Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-25T20:50:48.112Z Has data issue: false hasContentIssue false
  • English
  • Français

Interpersonal Ambivalence in Obsessive-Compulsive Disorder

Published online by Cambridge University Press:  13 September 2012

Steffen Moritz ,
Helen Niemeyer ,
Birgit Hottenrott ,
Lisa Schilling  and
Carsten Spitzer
Steffen Moritz*
Affiliation:
University Medical Center Hamburg-Eppendorf, Germany
Helen Niemeyer
Affiliation:
Heinrich-Heine-University, Düsseldorf, Germany
Birgit Hottenrott
Affiliation:
University Medical Center Hamburg-Eppendorf, Germany
Lisa Schilling
Affiliation:
University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg-Eilbek, Germany
Carsten Spitzer
Affiliation:
Schön Klinik Hamburg-Eilbek, Hamburg, Germany
*
Reprint requests to Steffen Moritz, University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistr. 52, D-20246 Hamburg, Germany. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: The social attitudes and interpersonal relationships of patients with obsessive-compulsive disorder (OCD) are subject to a longstanding controversy. Whereas cognitive-behavioural researchers emphasize exaggerated pro-social attitudes in OCD like inflated responsibility and worry for other people (especially significant others), dynamic theories traditionally focus on anti-social attitudes such as latent aggression and hostility. In two recent studies, we gathered support not only for a co-existence of these seemingly opposing attitudes in OCD, but also for a functional connection: inflated responsibility in part appears to serve as a coping strategy (or “defense”) against negative interpersonal feelings. Aims: In the present study, we tested a shortened version of the Responsibility and Interpersonal Behaviours and Attitudes Questionnaire (RIBAQ-R). Method: The scale was administered to 34 participants with OCD and 34 healthy controls. The questionnaire concurrently measures pro-social and anti-social interpersonal attitudes across three subscales. Results: In line with our prior studies, patients displayed higher scores on both exaggerated pro-social attitudes (e.g. “I suffer from a strict conscience concerning my relatives”) as well as latent aggression (e.g. “Sometimes I would like to harm strangers on the street“) and suspiciousness/distrust (e.g. “I cannot even trust my own family”). A total of 59% of the patients but only 12% of the healthy controls showed marked interpersonal ambivalence (defined as scores higher than one standard deviation from the mean of the nonclinical controls on both the pro-social and at least one of the two anti-social subscales). Conclusions: The study asserts high interpersonal ambivalence in OCD. Further research is required to pinpoint both the dynamic and causal links between opposing interpersonal styles. Normalization and social competence training may prove beneficial to resolve the apparent problems of patients with OCD regarding anger expression and social conflict management.

Keywords

Obsessive-compulsive disordercognitive-behavioural therapycognitioncognitive biaseslatent aggressionresponsibility
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 41 , Issue 5 , October 2013 , pp. 594 - 609
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2012 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abramowitz, J. S. (2006). The psychological treatment of obsessive-compulsive disorder. Canadian Journal of Psychiatry, 51, 407–416.CrossRefGoogle ScholarPubMed
Abramowitz, J. S. and Deacon, B. J. (2006). Psychometric properties and construct validity of the Obsessive-Compulsive Inventory-Revised: replication and extension with a clinical sample. Journal of Anxiety Disorders, 20, 1016–1035.CrossRefGoogle ScholarPubMed
Adam, Y., Meinlschmidt, G., Gloster, A. T. and Lieb, R. (2012). Obsessive-compulsive disorder in the community: 12-month prevalence, comorbidity and impairment. Social Psychiatry and Psychiatric Epidemiology, 47, 339–349.CrossRefGoogle ScholarPubMed
Apter, A., Horesh, N., Gothelf, D., Zalsman, G., Erlich, Z., Soreni, N., et al. (2003). Depression and suicidal behaviour in adolescent inpatients with obsessive compulsive disorder. Journal of Affective Disorders, 75, 181–189.CrossRefGoogle ScholarPubMed
