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Faulty Appraisals and Belief Domains in Obsessive Compulsive Disorder From Childhood to Adulthood

Year 2010, Volume: 2 Issue: 1, 117 - 131, 01.03.2010

Abstract

Among cognitive models attempting to explain the etiology of Obsessive Compulsive Disorder (OCD), models such as Inflated Responsibility Model, Misinterpretation of Significance Theory and Cognitive Control Model are currently considered to be valid in many aspects in understanding adulthood OCD. Embracing these models that underline various cognitions in adult OCD, the presence of six faulty appraisals and belief domains can be noticed: inflated responsibility; overimportance of thoughts; excessive concern about the importance of controlling one's thoughts, overestimation of threat, intolerance of uncertainty and perfectionism. Previous studies indicated a difference between early onset OCD and late onset OCD with regards to the presence of pure compulsions, insidious onset of symptoms. Examining faulty assessment and belief domains related with OCD reveals that overimportance of thoughts, intolerance of uncertainty and perfectionism is not only limited to adulthood, but also observed during childhood and/or adolescence periods. Nevertheless, inflated responsibility, excessive concern about the importance of controlling one's thoughts and overestimation of threat found in childhood and adolescence period is not as pronounced and striking as observed with adults. Considering the facts that OCD symptoms and related areas of faulty appraisals and belief domains differ amongst various age groups, early diagnosis and intervention will be critical in terms of the course of treatment for obsessive compulsive disorder. The purpose of this review is to briefly examine three current cognitive models proposed for OCD and evaluate six faulty appraisals and belief domains considered to play a role in the understanding of OCD with respect to developmental periods.

References

  • Reynolds S, Reeves J. Do cognitive models of obsessive compulsive disorder apply to children and adolescents? Behav Cogn Psychother 2008; 36:463-471.
  • Achenbach T. Conceptualization of developmental psychopathology. In Handbook of Developmental Psychopathology (Eds Lewis M, Miller SM). New York, Plenum Press. 1989, pp.3-27.
  • Amerikan Psikiyatri Birliği. Psikiyatride Hastalıkların Tanımlanması ve Sınıflandırılması Elkitabı, Yeniden Gözden Geçirilmiş 4. Baskı (DSM-IV-TR), (E.Köroğlu, Çev.) Ankara, Hekimler Yayın Birliği. 2001.
  • Weissman MM, Bland RC, Canino GJ, Greenwald S, Hwu HG, Lee CK et al. The cross national epidemiology of obsessive compulsive disorder. J Clin Psychiatry 1994; 55 Suppl:5-10.
  • Pauls DL, Alsobrook JP, Goodman W, Rasmussen S, Leckman JF. A family study of obsessive-compulsive disorder. Am J Psychiatry 1995; 152:76-84.
  • Penn JV, March J, Leonard HL. Obsessive-compulsive disorder in childhood and adolescents. In The American Psychiatric Press Review of Psychiatry Vol.16. (Eds Dickstein LJ, Riba MB, Oldham JM) Washington D.C., American Psychiatric Press. 1997, pp. III-1-23.
  • Chowdhury U, Frampton I, Heyman I. Clinical characteristics of young people referred to an obsessive-compulsive disorder clinic in the United Kingdom. Clin Child Psychol Psychiatry 2004; 9:395-401.
  • Cameron CL, Region CH. Obsessive-compulsive disorder in children and adolescents. J Psychiatr Ment Health Nurs 2007; 14:696-704.
  • Grados MA, Riddle MA. Obsessive-compulsive disorder in children and adolescents. CNS Drugs 1999; 12:257- 277.
  • Piacentini J, Langley AK. Cognitive-behavioral therapy for children who have obsessive-compulsive disorder. J Clin Psychol 2004; 60:1181-1194.
  • Pollock RA, Carter AS. The familial and developmental context of obsessive- compulsive disorder. Child Adolesc Psychiatr Clin North Am 1999; 8:461-479.
  • Beşiroğlu L, Ağargün MY. Obsesif kompulsif bozuklukta sağlık yardımı arama davra- nışı ile ilişkili etmenler: hastalık ile ilişkili ve genel etmenlerin rolü. Turk Psikiyatri Derg 2006; 17:213-222.
  • Farrell L, Barrett P. OCD across the developmental trajectory: cognitive processing of threat in children, adolescents and adults. Br J Psychol 2006; 97:95-114.
  • Lomax CL, Oldfield VB, Salkovskis PM. Clinical and treatment comparisons between adults with early- and late-onset obsessive compulsive disorder. Behav Res Ther 2009; 47:99-104.
  • Clark DA. Cognitive Behavioural Therapy for OCD. New York, The Guilford Press. 2007.
  • Salkovskis PM. Cognitive-behavioural factors and the persistence of intrusive thoughts in obsessional problems. Behav Res Ther 1989; 27:677-682.
  • Rachman S. A cognitive theory of obsessions. Behav Res Ther 1997; 35:793-802.
  • Obsessive Compulsive Cognitions Working Group. Cognitive assessment of obsessive-compulsive disorder. Behav Res Ther 1997; 35:667-681.
  • Clark DA. Obsesyonlar ve onların nötrleştirilmesi için bilişsel davranışçı terapi. I. Klinik Psikoloji Sempozyumu, 11-12 Mart 2009 Orta Doğu Teknik Üniversitesi, Ankara, Tür- kiye.
  • Libby S, Reynolds S, Derisley J, Clark S. Cognitive appraisals in young people with obsessive compulsive disorder. J Child Psychol Psychiatry 2004; 45: 1076-1084.
  • Barrett PM, Healy-Farrell LJ. Perceived responsibility in childhood obsessive compulsive disorder: an experimental manipulation. J Clin Child Adolesc Psychiatry 2003; 32:430-441.
  • Carter AS, Pollock RA. Obsessive-compulsive disorder in childhood. Curr Opin Pediatrics 2000; 12:325-330.
  • Verhaak LM, De Haan E. Cognitions in children with OCD. A pilot study for age specific relations with severity. Eur Child Adolesc Psychiatry 2007; 16:353-361.
  • Barrett PM, Healy L. An examination of the cognitive processes involved in childhood obsessive-compulsive disorder. Behav Res Ther 2003; 41:285-299.
  • Salkovskis PM. Obsessional-compulsive problems: a cognitive-behavioural analysis. Behav Res Ther 1985; 23: 571-583.
  • Rachman S. A cognitive theory of obsessions: elaborations. Behav Res Ther 1998; 36:385-401.

