Childhood trauma, sexual functions, psychiatric comorbidity and sociodemographic data in obsessive-compulsive disorders with sexual obsessions

Abstract

Objective: We compared the childhood trauma, the severity of sexual functions, comorbidity of axis I psychiatric disorder, the types and severity of obsessive-compulsive disorder (OCD) and sociodemographic data of patients with or without sexual obsession in OCD. Methods: Eighty patients of OCD were recruited from including consecutive admissions to an outpatient clinic. Pri-mary OCD patients assessed each subject using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). OCD symptoms and symptoms severity was assessed by the Yale-Brown Obsessive Compulsive Scale (YBOCS). Traumas were assessed by the Childhood Trauma Experiences Questionnaire. Sexual functions severity was assessed by the Arizona Sexual Experience Scale (ASEX). Current depressive and anxiety symptoms score were assessed using the 17-item Hamilton Rating Scale for Depression (HAM-D) and the Hamilton Anxiety Scale (HAM-A). Results: The frequency of sexual obsession was 15% in our clinical populations diagnosed with OCD. History of emotional abuse and incest were associated with a significantly higher rate of OCD with sexual obsessions. Reli-gious, aggressive, hoarding obsessions and hoarding compulsions were associated with a significantly higher rate of OCD with sexual obsessions. Comorbidity of Somatoform disorder was associated with a significantly higher rate of OCD with sexual obsessions. Subjects who have OCD with sexual obsessions did not significantly differ from those without sexual obsessions on any ASEX scores, Y-BOCS scores, HAM-D, HAM-A and demographic features. Conclusion: Sexual obsessions were related to religious, aggressive, hoarding obsessions and hoarding compul-sions, the emotional abuse, incest and a comorbidy of somatoform disorder.

Keywords

• sexual obsessions
• childhood trauma
• comorbidity

Cinsel obsesyonlarla seyreden obsesif-kompulsif bozukluklarda çocukluk çağı travması, cinsel işlevler, psikiyatrik komorbidite ve sosyodemografik veriler

Abstract

Amaç: Bu çalışmanın amacı; cinsel obsesyonlarla seyreden obsesif-kompulsif bozukluk (OKB) hastalarıyla diğer OKB hastalarını çocukluk çağı travması, cinsel işlev bozukluklarının şiddeti, eksen I psikiyatrik bozukluk komorbiditesi, OKB tip ve şiddeti ve de sosyodemografik verileri açısından karşılaştırmaktı. Yöntemler: Ayaktan tedavi ünitesine ardışık başvuruları içeren 80 OKB hastası alındı. Öncelikle, her bir OKB hasta-sı, DSM IV Eksen I Bozukluklar için Yapılandırılmış Klinik Görüşme (SCID-I) kullanılarak değerlendirildi. OKB semp-tomları ve semptom şiddeti Yale-Brown Obsesif Kompulsif Ölçek (YBOCS) ile değerlendirildi. Travmalar Çocukluk Çağı Travma Yaşantıları Anketi ile değerlendirildi. Cinsel işlev bozukluğu şiddeti Arizona Cinsel Yaşantılar Ölçeği kullanılarak değerlendirildi. Mevcut depresif ve anksiyete semptomları 17 maddeli Hamilton Depresyon Değerlendirme Ölçeği ve Hamilton Anksiyete Değerlendirme Ölçeği kullanılarak değerlendirildi. Bulgular: Bizim klinik populasyonumuzda cinsel obsesyon sıklığı OKB tanısı alanların %15\'inde mevcuttu. Duygusal istimar ve ensest belirgin biçimde daha yüksek oranda cinsel obsesyonlarla seyreden OKB ile ilişkili idi. Dini, agresif ve istifleme obsesyonları ile istifleme kompulsiyonları belirgin biçimde daha yüksek oranda cinsel obsesyonlarla seyreden OKB ile ilişkili idi. Cinsel obsesyonu olan OKB hastaları, cinsel obsesyonu olmayanlardan ASEX skorları, Y-BOCS skorları, HAM-D, HAM-A skorları ve demografik özellikler bakımından herhangi bir farklılık göstermedi. Sonuç: Cinsel obsesyonlar dini, agresif ve istifleme obsesyonları, istifleme kompulsiyonları, duygusal ihmal, ensest ve somatoform bozukluk komorbiditesi ile ilişkili bulundu.

