Authors
1 Karaj Islamic Azad University
2 Allameh Tabataba’i University
Abstract
Introduction: The present research was conducted to study how existential loneliness parameter presents in obsessive-compulsive condition. To this aim, attitudes and reactions of women with obsessive-compulsive tendencies were investigated in terms of the existential loneliness to obtain a better comprehension of obsessive-compulsive disorder (OCD).
Method: The research was conducted among Kermani women, Iran, choosing grounded theory qualitative method. Participants were chosen based on Yale-Brown Obsessive-Compulsive Scale (YBOCS). Sampling was started with snowball purposeful method and followed by theoretical sampling. Theoretical saturation took place with 13 persons. Existential loneliness was probed by means of the semi-structured interviews. The interviewees’ statements were coded and analyzed according to the grounded theory and by means of Strauss and Corbin method.
Results: Acceptance/non-acceptance was the central category and dependence versus independence, defensive and non-accepting coping, and adoptive and accepting coping were the resulted axial categories of this research, each had their subsets. Generally, the tendency toward dependence was more than independence. Participants used defensive and non-accepting mechanisms in confronting to the existential loneliness more than adoptive and accepting coping. Non-acceptance was the main reaction of women with obsessive-compulsive tendencies regarding the existential loneliness.
Conclusion: It seems that non-acceptance of existential loneliness can justify excessive anxieties, dysfunctional copings, and relational problems of patients with obsessive-compulsive disorder.
Keywords
1. DSM-5 AMERICAN PSYCHIATRIC ASSOCIATION, et al. Diagnostic and statistical manual of mental disorders. Arlington: American Psychiatric Publishing; 2013.
2. Stengler-Wenzke K, Kroll M, Matschinger H & Angermeyer MC. Quality of life of relatives of patients with obsessive-compulsive disorder. Compr Psychiatry 2006, 47(6): 523-7.
3. Torres AR, Hoff NT, Padovani CR & Ramos‐Cerqueira ATDA. Dimensional analysis of burden in family caregivers of patients with obsessive–compulsive disorder. Psychiatry Clin Neurosci 2012, 66(5): 432-41.
4. Cicek E, Cicek IE, Kayhan F, Uguz F & Kaya N. Quality of life, family burden and associated factors in relatives with obsessive–compulsive disorder. Gen Hosp Psychiatry 2013; 35(3): 253-8.
5. Kaplan H, Sadock B & Sadock V. Kaplan & Sadock’s synopsis of psychiatry: behavioral sciences, clinical psychiatry, Volume 2. Translated by: Nosratollah Pourafkari. Tehran: Sharab – Ayandesazan Publication; 2009 [In Persian].
6. Ahmari S E & Dougherty D D. Dissecting OCD circuits: from animal models to targeted treatments. Depress Anxiety 2015; 32(8): 550-62.
7. Monteiro P & Feng G. Learning from animal models of obsessive-compulsive disorder. Biol Psychiatry 2016; 79(1): 7-16.
8. Zai G, Brandl E J, Müller D J, Richter M A & Kennedy J L. Pharmacogenetics of antidepressant treatment in obsessive-compulsive disorder: an update and implications for clinicians. Pharmacogenomics 2014; 15(8): 1147-57.
9. Hu X Z, Wen Y S, Ma J D, Han D M & et al. A promising randomized trial of a new therapy for obsessive–compulsive disorder. Brain Behav 2012; 2(4): 443-54.
10. Pauls D L. The genetics of obsessive-compulsive disorder: a review. Dialogues Clin Neurosci 2010; 12(2): 149-63.
11. Stewart S E, Yu D, Scharf J M, Neale B M, Fagerness J A, Mathews C A, ... & McGrath L. Genome-wide association study of obsessive-compulsive disorder. Mol Psychiatry 2013; 18(7): 788-98.
12. Mathews C A, Delucchi K, Cath D C, Willemsen G & Boomsma D I. Partitioning the etiology of hoarding and obsessive–compulsive symptoms. Psychol Med 2014; 44(13): 2867-76.
13. Markarian Y, Larson M J, Aldea M A, Baldwin S A, Good D, Berkeljon A, ... & McKay D. Multiple pathways to functional impairment in obsessive–compulsive disorder. Clin Psychol Rev 2010; 30(1): 78-88.
14. Ogata N, Gillis T E, Liu X, Cunningham S M, Lowen S B, Adams B L, ... & Kaufman M J. Brain structural abnormalities in Doberman pinschers with canine compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry 2013; 45, 1-6.
15. Taylor S. Etiology of obsessions and compulsions: a meta-analysis and narrative review of twin studies. Clin Psychol Rev 2011; 31(8): 1361-72.
16. Coles M E, Schofield C A & Nota J A. Initial Data on Recollections of Pathways to Inflated Responsibility Beliefs in Patients with Obsessive-Compulsive Disorder. Behav Cogn Psychother 2015; 43(04): 385-95.