Çocukluktan Erişkinliğe Obsesif Kompulsif Bozuklukta Hatalı Değerlendirme ve İnanç Alanları

Year 2010, Volume: 2 Issue: 1, 117 - 131, 01.03.2010

Abstract

Obsesif kompulsif bozukluğun (OKB) etiyolojisine yönelik olarak ortaya konan bilişsel modellerden Abartılı Sorumluluk Algısı Modeli, Yanlış Yorumlama Modeli ve Bilişsel Kontrol Modeli günümüzde birçok yönden geçerliliklerini sürdürmektedirler. Erişkin OKB'nda saptanan çeşitli bilişlere vurgu yapan bu modellere göre OKB'de etkin olan altı hatalı değerlendirme ve inanç alanı bulunmaktadır. Bunlar; abartılı sorumluluk algısı, düşüncenin önemsenmesi, düşüncelerin kontrolü, abartılı tehdit algısı, belirsizliğe tahammülsüzlük ve mükemmeliyetçiliktir. Erken yaşlarda OKB tanısı almış olan kişilerde görülen hastalık belirtilerinin obsesyonların saf kompulsiyonlarla seyredebilmesi, belirtilerin kademeli olarak ortaya çıkması ve sinsice ilerlemesi noktalarında ileri yaş OKB olgularında görülen belirtilerden farklılaştığı görülmektedir. OKB'ye ilişkin hatalı değerlendirme ve inanç alanları incelendiğinde düşüncenin önemsenmesinin, belirsizliğe tahammülsüzlüğün ve mükemmeliyetçiliğin erişkinlikte olduğu gibi, çocukluk ve/veya ergenlik dönemlerinde de bulunduğu; ancak, çocukluk ve ergenlik dönemlerinde görülen abartılmış sorumluluk algısının, düşüncelerin kontrolünün ve abartılı tehdit algısının, erişkinlerde olduğu kadar belirgin ve dikkat çekici olmadığı sonucuna ulaşılmaktadır. OKB belirtilerinin ve bu bozuklukla ilgili olan hatalı değerlendirme ve inanç alanlarının farklı yaş dönemlerinde ayrıştığı noktalar göz önünde bulundurularak erken teşhis ve müdahale yoluna gidilmesi OKB tedavisinin gidişatı için önem taşımaktadır. Bu yazının amacı, OKB etyolojisine yönelik ortaya atılan üç güncel bilişsel modeli ve OKB'nin bilişsel kuramının anlaşılmasını kolaylaştıracak altı hatalı değerlendirme ve inanç alanlarının gelişim dönemleri yönünden kısaca incelemektir.