Beck, A. T. (1995). Beck-Depressions-Inventar (BDI). [Beck Depression Inventory]. Göttingen: Hogrefe.Google Scholar
Bejerot, S., Ekselius, L. and von Knorring, L. (1998). Comorbidity between obsessive-compulsive disorder (OCD) and personality disorders. Acta Psychiatrica Scandinavica, 97, 398–402.CrossRefGoogle ScholarPubMed
Belloch, A., Morillo, C., Luciano, J. V., García-Soriano, G., Cabedo, E. and Carrió, C. (2010). Dysfunctional belief domains related to obsessive-compulsive disorder: a further examination of their dimensionality and specificity. Spanish Journal of Psychology, 13, 376–388.CrossRefGoogle ScholarPubMed
Coles, M. E., Pinto, A., Mancebo, M. C., Rasmussen, S. A. and Eisen, J. L. (2008). OCD with comorbid OCPD: a subtype of OCD? Psychiatry Research, 42, 289–296.CrossRefGoogle ScholarPubMed
Coles, M. E. and Schofield, C. A. (2008). Assessing the development of inflated responsibility beliefs: the pathways to inflated responsibility beliefs scale (PIRBS). Behaviour Therapy, 39, 322–335.CrossRefGoogle Scholar
de Reus, R. J. M. and Emmelkamp, P. M. G. (2010). Obsessive–compulsive personality disorder: a review of current empirical findings. Personality and Mental Health, 6, 1–21.CrossRefGoogle Scholar
Fahrenberg, J., Hampel, R. and Selg, H. (1989). Das Freiburger Persönlichkeitsinventar FPI: revidierte Fassung FPI-R und teilweise geänderte Fassung FPI A1 [The Freiburg Personality Inventory FPI: revised version FPI-R and partly revised version FPI A1]. Göttingen, Germany: Hogrefe.Google Scholar
Fenichel, O. (1945). The Psychoanalytic Theory of Neurosis. New York: W. W. Norton & Company.Google Scholar
Foa, E. B., Huppert, J. D., Leiberg, S., Langner, R., Kichic, R., Hajcak, G., et al. (2002). The Obsessive-Compulsive Inventory: development and validation of a short version. Psychological Assessment, 14, 485–496.CrossRefGoogle ScholarPubMed
Freud, S. (1955). Notes upon a case of obsessional neurosis. In Strachey, J. (Ed.), The Standard Edition of the Complete Psychological Works of Sigmund Freud. London: Hogarth Press.Google Scholar
Gava, I., Barbui, C., Aguglia, E., Carlino, D., Churchill, R., De Vanna, M., et al. (2007). Psychological treatments versus treatment as usual for obsessive compulsive disorder (OCD). Cochrane Database of Systematic Reviews.CrossRefGoogle Scholar
Gönner, S., Leonhart, R. and Ecker, W. (2007). Das Zwangsinventar OCI-R - die deutsche Version des Obsessive-Compulsive Inventory-Revised: Ein kurzes Selbstbeurteilungsinstrument zur mehrdimensionalen Messung von Zwangssymptomen [The German version of the obsessive-compulsive inventory-revised: a brief self-report measure for the multidimensional assessment of obsessive-compulsive symptoms]. Psychotherapie, Psychosomatik, Medizinische Psychologie, 57, 395–404.CrossRefGoogle Scholar
Gönner, S., Leonhart, R. and Ecker, W. (2008). The Obsessive-Compulsive Inventory-Revised (OCI-R): validation of the German version in a sample of patients with OCD, anxiety disorders, and depressive disorders. Journal of Anxiety Disorders, 22, 734–749.CrossRefGoogle Scholar
Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Delgado, P., Heninger, G. R., et al. (1989). The Yale-Brown Obsessive Compulsive Scale. II. Validity. Archives of General Psychiatry, 46, 1012–1016.CrossRefGoogle ScholarPubMed
Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. L., et al. (1989). The Yale-Brown Obsessive Compulsive Scale. I. development, use, and reliability. Archives of General Psychiatry, 46, 1006–1011.CrossRefGoogle ScholarPubMed
Guerrero, A. P., Hishinuma, E. S., Andrade, N. N., Bell, C. K., Kurahara, D. K., Lee, T. G., et al. (2003). Demographic and clinical characteristics of adolescents in Hawaii with obsessive-compulsive disorder. Archives of Pediatrics and Adolescent Medicine, 157, 665–670.CrossRefGoogle ScholarPubMed
Hand, I. (1988). Obsessive-compulsive patients and their families. In Falloon, I. R. H. (Ed.), Handbook of Behavioural Family Therapy (pp. 231–256). New York: Guilford Press.Google Scholar
Hand, I. (1991). Aggression und soziale Defizite bei psychischen Erkrankungen. Überlegungen zu einer Modellbildung [Aggression and social deficts in psychological disorders. Considerations for a new model]. In Pöldinger, W. (Ed.), Aggression und Autoaggression (Vol. 8, pp. 27–45). Hanover: Duphar Med. Script.Google Scholar
