Department of Psychiatry, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, GGZ inGeest, Oldenaller 1, 1081, HJ, Amsterdam, The Netherlands.
Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands.
BMC Psychiatry. 2018 Dec 27;18(1):400. doi: 10.1186/s12888-018-1985-3.
The aim of this study was to explore perceptions of free will in the repetitive behaviors of patients with obsessive-compulsive disorder (OCD) and to explore their relation with core clinical characteristics.
Experiences of free will were assessed with the Symptomatology And Perceived Free will rating scale (SAPF) in 295 subjects with a lifetime diagnosis of OCD. Patients' scores on the SAPF were subjected to an explorative principal axis factor analysis (PAF). Factor scores were regressed on five OCD symptom dimensions and on seven clinical variables: illness duration, severity of OCD, insight, anxiety and depression, suicidal ideation and quality of life.
The PAF revealed three factors: the perceived ability to control and change one's course of action when faced with an obsession or compulsion (the "alternative possibilities" factor); the experience of obsessions or compulsions as intentional (the "intentionality" factor); and the experience of being the source or owner of the obsessions or compulsions (the "ownership" factor). Lower scores on the "alternative possibilities" factor were associated with lower scores on the washing dimension (β = 0.237, p = 0.004) and higher scores on the precision dimension (β = - 0.190, p = 0.025) and independently associated with longer illness duration (β = - 0.134, p = 0.039), higher illness severity (β = - 0.298, p < 0.001) and lower quality of life (β = 0.172, p = 0.046). Lower scores on the "intentionality" factor were independently associated with lower quality of life (β = 0.233, p = 0.027). Higher scores on the "ownership" factor were associated with higher scores on the precision dimension (β = 0.207, p = 0.023) and independently associated with poorer insight (β = 0.170, p = 0.045).
The most notable finding of this study is that a diminished experience of free will in OCD is associated with core clinical characteristics: illness duration and severity, insight and quality of life.
本研究旨在探讨强迫症（OCD）患者重复行为中的自由意志感知，并探讨其与核心临床特征的关系。
在 295 名有 OCD 终身诊断的患者中，使用症状和感知自由意志评定量表（SAPF）评估自由意志的体验。对 SAPF 评分进行探索性主轴因子分析（PAF）。因子得分与 OCD 五个症状维度和七个临床变量回归：疾病持续时间、OCD 严重程度、洞察力、焦虑和抑郁、自杀意念和生活质量。
PAF 揭示了三个因素：面对强迫观念或冲动时，能够控制和改变自己行为的能力（“替代可能性”因素）；强迫观念或冲动被体验为有意的（“意向性”因素）；以及强迫观念或冲动被体验为自己的来源或所有者（“所有权”因素）。“替代可能性”因子得分较低与洗涤维度得分较低相关（β=0.237，p=0.004），与精确维度得分较高相关（β=-0.190，p=0.025），且与疾病持续时间较长独立相关（β=-0.134，p=0.039）、疾病严重程度较高（β=-0.298，p<0.001）和生活质量较低（β=0.172，p=0.046）。“意向性”因子得分较低与生活质量较低独立相关（β=0.233，p=0.027）。“所有权”因子得分较高与精确维度得分较高相关（β=0.207，p=0.023），且与洞察力较差独立相关（β=0.170，p=0.045）。
本研究的最显著发现是，OCD 中自由意志体验的减弱与核心临床特征相关：疾病持续时间和严重程度、洞察力和生活质量。
