Martin Heather S, Falkenstein Martha J, Nota Jacob A, Kuckertz Jennie M
Obsessive Compulsive Disorder Institute, McLean Hospital, 115 Mill St, Belmont, MA, 02478.
Department of Psychiatry, Harvard Medical School, 115 Mill St, Belmont, MA, 02478.
Cognit Ther Res. 2025 Aug;49(4):795-806. doi: 10.1007/s10608-024-10561-2. Epub 2025 Jan 25.
Content-based models, which focus on observable symptom content, have dominated much of the literature on heterogeneity in OCD. However, alternate models emphasize the motivations underlying different symptom presentations, including harm avoidance (HA) and incompleteness (INC). To promote understanding of these motivations, we examined their associations with various content-based symptom dimensions, obsessive belief patterns, and other clinical characteristics.
We examined a large set of demographic and clinical characteristics and their associations with HA and/or INC among individuals ( = 218) receiving treatment for OCD and related disorders in a partial hospital/residential program. We also examined the extent to which HA and INC mapped onto dimensions in prevailing symptom content and obsessive belief models.
Results showed that women reported more HA than men, and INC was associated with an earlier age of onset. HA and INC were not differentially associated with sexual orientation, self-view, quality of life, depression, or suicidality. HA and INC mapped onto symptom content and obsessive belief models in some, but not all the ways we expected. Notably, contamination/washing in our sample was associated with INC, but not HA.
Understanding motivations underlying OCD symptoms may lead to personalized care and improvement in treatment outcomes. We suggest that future research should continue to examine the motivational model, as well as ways in which presentations of each motivation may differ.
基于内容的模型专注于可观察到的症状内容，在强迫症异质性的诸多文献中占据主导地位。然而，其他模型强调不同症状表现背后的动机，包括避免伤害（HA）和不完整性（INC）。为增进对这些动机的理解，我们研究了它们与各种基于内容的症状维度、强迫观念模式及其他临床特征之间的关联。
我们在一个部分住院/寄宿项目中，研究了大量人口统计学和临床特征，以及它们与接受强迫症及相关障碍治疗的个体（ = 218）的HA和/或INC之间的关联。我们还研究了HA和INC在多大程度上与主流症状内容和强迫观念模型中的维度相对应。
结果显示，女性报告的HA比男性更多，且INC与发病年龄较早有关。HA和INC与性取向、自我认知、生活质量、抑郁或自杀倾向没有差异关联。HA和INC在某些方面，但并非我们预期的所有方面，与症状内容和强迫观念模型相对应。值得注意的是，我们样本中的污染/清洗与INC有关，而与HA无关。
理解强迫症症状背后的动机可能会带来个性化护理并改善治疗效果。我们建议未来的研究应继续考察动机模型，以及每种动机的表现方式可能存在的差异。