Hand, I. (1998). Out-patient, multi-modal behaviour therapy for obsessive-compulsive disorder. British Journal of Psychiatry, 35, 45–52.CrossRefGoogle Scholar
Hauschildt, M., Jelinek, L., Randjbar, S., Hottenrott, B. and Moritz, S. (2010). Generic and illness-specific quality of life in obsessive-compulsive disorder. Behavioural and Cognitive Psychotherapy, 38, 417–436.CrossRefGoogle ScholarPubMed
Hodgson, R. and Rachman, S. (1977). Obsessive-compulsive complaints. Behaviour Research and Therapy, 15, 389–395.CrossRefGoogle Scholar
Huppert, J. D., Walther, M. R., Hajcak, G., Yadin, E., Foa, E. B., Simpson, H. B., et al. (2007). The OCI-R: validation of the subscales in a clinical sample. Journal of Anxiety Disorders, 21, 394–406.CrossRefGoogle Scholar
Jacobsen, D., Kloss, M., Fricke, S., Hand, I. and Moritz, S. (2003). Reliabilität der deutschen Version der Yale-Brown Obsessive Compulsive Scale [Reliability of the German version of the Yale-Brown Obsessive Compulsive Scale]. Verhaltenstherapie, 13, 111–113.CrossRefGoogle Scholar
Kempke, S. and Luyten, P. (2007). Psychodynamic and cognitive-behavioural approaches of obsessive-compulsive disorder: is it time to work through our ambivalence? Bulletin of the Menninger Clinic, 71, 291–311.CrossRefGoogle Scholar
Kohn, R., Saxena, S., Levav, I. and Saraceno, B. (2004). The treatment gap in mental health care. Bulletin of the World Health Organisation, 82, 858–866.Google ScholarPubMed
Kozak, M. J. and Foa, E. B. (1997). Mastery of Obsessive Compulsive Disorder: a cognitive behavioural approach. San Antonio: Psychological Corporation.Google Scholar
Manchanda, R., Sethi, B. B. and Gupta, S. C. (1979). Hostility and guilt in obsessive-compulsive neurosis. British Journal of Psychiatry, 135, 52–54.CrossRefGoogle ScholarPubMed
Michael, B., Spitzer, R. L., Gibbon, M. and Williams, J. B. W. (2002). Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition (SCID-I/P) New York: Biometrics Research New York State Psychiatric Institute.Google Scholar
Millar, D. G. (1983). Hostile emotion and obsessional neurosis. Psychological Medicine, 13, 813–819.CrossRefGoogle ScholarPubMed
Moritz, S. (2008). A review on quality of life and depression in obsessive-compulsive disorder. CNS Spectrums, 13 (Suppl. 14), 16–22.CrossRefGoogle ScholarPubMed
Moritz, S., Jelinek, L., Hauschildt, M. and Naber, D. (2010). How to treat the untreated: effectiveness of a self-help metacognitive training program (myMCT) for obsessive-compulsive disorder. Dialogues in Clinical Neurosciences, 12, 209–220.CrossRefGoogle ScholarPubMed
Moritz, S., Kempke, S., Luyten, P., Randjbar, S. and Jelinek, L. (2011). Was Freud partly right on obsessive-compulsive disorder (OCD)? Investigation of latent aggression in OCD. Psychiatry Research, 187, 180–184.CrossRefGoogle ScholarPubMed
Moritz, S., Meier, B., Kloss, M., Jacobsen, D., Wein, C., Fricke, S., et al. (2002). Dimensional structure of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Psychiatry Research, 109, 193–199.CrossRefGoogle ScholarPubMed
Moritz, S., Wahl, K., Ertle, A., Jelinek, L., Hauschildt, M., Klinge, R., et al. (2009). Neither saints nor wolves in disguise: ambivalent interpersonal attitudes and behaviours in obsessive-compulsive disorder. Behaviour Modification, 33, 274–292.CrossRefGoogle ScholarPubMed
Moscovitch, D. A., McCabe, R. E., Antony, M. M., Rocca, L. and Swinson, R. P. (2008). Anger experience and expression across the anxiety disorders. Depression & Anxiety, 25, 107–113.CrossRefGoogle ScholarPubMed
O'Kearney, R. T., Anstey, K. J. and von Sanden, C. (2006). Behavioural and cognitive behavioural therapy for obsessive compulsive disorder in children and adolescents. Cochrane Database Systematic Reviews, 18. CD004856.Google Scholar
Obsessive Compulsive Cognitions Working Group (1997). Cognitive assessment of obsessive-compulsive disorder. Behaviour Research and Therapy, 35, 667–681.CrossRefGoogle Scholar
Obsessive Compulsive Cognitions Working Group (2001). Development and initial validation of the Obsessive Beliefs Questionnaire and the Interpretation of Intrusions Inventory. Behaviour Research and Therapy, 39, 987–1006.CrossRefGoogle Scholar
Obsessive Compulsive Cognitions Working Group (2003). Psychometric validation of the Obsessive Beliefs Questionnaire and the Interpretation of Intrusions Inventory: Part I. Behaviour Research and Therapy, 41, 863–878.CrossRefGoogle Scholar
