A Review of The Contributions of Adulthood Attachment Orientations to Development of Obsessive-Compulsive Disorder: An Illustration of Psychotherapy Integration

Yıl 2014, Cilt: 1 Sayı: 1, 26 - 40, 01.03.2014

Filiz Özekin-üncüer

https://doi.org/10.31682/ayna.470568

Cited By: 1

Öz

Obsessive-compulsive disorder (OCD) is one of the most disabling and highly prevalent anxiety disorders. Cognitive models of OCD propose that negative evaluation of intrusions occur as a consequence of underlying maladaptive beliefs, such as inflated responsibility, overestimation of threat, intolerance for uncertainty, perfectionism, the need to control thoughts, and over-importance of thoughts. Although cognitive models have enhanced the knowledge and treatment of OCD, they have been criticized for focusing largely on maintaining and exacerbating factors of OCD-related beliefs and neglecting the developmental and motivational factors, such as early attachment and parenting behaviors (Doron & Kyrios, 2005; O'Kearney, 2001). It is argued that consideration of underlying vulnerabilities, such as attachment insecurities and early experiences of parenting may lead to a broader understanding of the development and maintenance of OCD-related beliefs and symptoms. Thus, the current paper consists of four main parts reviewing the roles of attachment insecurities, self-views, and parental attitudes in the development of obsessive-compulsive symptomatology. In order to demonstrate the importance of understanding these factors while dealing with a patient having OCD, the case of Ms. D. is illustrated. Ms. D., who is directed into our clinic with the diagnosis of obsessive-compulsive disorder, is a 21 years old, second-year university student. Her obsessions have involved the theme of contamination and that her entire body would be invaded by germs. In response to these obsessions, her compulsions have involved washing hands, using disinfectants, and cleaning the furniture in her house with a rigid routine after coming from the outside.

Anahtar Kelimeler

Obsessive-compulsive disorder, Insecure Attachment, Parental Attitudes

Yetişkin Bağlanma Biçimleri ile Obsesif-Kompulsif BozuklukArasındaki İlişkinin İncelenmesi: Psikoterapi UygulamasınaBir Örnek

Öz

Obsesif-kompulsif bozukluk (OKB), bireylerin işlevselliğinde gözle görülür bozulmaya sebep olan oldukça yaygın anksiyete bozukluklarından biridir. Bilişsel modellere göre OKB semptomlarının şiddetlenmesinde, istem dışı girici (intrusif) düşüncelerin işlevsel olmayan inançlar sonucunda hatalı olarak yorumlanması ve bu düşüncelere atfedilen önem, önemli bir rol oynamaktadır. İşlevsel olmayan inançların oluşumunda rol oynayan bağlanma örüntüsü ve ebeveyn tutumları gibi gelişimsel faktörlerin incelenmesi ve altta yatan süreçlerin de anlaşılmasıyla birlikte bilişsel modeller temelinde oluşturulan tedavi yöntemlerinin geliştirilebileceği öne sürülmektedir. Bu makalede, bazı temel terminolojik açıklamalarla birlikte, obsesif-kompulsif belirtiler ile kişilerin bağlanma örüntüleri ve benlik algıları arasındaki ilişki ampirik çalışmalardan elde edilen bulgular ve klinik deneyim bazında incelenmiştir. Son kısımda ise, OKB tanısı ile takip edilen bir vaka anlatılarak, bu konunun psikoterapi açısından önemi ve uygulamanın nasıl yapılacağı tartışılmıştır.

