-ended exploration of the obsessive-compulsive disorder experience and correlating identified subtypes with patient narratives.
We explored variations in patients' experience prior to, during and immediately after performing their compulsions.
Semi-structured interviews were conducted with 20 adults with obsessive-compulsive disorder, followed by inductive thematic analysis. Participant responses were not analyzed within the context of an existing theoretical framework, and themes were labeled descriptively.
The previous dichotomy of 'anxiety' vs 'incompleteness' emerged organically during narrative analysis. In addition, we found that some individuals with obsessive-compulsive disorder utilized their behaviors as a way to cope with stress and anxiety more generally. Other participants did not share this experience and denied finding any comfort in their obsessive-compulsive behaviors. The consequences of attentional difficulties were highlighted, with some participants describing how difficulty focusing on a task could influence the need for it to be repeated multiple times.
The extent to which patients use obsessive-compulsive disorder as a coping mechanism is a relevant distinction with potential implications for treatment engagement. Patients may experience ambivalence about suppressing behaviors that they have come to rely upon for management of stress and anxiety, even if these behaviors represent symptoms of a psychiatric illness.
目前对于理解强迫症异质性的尝试依赖于定量方法。此类研究结果指向强迫症的维度结构。现有的关于强迫症的定性研究主要聚焦于更深入地理解强迫症体验的特定方面。然而，定性方法在进一步加深我们对强迫症异质性的理解方面也具有潜在价值，因为它允许对强迫症体验进行开放式探索，并将所识别的亚型与患者叙述相关联。
我们探讨了患者在执行强迫行为之前、期间及之后即刻的体验差异。
对20名成年强迫症患者进行了半结构化访谈，随后进行归纳主题分析。参与者的回答未在现有理论框架的背景下进行分析，主题采用描述性标注。
在叙事分析过程中，先前的“焦虑”与“不完整感”二分法自然浮现。此外，我们发现一些强迫症患者将其行为作为更普遍地应对压力和焦虑的一种方式。其他参与者则没有这种体验，并且否认从强迫行为中获得任何安慰。注意力困难的后果得到了凸显，一些参与者描述了专注于一项任务的困难如何可能影响对其进行多次重复的需求。
患者将强迫症作为一种应对机制的程度是一个具有相关区别，对治疗参与度可能具有潜在影响。患者对于抑制他们已开始依赖以管理压力和焦虑的行为可能会感到矛盾，即使这些行为代表精神疾病的症状。