Obsessive Compulsive Cognitions Working Group (2005). Psychometric validation of the Obsessive Beliefs Questionnaire and the Interpretation of Intrusions Inventory – Part II: factor analyses and testing of a brief version. Behaviour Research and Therapy, 43, 1527–1542.CrossRefGoogle Scholar
Offer, R., Lavie, R., Gothelf, D. and Apter, A. (2000). Defense mechanisms, negative emotions, and psychopathology in adolescent inpatients. Comprehensive Psychiatry, 41, 35–41.CrossRefGoogle ScholarPubMed
Pfeffer, C. R. (1986). The Suicidal Child. New York: Guilford.Google Scholar
Pinard, G. (2006). The pharmacologic and psychological treatment of obsessive-compulsive disorder. Canadian Journal of Psychiatry, 51, 405–406.CrossRefGoogle ScholarPubMed
Plutchik, R., Kellerman, H. and Conte, H. R. (1979). A structural theory of ego defenses and emotions. In Izard, C. E. (Ed.), Emotions in Personality and Psychopathology (pp. 229–257). New York: Plenum Press.Google Scholar
Radomsky, A. S., Ashbaugh, A. R. and Gelfand, L. A. (2007). Relationships between anger, symptoms, and cognitive factors in OCD checkers. Behaviour Research and Therapy, 45, 2712–2725.CrossRefGoogle ScholarPubMed
Rosa-Alcazar, A. I., Sanchez-Meca, J., Gomez-Conesa, A. and Marin-Martinez, F. (2008). Psychological treatment of obsessive-compulsive disorder: a meta-analysis. Clinical Psychology Review, 28, 1310–1325.CrossRefGoogle ScholarPubMed
Salkovskis, P., Shafran, R., Rachman, S. and Freeston, M. H. (1999). Multiple pathways to inflated responsibility beliefs in obsessional problems: possible origins and implications for therapy and research. Behaviour Research and Therapy, 37, 1055–1072.CrossRefGoogle Scholar
Salkovskis, P. M. and Forrester, E. (2002). Responsibility. In Frost, R. O. and Steketee, G. (Eds.), Cognitive Approaches to Obsessions and Compulsions: theory, assessment and treatment (pp. 45–51). Amsterdam: Pergamon.CrossRefGoogle Scholar
Salkovskis, P. M., Wroe, A. L., Gledhill, A., Morrison, N., Forrester, E., Richards, C., et al. (2000). Responsibility attitudes and interpretations are characteristic of obsessive compulsive disorder. Behaviour Research and Therapy, 38, 347–372.CrossRefGoogle ScholarPubMed
Schaible, R., Armbrust, M. and Nutzinger, D. O. (2001). Yale-Brown Obsessive Compulsive Scale: Sind Selbst- und Fremdrating äquivalent? [Yale-Brown Obsessive Compulsive Scale: Are self-rating and interview equivalent measures?]. Verhaltenstherapie, 11, 298–303.CrossRefGoogle Scholar
Shoval, G., Zalsman, G., Sher, L., Apter, A. and Weizman, A. (2006). Clinical characteristics of inpatient adolescents with severe obsessive-compulsive disorder. Depression and Anxiety, 23, 62–70.CrossRefGoogle ScholarPubMed
Stein, D. J. and Hollander, E. (1993). Impulsive aggression and obsessive-compulsive disorder Psychiatric Annals, 23, 389–395.CrossRefGoogle Scholar
Steketee, G., Frost, R. O. and Cohen, I. (1998). Beliefs in obsessive-compulsive disorder. Journal of Anxiety Disorders, 12, 525–537.CrossRefGoogle ScholarPubMed
Storch, E. A., Lack, C. W., Merlo, L. J., Geffken, G. R., Jacob, M. L., Murphy, T. K., et al. (2007). Clinical features of children and adolescents with obsessive-compulsive disorder and hoarding symptoms. Comprehensive Psychiatry, 48, 313–318.CrossRefGoogle ScholarPubMed
Taylor, S. (1995). Assessment of obsessions and compulsions: reliability, validity, and sensitivity to treatment effects. Clinical Psychology Review, 15, 261–296.CrossRefGoogle Scholar
Torres, A. R., Moran, P., Bebbington, P., Brugha, T., Bhugra, D., Coid, J. W., et al. (2006). Obsessive-compulsive disorder and personality disorder: evidence from the British National Survey of Psychiatric Morbidity 2000. Social Psychiatry and Psychiatric Epidemiology, 41, 862–867.CrossRefGoogle ScholarPubMed
Whiteside, S. P. and Abramowitz, J. S. (2004). Obsessive-compulsive symptoms and the expression of anger. Cognitive Therapy and Research, 28, 259–268.CrossRefGoogle Scholar
Whiteside, S. P. and Abramowitz, J. S. (2005). The expression of anger and its relationship to symptoms and cognitions in Obsessive-Compulsive Disorder. Depression and Anxiety, 21, 106–111.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.