References

  • Reynolds S, Reeves J. Do cognitive models of obsessive compulsive disorder apply to children and adolescents? Behav Cogn Psychother 2008; 36:463-471.
  • Achenbach T. Conceptualization of developmental psychopathology. In Handbook of Developmental Psychopathology (Eds Lewis M, Miller SM). New York, Plenum Press. 1989, pp.3-27.
  • Amerikan Psikiyatri Birliği. Psikiyatride Hastalıkların Tanımlanması ve Sınıflandırılması Elkitabı, Yeniden Gözden Geçirilmiş 4. Baskı (DSM-IV-TR), (E.Köroğlu, Çev.) Ankara, Hekimler Yayın Birliği. 2001.
  • Weissman MM, Bland RC, Canino GJ, Greenwald S, Hwu HG, Lee CK et al. The cross national epidemiology of obsessive compulsive disorder. J Clin Psychiatry 1994; 55 Suppl:5-10.
  • Pauls DL, Alsobrook JP, Goodman W, Rasmussen S, Leckman JF. A family study of obsessive-compulsive disorder. Am J Psychiatry 1995; 152:76-84.
  • Penn JV, March J, Leonard HL. Obsessive-compulsive disorder in childhood and adolescents. In The American Psychiatric Press Review of Psychiatry Vol.16. (Eds Dickstein LJ, Riba MB, Oldham JM) Washington D.C., American Psychiatric Press. 1997, pp. III-1-23.
  • Chowdhury U, Frampton I, Heyman I. Clinical characteristics of young people referred to an obsessive-compulsive disorder clinic in the United Kingdom. Clin Child Psychol Psychiatry 2004; 9:395-401.
  • Cameron CL, Region CH. Obsessive-compulsive disorder in children and adolescents. J Psychiatr Ment Health Nurs 2007; 14:696-704.
  • Grados MA, Riddle MA. Obsessive-compulsive disorder in children and adolescents. CNS Drugs 1999; 12:257- 277.
  • Piacentini J, Langley AK. Cognitive-behavioral therapy for children who have obsessive-compulsive disorder. J Clin Psychol 2004; 60:1181-1194.
  • Pollock RA, Carter AS. The familial and developmental context of obsessive- compulsive disorder. Child Adolesc Psychiatr Clin North Am 1999; 8:461-479.
  • Beşiroğlu L, Ağargün MY. Obsesif kompulsif bozuklukta sağlık yardımı arama davra- nışı ile ilişkili etmenler: hastalık ile ilişkili ve genel etmenlerin rolü. Turk Psikiyatri Derg 2006; 17:213-222.
  • Farrell L, Barrett P. OCD across the developmental trajectory: cognitive processing of threat in children, adolescents and adults. Br J Psychol 2006; 97:95-114.
  • Lomax CL, Oldfield VB, Salkovskis PM. Clinical and treatment comparisons between adults with early- and late-onset obsessive compulsive disorder. Behav Res Ther 2009; 47:99-104.
  • Clark DA. Cognitive Behavioural Therapy for OCD. New York, The Guilford Press. 2007.
  • Salkovskis PM. Cognitive-behavioural factors and the persistence of intrusive thoughts in obsessional problems. Behav Res Ther 1989; 27:677-682.
  • Rachman S. A cognitive theory of obsessions. Behav Res Ther 1997; 35:793-802.
  • Obsessive Compulsive Cognitions Working Group. Cognitive assessment of obsessive-compulsive disorder. Behav Res Ther 1997; 35:667-681.
  • Clark DA. Obsesyonlar ve onların nötrleştirilmesi için bilişsel davranışçı terapi. I. Klinik Psikoloji Sempozyumu, 11-12 Mart 2009 Orta Doğu Teknik Üniversitesi, Ankara, Tür- kiye.
  • Libby S, Reynolds S, Derisley J, Clark S. Cognitive appraisals in young people with obsessive compulsive disorder. J Child Psychol Psychiatry 2004; 45: 1076-1084.
  • Barrett PM, Healy-Farrell LJ. Perceived responsibility in childhood obsessive compulsive disorder: an experimental manipulation. J Clin Child Adolesc Psychiatry 2003; 32:430-441.
  • Carter AS, Pollock RA. Obsessive-compulsive disorder in childhood. Curr Opin Pediatrics 2000; 12:325-330.
  • Verhaak LM, De Haan E. Cognitions in children with OCD. A pilot study for age specific relations with severity. Eur Child Adolesc Psychiatry 2007; 16:353-361.
  • Barrett PM, Healy L. An examination of the cognitive processes involved in childhood obsessive-compulsive disorder. Behav Res Ther 2003; 41:285-299.
  • Salkovskis PM. Obsessional-compulsive problems: a cognitive-behavioural analysis. Behav Res Ther 1985; 23: 571-583.
  • Rachman S. A cognitive theory of obsessions: elaborations. Behav Res Ther 1998; 36:385-401.
There are 26 citations in total.

Details

Primary Language Turkish
Journal Section Review
Authors

İrem Pişgin This is me

Dilek Şirvanlı Özen This is me

Publication Date March 1, 2010
Published in Issue Year 2010 Volume: 2 Issue: 1

Cite

AMA Pişgin İ, Özen DŞ. Çocukluktan Erişkinliğe Obsesif Kompulsif Bozuklukta Hatalı Değerlendirme ve İnanç Alanları. Psikiyatride Güncel Yaklaşımlar - Current Approaches in Psychiatry. March 2010;2(1):117-131.

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