Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Amsterdam UMC, Location VUmc, Department of Psychiatry, Amsterdam Public Health research institute and GGZ inGeest Specialized Mental Health Care, the Netherlands.
Br J Clin Psychol. 2021 Sep;60(3):312-332. doi: 10.1111/bjc.12292. Epub 2021 Apr 18.
Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder, often complicated with comorbidities. Social phobia (SP) is the most frequent co-occurring anxiety disorder in OCD, associated with increased clinical severity. However, no study had examined the relevance of interpersonal processes in this comorbidity, which are at the core of SP. This study characterized the clinical (i.e., symptom profile, age of onset, chronicity, and comorbidity), vulnerability (i.e., childhood trauma, negative life events), and interpersonal (attachment style, expressed emotion, and social support) correlates of comorbid SP in a large sample of OCD patients.
We analysed the data of 382 OCD patients participating in the Netherlands Obsessive Compulsive Disorder Association (NOCDA) study. We examined the correlates of SP in OCD using self-report questionnaires and structured clinical interviews. In addition, data of 312 non-OCD SP patients were drawn from the Netherlands Study of Depression and Anxiety (NESDA), to compare the age of onset of SP between groups. Descriptive univariate analyses were followed by backward stepwise logistic regression analyses.
Social phobia was present among approximately 20% of OCD patients. Social phobia in OCD was associated with increased depression severity and decreased ratings of secure attachment style. Among OCD patients, SP had a significantly earlier age onset as compared to SP in non-OCD patients.
Social phobia in OCD might render a vulnerable clinical picture, characterized with early onset of SP symptoms, insecure attachment style, and increased depressive symptoms. Future studies should use prospective designs to better understand the nature of comorbid SP in OCD.
Approximately one fifth of OCD patients were diagnosed with comorbid social phobia in a large representative clinical sample. OCD patients with comorbid social phobia presented with a vulnerable clinical picture, characterized with increased depression severity and decreased ratings of secure attachment style. Social phobia in OCD was associated with an earlier AOO as compared to the AOO of social phobia without OCD. The findings are limited by a cross-sectional design; thus, causality could not be assessed. Research is needed to further examine the mechanisms of comorbid social phobia in OCD.
强迫症（OCD）是一种使人衰弱的精神疾病，常伴有共病。社交恐惧症（SP）是 OCD 中最常见的共发焦虑症，与临床严重程度增加有关。然而，尚无研究探讨共病中人际过程的相关性，而这些相关性是 SP 的核心。本研究在一个大型 OCD 患者样本中，对 SP 共病的临床（即症状谱、发病年龄、慢性和共病）、易感性（即儿童创伤、生活负性事件）和人际（依恋风格、表达情感和社会支持）相关性进行了特征描述。
我们分析了参加荷兰强迫症协会（NOCDA）研究的 382 名 OCD 患者的数据。我们使用自我报告问卷和结构化临床访谈，对 OCD 中的 SP 相关性进行了检查。此外，从荷兰抑郁与焦虑研究（NESDA）中提取了 312 名非 OCD SP 患者的数据，以比较两组 SP 的发病年龄。首先进行描述性单变量分析，然后进行向后逐步逻辑回归分析。
大约 20%的 OCD 患者存在社交恐惧症。OCD 中的社交恐惧症与抑郁严重程度增加和安全感依恋风格降低有关。与非 OCD 患者相比，OCD 患者的 SP 发病年龄明显更早。
OCD 中的社交恐惧症可能会导致易感性的临床特征，表现为 SP 症状的早发性、不安全的依恋风格和增加的抑郁症状。未来的研究应该使用前瞻性设计来更好地理解 OCD 中社交恐惧症的性质。
在一个大型代表性临床样本中，大约五分之一的 OCD 患者被诊断为社交恐惧症共病。OCD 患者伴发社交恐惧症表现为易感性的临床特征，表现为抑郁严重程度增加和安全感依恋风格降低。与无 OCD 的社交恐惧症相比，OCD 中的社交恐惧症与发病年龄较早有关。由于研究设计为横断面研究，因此无法评估因果关系。需要进一步研究来更深入地探讨 OCD 中社交恐惧症的共病机制。