Anahtar Kelimeler

Obsesif-kompulsif bozukluk, güvensiz bağlanma, ebeveyn tutumları

Kaynakça

• Abramowitz, J. S. (1998). Does cognitive-behavioral therapy cure obsessive-compulsive disorder? A meta-analytic evaluation of clinical significance. Behavior Therapy, 29, 339-335.
• Alonso, P., Menchon, J.M., Mataix-Cols, D., Pifarre, J., Urretavizcaya, M., Crespo, M.J., Jimenez, S., Vallejo, G., & Vallejo, J. (2004). Perceived parental rearing style in obsessive-com- pulsive disorder: relation to symptom dimensions. Psychiatry Research, 127, 267-278.
• American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders. Washington DC.
• Bartholomew, K., & Horowitz, L.M. (1991). Attachment styles among young adults: A test of a four category model. J Pers Soc Psychol, 61(2), 226-244.
• Beck, A.T., Emery, G., & Greenber, R.L. (1985). Anksiyete bozuklukları ve fobiler: Bilişsel bir bakış açısı (V. Öztürk, 2006, Çev). Litera Yayınları: İstanbul.
• Bowlby, J. (1969). Bağlanma (T.V. Soylu, Çev). Pinhan Yayıncılık: İstanbul.
• Carpernter, L. ve Cheung Chung, M. (2011). Childhood trauma in obsessive compulsive disorder: The roles of alexithymia and attachment. Psychology and Psychotherapy:
• Theory, Research and Practice, 84, 367-388. Doron, G., & Kyrios, M. (2005). Obsessive compulsive disorder: A review of possible specific internal representations within a broader cognitive theory. Clinical Psychology Review, , 415–432.
• Doron, G. & Moulding, R. (2009). Cognitive behavioral treatment of obsessive compulsive disorder: a broader framework. Israel Journal of Psychiatry and Related Sciences, 46(4), 257-263.
• Doron, G., Moulding, R., Kyrios, M., Nedeljkovic, M., & Mikulincer, M. (2009). Adult attachment insecurities are related to obsessive compulsive phenomena. Journal of Social and Clinical Psychology, 28(8), 1022-1049.
• Doron, G., Moulding, R., Nedeljkovic, M., Kyrios, M., Mikulincer, M., & Sar-el, D. (2012).
• Adult attachment insecurities are associated with obsessive compulsive disorder. Psychology and Psychotherapy: Theory, Research and Practice, 85, 163-178. Fraley, R. C., & Shaver, P. R. (2008). Attachment theory and its place in contemporary personality research. In O. John ve R. W. Robins, Handbook of Personality: Theory and Research
• (3rd ed., pp. 518-541). New York: Guilford Press. Franklin, M.E., Abramowitz, J.S., Jonathan, S., Kozak, M.J., Levitt, J.T., & Foa, E.B. (2000).
• Effectiveness of exposure and ritual prevention for obsessive-compulsive disorder: Randomized compared with nonrandomized samples. Journal of Consulting and Clinical Psychology, 68(4), 602. Guidano, V.F. & Liotti, G. (1983). Cognitive processes and emotional disorders: A structural approach to psychotherapy. Guilford Press: New York.
• Hacıömeroğlu, B. (2008). Perceived parental rearing behaviors, responsibility attitudes and life events as predictors of obsessive compulsive symptomatology: test of a cognitive model.
• Unpublished doctoral dissertation, Middle East Technical University, Ankara. Kempke, S. & Luyten, P. (2007). Psychodynamic and cognitive-behavioral approaches of obsessive-compulsive disorder: Is it time to work through our ambivalence? Bulletin of Menniger Clinic, 71(4), 291-311.
• Kesebir S., Özdoğan-Kavzoğlu S., & Üstündağ M.F. (2011). Attachment and psychopathology.
• Current Approaches in Psychiatry 3(2):321-342. Liotti, G. (2011). Attachment disorganization and the controlling strategies: An illustration of the contributions of attachment theory to developmental psychopathology and to psychotherapy integration. Journal of Psychotherapy Integration, 21(3), 232-252.
• Lochner, C. & Stein, D.J. (2001). Gender in obsessive–compulsive disorder and obsessive– compulsive spectrum disorders: A literature review. Arch. Women’s Mental Health, 4, 19–26.
