DESCRIPTIVE PHENOMENOLOGY OF DEPRESSIVE AND ANXIOUS SYMPTOMS IN PATIENTS WITH OBSESSIVE-COMPULSIVE DISORDER

Abstract

. The obsessive-compulsive disorder (OCD) is characterized by specific symptoms (obsessions and compulsions), but it also presents significant depressive and anxious symptoms. Some life-time psychiatric comorbidities collaborate to different psychopathological presentations of OCD and interfere even in response to conventional treatments. Especially depressive disorders, as other anxiety disorders, have high prevalence in patients with OCD, reaching near 70% for major depressive disorder and 37% for social anxiety disorder. Mathis et al. (2013) evaluated the age of onset of OCD and several comorbid disorders and found that both depression and anxiety disorders (except separation anxiety) occur temporally after the emergence of OCS, leading to understand such depressive and anxious symptoms as secondary to the OCS. In light of this, our research aim to investigate aspects of the descriptive phenomenology of the depressive and anxious symptoms in 1,001 patients with OCD. Method: We conducted a factor analysis with the items of the Beck Depression Inventory and of the Beck Anxiety Inventory for the development of specific depressive-anxious factors that are present in OCD as a unique disorder. Thereafter, for each of the six symptoms dimensions of the Dimensional Yale-Brown Obsessive Compulsive Scale (DY-BOCS) (aggressive, sexual/religious, symmetry/ordering/arrangement, contamination/cleaning/washing, hoarding and miscellaneous dimensions), it was carried out other six specific factor analysis with the same depressive and anxious Beck's instruments symptoms, generating, meanwhile, specific depressive-anxious factors for each of the six DYBOCS dimensions. To facilitate the understanding of the factor analysis, the depressive-anxious factors were grouped in four general factors: emotional, cognitive, autonomic (or somatic) and behavioral aspects. Results: The factorial analysis results in five factors that describe the depressive-anxious factors present in OCD as a unique disorder (low functionality on patient’s occupation, irritability and sexual dysfunction, tremors, lack of appetite, and low self-esteem and guilty). Other fourteen depressive-anxious factors were specifically related to the six DY-BOCS dimensions, especially for sexual/religious dimension, which the cognitive factor was not related to, while for the other dimensions, cognitive aspects were always important. Conclusion: Depressive-anxious specific factors found in our study described different psychopathological aspects of OCD patients, depending on the OCS predominant content. Sexual/religious dimension seems to be different from the other DY-BOCS dimension according to the depressive-anxious factors presentation. As the specific depressive-anxious symptoms may interfere in cognitive, emotional, behavioral and autonomic aspects of OCD patients, it is quite reasonable to argue that they may contribute to the refractoriness of some cases, turning available conventional treatments obsolete or insufficient. The results of this study extend the load of evidence that OCD is a heterogeneous disorder. This heterogeneity is not only in its nuclear symptomatic presentations, but also in terms of its secondary depressive and anxious issues. It is also suggestible that each group of patients (depending on the OCS or depressive-anxious presentation) may require an individualized therapeutic approach, which targets the main features of each OCS dimension.