Keywords

• Cinsel obsesyon
• çocukluk çağı travmaları
• komorbidite

References

1. Weissman MM, Bland RC, Canino GJ, et al. The cross na- tional epidemiology of obsessive compulsive disorder. The Cross National Collaborative Group. J Clin Psychiatry 1994;55:5-10.
2. Akhtar S, Wig NN, Varma VK, et al. A phenomenological analysis of symptoms in obsessive-compulsive neurosis. Br J Psychiatry 1975;127:342-348.
3. Chia BH. A Singapore study of obsessive compulsive disor- der. Singapore Med J 1996; 37:402-406.
4. Dowson JH. The phenomenology of severe obsessive-com- pulsive neurosis. Br J Psychiatry 1977;131:75-78.
5. Egrilmez A, Gülseren L, Gülseren S, Kültür S. Phenomenol- ogy of obsessions in a Turkish series of OCD patients. Psy- chopathology 1997;30:106-110.
6. Greenberg D. Are religious compulsions religious or com- pulsive: a phenomenological study. Am J Psychother 1984;38:524-532.
7. Holzer JC, Goodman WK, McDougle CJ, et al. Obsessive- compulsive disorder with and without a chronic tic disor- der. A comparison of symptoms in 70 patients. Br J Psy- chiatry 1994;164:469-473.
8. Mataix-Cols D, Rauch SL, Manzo PA, et al. Use of factor- analyzed symptom dimensions to predict outcome with serotonin reuptake inhibitors and placebo in the treat- ment of obsessive-compulsive disorder. Am J Psychiatry 1999;156:1409-1416.

