SELF-TRANSCENDENCE IN OBSESSIVE COMPULSIVE DISORDER: AN EXPLORATORY STUDY OF PSYCHOPATHOLOGICAL, SOCIODEMOGRAPHIC AND CLINICAL ASPECTS

Abstract

The obsessive-compulsive disorder (OCD) is a chronic disease that can cause serious functional and family impairment. According to Cloninger 's personality model some temperament and character factors have been associated with specific psychopathology and disease severity of OCD. However, some trait characters like self-transcendence (ST) still wasn’t properly explored in this context. Descriptions of religious content of OCD symptoms are found in sacred books from the 2nd century and are called scrupulosity. There are few studies evaluating the role of spirituality in the OCD concept, which differs from religion, since spirituality could be defined as the focus on spiritual things and the spirit world rather than on earthly and physical things, while religion is a set of beliefs and rituals that claim to put his followers in a right relationship with God. This article aims to assess whether the construct of SF in Temperament and Character Inventory (TCI) may be related to the concept of spirituality and if it could have a protective property in OCD psychopathology. This is an exploratory case-control study involving 49 patients with OCD divided into two groups: high and low ST. Variables with a P<0,2 in the univariate analysis, respecting multicollinearity and clinical-epidemiologic relevance, were included in a multiple logistic regression analysis (with forward variable selection and Wald statistics to denote significance of variables in the model) to determine if the factors were independently associated to higher ST. Results: High ST was associated to the diagnosis of major depression (Odds ratio =7.87, p=0.042), and to the scores of contamination and cleaning dimensions according of the DYBOCS (Dimensional Yale Brown Obsessive-Compulsive Scale) (Odds ratio =1.56, p=0.004). Patients with high ST also showed higher family suffering (p=0.02) and better quality of life (QoL) (specifically on physical dimension (p=0.05) and social concerns (p=0.03)), but those variables did not remain at the regression model. According to literature, the association of high ST and Harm Avoidance and low Self-Directness traits can constitute a schizotypy marker, and therefore may represent vulnerability to mood disorders, such as major depression. This aspect could also explain the association of high-ST with higher family suffering (also found in this study), since these patients have higher unemployment and social withdrawal and thus require greater family care. One hypothesis to explain the strong association to major depression comorbidity is that the ST is high in more severe OCD patients as those with comorbid major depression and, in this case, it could be associated with magical thinking, thought-action fusion and even psychotic symptoms. That is, instead of representing transpersonal identification and spiritual acceptance transcendence could reflect loss in the definition of the self. However, longitudinal studies are necessary to further investigate the direction of cause and effect of these aspects. ST could not be considered a protective factor in OCD as it is associated with worsening of contamination/cleaning OCD symptoms and comorbid depression.