نگرانی ها و وسواس ها در افرادی با اختلال وسواس اجباری با و بدون اختلال اضطراب تعمیم یافتۀ (فراگیر یا منتشر)

Participants from the DSM-IV field trial for OCD (N=381) were divided into two groups based on the SCID interview: those who met current criteria for obsessive–compulsive disorder (OCD) but not generalized anxiety disorder (GAD) and those who met current diagnostic criteria for both. The groups were compared on their severity of obsessive and compulsive symptoms, as well as on the percent of individuals who reported excessive worry concerning everyday issues (e.g. health, finances). The comorbidity rate was 20%. While the presence of GAD did not elevate OCD symptoms per se, it was associated with more pathological responsibility and indecisiveness. Excessive worries were significantly more common in those with comorbid OCD and GAD. The relationship between obsessions and worries is discussed.

The comorbidity of obsessive–compulsive disorder (OCD) with other anxiety disorders has been the topic of several investigations (e.g. Brown et al., 1993; Crino and Andrews, 1996). All studies reveal high comorbidity of OCD with other axis I and II disorders, especially with major depressive disorder and the various anxiety disorders. The comorbidity of OCD with generalized anxiety disorder (GAD) is of particular interest due to the seeming similarity between obsessions in OCD and worries in GAD, which both occupy central positions in the definitions of these disorders. While clinical observations support a distinction between the two phenomena, the terms `obsession' and `worry' are often used interchangeably because both refer to repetitive unwelcome thoughts. The DSM-IV work group on OCD (Foa et al., 1996) noted the potential diagnostic ambiguities that can arise from the resemblance between obsessions in OCD and worries in GAD. They invited Turner et al. (1992)to write a position paper that reviewed the relevant literature and summarized similarities and differences between these two phenomena. Turner et al. (1992)concluded that while both obsessions and worries are associated with negative affect, three important differences do exist. First, worry relates to exaggerated concern over everyday problems whereas the content of obsessions is not about everyday concerns. Second, obsessions are often experienced as more intrusive than worries. Third, obsessions often lead to behavioral or mental compulsions that aim at neutralizing or reducing the distress that they evoke, whereas worries do not give rise to such compulsions. Accordingly, in DSM-IV (APA, 1994, p. 422), the criteria for obsessions were amended to indicate that ``the thoughts, impulses, or images [obsessions] are not simply excessive worries about real-life problems''. The relationship between obsessions and worries in patients with comorbid OCD and GAD has not been examined. The conclusion of Turner et al. (1992)that worry does not produce ritualizing leads to the prediction that such comorbidity would not result in increased severity of obsessions or compulsions. The proposition that worry pertains to everyday life themes whereas obsessions do not, would lead to the prediction that higher rates of concern with everyday matters would be observed in OCD patients with comorbid GAD more than in those with OCD without GAD. The present paper addresses these issues by examining the types of concern exhibited in OCD individuals with and without GAD in the sample of participants in the DSM-IV Field Trial for OCD (Foa and Kozak, 1995)

Of the 381 participants in the field trial with OCD, 76 (20%) also met the criteria for GAD. The mean age for the group of OCD with GAD (M=36.4, SD=13.8) and that of OCD without GAD (M=36.1, SD=13.1) were not significantly different. However, the percent of females in the OCD with GAD group was significantly larger than the percent of females in the OCD without GAD group (62% versus 51%, respectively; χ2[1, N=381]=4.97, p=0.03). Both groups' means and standard deviations for the YBOCS items are presented in Table 1. Table 1. Comparisons of YBOCS items between groups OCD without GAD (n=305) OCD with GAD (n=75) M (SD) M (SD) Total YBOCS score 21.4 (7.3) 20.9 (8.5) Obsession subscale 10.5 (4.0) 10.7 (4.4) Time spent on obsessions 2.3 (1.1) 2.3 (1.2) Interference from obsessions 2.0 (0.9) 2.0 (1.0) Distress from obsessions 2.2 (0.9) 2.2 (1.0) Resistance to obsessions 1.7 (1.1) 1.8 (1.2) Control over obsessions 2.3 (1.0) 2.3 (1.1) Compulsion subscale 10.9 (4.0) 10.3 (4.7) Time spent on compulsions 2.2 (1.0) 2.2 (1.2) Interference from compulsions 2.0 (1.0) 1.7 (1.1) Distress from compulsions 2.4 (1.0) 2.1 (1.1) Resistance to compulsions 2.0 (1.0) 2.0 (1.2) Control over compulsions 2.4 (1.0) 2.3 (1.1) Supplemental items Insight into O-C symptoms 0.6 (0.7) 0.8 (0.8) Avoidance 1.6 (1.0) 1.7 (1.1) Indecisiveness∗ 1.3 (1.1) 1.8 (1.2) Pathological responsibility∗ 1.0 (1.1) 1.5 (1.0) Slowness 1.3 (1.1) 1.3 (1.1) Pathological doubting 1.4 (1.1) 1.7 (1.1) ∗p<0.002 (alpha set using the Bonferroni correction). Table options Between group t-tests for the 17 YBOCS items were computed to examine whether the additional diagnosis of GAD was related to differences in the severity of OCD symptoms. To correct for type I error we used the Bonferroni correction procedure and set the alpha level to p=0.003. No significant differences between groups emerged on the obsessions or compulsions sections of the scale. However, group differences emerged in the associated symptoms section. Patients diagnosed with concurrent OCD and GAD exhibited significantly more indecisiveness and pathological responsibility than those with OCD but no GAD. The percent of participants in each group who reported excessive worry in each of the eight content areas are presented in Fig. 1. Full-size image (26 K) Fig. 1. Percent of OCD patients with and without GAD who reported excessive worries by content of worry. Figure options As is apparent from Fig. 1, patients with both OCD and GAD reported more worry about common, everyday topics than those without GAD. Chi-square analyses with Bonferroni corrected alpha levels (p<0.006) further indicated that the differences in percents were statistically significant for each content area (all p's<0.001) except `other worries' (χ2[1, N=381]=4.32, p=0.04).