9. Mahgoub OM, Abdel-Hafeiz HB. Pattern of obsessive-com- pulsive disorder in eastern Saudi Arabia. Br J Psychiatry 1991;158:840-842.
10. Okasha A, Saad A, Khalil AH, et al. Phenomenology of ob- sessive-compulsive disorder: a transcultural study. Compr Psychiatry 1994;35:191-197.
11. Rasmussen SA, Eisen JL. The epidemiology and clinical features of obsessive compulsive disorder. Psychiatr Clin North Am 1992;15:743-758.
12. Shooka A, al-Haddad MK, Raees A. OCD in Bahrain: a phe- nomenological profile. Int J Soc Psychiatry 1998;44:14:7- 54.
13. Tezcan E, Millet B.Phenomenology of obsessive-compul- sive disorders. Forms and characteristics of obsessions and compulsions in East Turkey. Encephale 1997;23:342-350.
14. Karadaĝ F, Oguzhanoglu NK, Ozdel O, et al. OCD symp- toms in a sample of Turkish patients: a phenomenological picture. Depress Anxiety 2006;23:145-152.
15. Tek C, Ulug B. Religiosity and religious obsessions in obses- sive-compulsive disorder. Psychiatry Res 2001:1;104:99- 108.
16. Staebler CR, Pollard CA, Merkel WT. Sexual history and quality of current relationships in patients with obsessive compulsive disorder: a comparison with two other psychi- atric samples. J Sex Marital Ther 1993;19:147-153.
17. Mathews CA, Kaur N, Stein MB. Childhood trauma and obsessive-compulsive symptoms. Depress Anxiety 2008;25:742-751.
18. Heiman JR. Sexual dysfunction: Overview of prevalence, etiological factors and treatments. J Sex Res. 2002;39:73– 78.
19. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: Prevalence and predictors. JAMA 1999;281:537–544.
20. Aksaray G, Yelken B, Kaptanoglu C, et al. Sexuality in women with obsessive compulsive disorder. J Sex Marital Ther 2001;27:273–277.
21. Freund B, Steketee G. Sexual history, attitudes and func- tioning of obsessive-compulsive patients. J Sex Marital Ther. 1989;15:31–41.
22. Vulink NC, Denys D, Bus L, Westenberg HG. Sexual plea- sure in women with obsessive-compulsive disorder? J Af- fect Disord 2006;91:19–25.
23. First MB, Spitzer RL, Gibbon M, et al. Structured clini- cal interview for DSM-IV clinical version (SCID-I/CV). American Psychiatric Press. Washington D.C. 1997.
24. Ozkurkcugil A, Aydemir O, Yildiz M, et al. Structured Clin- ical Interview for DSM-IV (SCID IV), Turkish Version. J Drug Treatment 1999;12:233-236.
25. Goodman WK, Price LH, Rasmussen SA, et al. The Yale- Brown Obsessive Compulsive Scale, I: Development, use and reliability. Arch Gen Psychiatry 1989;46:1006-1011.
26. Karamustafalioglu O, Ucisik A, Ulusoy M, et al. Yale- Brown Obsessive-Compulsive Scale in Turkish: reliability and validity. 29. National Psychiatry Congreas. Summary Book. Bursa, 1993;86.
27. Yargıç Lİ, Tutkun H, Şar V: Childhood traumas and dis- sociative experiences in adulthood. Proceedings of the 5th Spring Conference of the International Society for the Study of Dissociation,10-13 May 1995, Amsterdam, Hol- land.
28. Brown GR, Anderson B: Psychiatric morbidity in adult inpatients with childhood histories of sexual and physical abuse. Am J Psychiatry 1991;148:55-61.
29. McGahuey CA, Gelenberg AJ, Laukes CA, et al. The Ari- zona Sexual Experience Scale (ASEX): Reliability and va- lidity. J Sex Marital Ther 2000;26:25–40.
30. Soykan A. The Reliability and Validity of Arizona Sexual Experiences Scale in Turkish ESRD Patients Undergoing Hemodialysis. Int J Impotance Resh 2004;16:531-534.
31. Hamilton M. Development of a rating scale for primary de- pressive illness. Br J Soc Clin Psychology. 1967;6:278-96.
32. Akdemir A, Örsel S, Dağ I ve ark. Hamilton Depresyon De- recelendirme Ölçeği (HDDÖ)nin geçerliliği, güvenirliliği ve klinikte kullanımı. Psikiyatri Psikoloji Psikofarmakoloji Dergisi.1996;4:251-259.
33. Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol 1959;32:50-55.
34. Yazıcı MK, Demir B, Tanrıverdi N ve ark. Hamilton Anksi- yete Değerlendirme Ölçeği, Değerlendiriciler Arası Güve- nilirlik ve Geçerlilik Çalışması. Türk Psikiyatri Dergisi, 1998; 9:114-117.
35. Alonso P, Menchon JM, Pifarre J, et al. Long-term follow- up and predictors of clinical outcome in obsessive-compul- sive patients treated with serotonin reuptake inhibitors and behavioral therapy. J Clin Psychiatry 2001;62:535-540.
36. Mataix-Cols D, Rauch SL, Baer L, et al. Symptom stabil- ity in adult obsessive-compulsive disorder: data from a naturalistic two-year follow-up study. Am J Psychiatry 2002;159:263-268.
37. Denys D, de Geus F, van Megen HJ, Westenberg HG.Use of factor analysis to detect potential phenotypes in obsessive- compulsive disorder. Psychiatry Res 2004:30;128:273-280.
38. Hasler G, LaSalle-Ricci VH, et al. Obsessive-compulsive disorder symptom dimensions show specific relationships to psychiatric comorbidity. Psychiatry Res 2005;15;135:121- 132.
39. Tükel R, Polat A, Genç A, et al. Gender-related differences among Turkish patients with obsessive-compulsive disor- der. Compr Psychiatry 2004;45:362-366.
40. Lensi P, Cassano GB, Correddu G, et al. Obsessive-compul- sive disorder. Familial-developmental history, symptom- atology, comorbidity and course with special reference to gender-related differences. Br J Psychiatry 1996;169:101- 107.
41. Grant JE, Pinto A, Gunnip M, et al. Sexual obsessions and clinical correlates in adults with obsessive-compulsive dis- order. Compr Psychiatry 2006;47:325-329.
42. Mathews CA, Kaur N, Stein MB. Childhood trauma and obsessive-compulsive symptoms. Depress Anxiety 2008;25:742-751.
43. Freeman JB, Leonard HL. Sexual obsessions in obsessive- compulsive disorder. . J Am Acad Child Adolesc Psychiatry 2000;39:141-142.
44. Kendall-Tackett KA, Williams LM, Finkelhor D. Impact of sexual abuse on children: a review and synthesis of recent empirical studies. Psychol Bull 1993;113:164-180
45. De Silva P, Marks M. The role of traumatic experiences in the genesis of obsessive-compulsive disorder. Behav Res Ther. 199;37:941-951.
46. Forman-Hoffman VL, Mengeling M, Booth BM, et al. Eat- ing disorders, post-traumatic stress, and sexual trauma in women veterans. Mil Med 2012;177:1161-1168.
47. Maina G, Albert U, Bogetto F, et al. Recent life events and obsessive-compulsive disorder (OCD): the role of pregnan- cy/delivery. Psychiatry Res 1999 Dec 13;89:49-58.
48. Zhang T, Chow A, Wang L, et al. Role of childhood trau- matic experience in personality disorders in China. Compr Psychiatry 2012;53:829-836.
49. Khanna S, Rajendra PN, Channabasavanna SM. Life events and onset of obsessive compulsive disorder. Int J Soc Psy- chiatry. 1988;34:305-309.
50. Rasmussen SA, Tsuang MT. Clinical characteristics and family history in DSM-III obsessive-compulsive disorder. Am J Psychiatry. 1986;143:317-322.
51. Vulink NC, Denys D, Bus L, Westenberg HG. Sexual plea- sure in women with obsessive-compulsive disorder? J Af- fect Disord 2006;91:19-25.
52. Aksaray G, Yelken B, Kaptanoğlu C, et al. Sexuality in women with obsessive compulsive disorder. J Sex Marital Ther 2001;27:273-277.
53. Fontenelle LF, de Souza WF, de Menezes GB, et al. Sexual function and dysfunction in Brazilian patients with obses- sive-compulsive disorder and social anxiety disorder. J Nerv Ment Dis 2007;195:254-257.
54. Denys D, de Geus F, van Megen HJ, Westenberg HG. Use of factor analysis to detect potential phenotypes in obsessive- compulsive disorder. Psychiatry Res 2004;30;128:273-280.
55. Perugi G, Toni C, Frare F, et al. Obsessive-compulsive- bipolar comorbidity: a systematic exploration of clini- cal features and treatment outcome. J Clin Psychiatry 2002;63:1129-1134.