• Matrix-Cols, D., Rosario-Campos, M.C., & Leckman, J.F. (2005). A multidimensional model of obsessive-compulsive disorder. American Journal of Psychiatry, 162, 228-238.
• Mears, R. (2001). A Specific developmental deficit in obsessive-compulsive disorder: The example of the Wolf Man. Psychoanalytic Inquiry, 21, 289-319.
• Mikulincer, M. & Shaver, P.R. (2007). Attachment in adulthood: Structure, dynamics and change. The Guilford Press: New York.
• Mikulincer, M., Shaver, P.R., & Pereg, D. (2003). Attachment theory and affect regulation:
• The dynamics, development and cognitive consequences of attachment-related strategies. Motiva- tion and Emotion, 27(2), 77-102. Myhr, G., Sookman, D., & Pinard, G. (2004). Attachment security and parental bonding in adults with obsessive-compulsive disorder: a comparison with depressed out-patients and healthy controls. Acta Psychiatrica Scandinavica, 109, 447-456.
• O’Kearney, R. (2001). Motivations and emotions in cognitive theory of obsessive-compulsive disorder. Australian Journal of Psychology, 53(1), 7-9.
• Obegi, J.H. & Berant, E.( 2009). Attachment theory and research in clinical work with adults.
• Obsessive Compulsive Cognitions Working Group (OCCDWG) (1997). Cognitive assessment of obsessive-compulsive disorder. Behav. Res. Ther., 35(7), 667-681.
• Obsessive Compulsive Cognitions Working Group (OCCDWG) (2003). Psychometric validation of obsessive beliefs questionnaire and the interpretation of intrusions inventory: Part I.
• Behavior Research and Therapy, 41, 863-878. Obsessive Compulsive Cognitions Working Group (OCCDWG) (2005). Psychometric validation of obsessive beliefs questionnaire and the interpretation of intrusions inventory: Part I.
• Behavior Research and Therapy, 43, 1527-1542.
• Pielage, S.B., Gerlsma, J., & Schaap, C.P.D.R. (2000). Insecure attachment as a risk factor for psychopathology: The role of stressful events. Clinical Psychology and Psychotherapy, 7, 296-302.
• Power, M. & Dalgleish, T. (1997). Cognition and emotion: From order to disorder. Psychology Press: UK.
• Rachman, S. (1997). A cognitive theory of obsessions. Behav. Res. Ther., 35(9), 793-802.
• Radomsky, A.S., Ashbaugh, A.R., & Gelfand, L.A. (2007). Relationships between anger, symptoms and cognitive factors in OCD checkers. Behaviour Research and Therapy, (11), 2712-2725.
• Salkovskis, P., Shafran, Z., Rachman, S., & Freeston, M.H. (1999). Multiple pathways to inflated responsibility beliefs in obsessional problems: possible origins and implications for therapy and research. Behavior Research and Therapy, 37(11), 1055-1072.
• Salkovskis, P.M. (1985). Obsessional-compulsive problems: a cognitive-behavioral analysis.
• Behaviour Research and Therapy, 23, 571-583. Sookman, D., Pinard, G., & Beauchemin, N. (1994). Multidimensional schematic restructuring treatment for obsessions: Theory and practice. Journal of Cognitive Psychotherapy, (3), 175-194.
• Vogel, P.A., Stiles, T.C., & Nordahl, H.M. (2000). Cognitive personality styles in OCD outpatients compared to depressed outpatients and healthy controls. Behavioral and Cognitive Psychotherapy, 28(3), 247-258.
• Waters E. & Cummings E.M. (2000). A secure base from which to explore close relationships. Child Development, 71, 164-172.
• Wells, A. (1997). Cognitive therapy of anxiety disorders: A practice manual and conceptual guide. John Wiley and Sons: New York.
• Whiteside, S.P. & Abramowitz, J.S. (2004). Obsessive-compulsive symptoms and expression of anger. Cognitive Therapy and Research, 28(2), 259-268.
• Yoshida, T., Taga, C., Matsumoto, Y., & Fukui, K. (2005). Paternal overprotection in obsessive-compulsive disorder and depression with obsessive traits. Psychiatry and Clinical Neurosciences, 59, 533-538.
• Young, J.E., Klosko, J.S., & Weishaar, M.E. (2003). Şema Terapi (T.Soylu, Çev.). Litera Yay: İst.