17. McGuire J F, Lewin A B, Horng B, Murphy T K & Storch E A. The nature, assessment, and treatment of obsessive–compulsive disorder. Postgrad Med 2012; 124(1): 152-65.
18. Yalom ID. Existential Psychotherapy. Translated by: Sepideh Habib. Tehran: Ney Publication, 2013. [In Persian].
19. Mayers A M, Khoo S T & Svartberg M. The Existential Loneliness Questionnaire: background, development, and preliminary findings. J Clin Psychol 2002; 58(9): 1183-93.
20. Singh R N. Loneliness: Dynamics, Dimensions and many Faces. Int Rev Mod Sociol 1991; 21(1): 109-20.
21. Bekhet A K, Zauszniewski J A & Nakhla W E. Loneliness: a concept analysis. Nurs Forum 2008; 43(4): 207-13
22. Prochaska J & Norcross J. Systems of psychotherapy: A transtheoretical analysis. Translated by Yahya Seyed Mohammadi, Tehran: Ravan Publication, 2013. [In Persian].
23. Pinel EC, Long AE, Landau MJ & Pyszczynski T. I-Sharing, the Problem of Existential Isolation, and Their Implications for Interpersonal and Intergroup Phenomena. In: Greenberg J, Koole SL, Sander L, Pyszczynski T, editors. Handbook of Experimental Existential Psychology. New York, NY, US: Guilford Press; 2004. pp. 352–68. [Online]. [cited 2015 Nov 8]; Available from: https://www.uvm.edu/~psych/.../gen.../eep_chapter.pdf
24. May R, Irvin Y. Existential psychotherapy. In: Wedding D & Corsini R, editors. Current Psychotherapies 10th ed. U.S.A: Cengage Learning; 2013. [Online]. [cited 2015 Nov 8]; Avalaible from: www.cengage.com
25. Van Deurzen E & Adams M. Skills in existential counselling & psychotherapy. Translated by Iman Yousefzadeh; Elham Zamanshoar & Masoumeh Es-haghy. Tehran: Danjeh Publication; 2015. [In Persian].
26. Yalom ID. Love’s executioner and other tales of psychotherapy. Translated by Mahsheed Yasayi. Tehran: Amon publication; 2013. [In Persian].
27. Ettema E J, Derksen L D & van Leeuwen E. Existential loneliness and end-of-life care: a systematic review. Theor Med Bioeth 2010; 31(2): 141-69.
28. May R. The Discovery of Being. Translated by: Seyed Mohammad Bagher Hosseini Fayaz. Tehran: Danjeh Publication, 2013. [In Persian].
29. Yalom ID. Staring at the sun: overcoming the terror of death. Translated by Mahdi Ghabraei. Mashhad: Nikoonashr; 2011. [In Persian].
30. Strachan E, Schimel J, Arndt J, Williams T, Solomon S, Pyszczynski T & Greenberg J. Terror mismanagement: evidence that mortality salience exacerbates phobic and compulsive behaviors. Pers Soc Psychol Bull 2007; 33(8): 1137-51.
31. Tillich P. The Courage of Being. Translated by: Morad Farhadpour. Tehran: Elmifarhangi Publication; 2008. [In Persian].
32. Glas G. Why existential issues need to be addressed in clinical practice: a conceptual analysis. In: Moreira-Almeida A, Dein S, Verhagen PJ, editors. Psyche and Spirit: connecting psychiatry and spirituality 2014; 3(1): 4 [Online]. [cited 2015 Nov 6]; Avalaible from: http://www.religionandpsychiatry.com/ariadne/loader.php/wpa/newsletter/
33. Sand L & Strang P. Existential loneliness in a palliative home care setting. J Palliat Med 2006; 9(6): 1376-87.
34. Mayers A M & Svartberg M. Existential loneliness: A review of the concept, its psychosocial precipitants and psychotherapeutic implications for HIV‐infected women. Br J Med Psychol 2001; 74(4): 539-53.
35. Lindgren B M, Sundbaum J, Eriksson M & Graneheim U H. Looking at the world through a frosted window: experiences of loneliness among persons with mental ill‐health. J Psychiatr Ment Health Nurs 2014; 21(2): 114-20.
36. Goodman WK, Price LH, Rasmussen SA, Mazure C, Delgado P, Heninger GR, & Charney DS. The yale-brown obsessive compulsive scale: II. Validity. Arch Gen Psychiatry 1989; 46(11): 1012-6.
37. Rajezi Esfahani S, Motaghipour Y, Kamkari K, Zahiredin A & Janbozorgi M. Reliability and Validity of the Persian Version of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Iranian Journal of Psychiatry and Clinical Psychology 2012, 17(4): 297-303. [In Persian].
38. Strauss A & Corbin J. Basics of Qualitative Research: Techniques and Procedures for Grounded Theory. Translated by: Ebrahim Afshar. Tehran: Ney Publication; (1990). [In Persian].
39. Mohammadpour A. Qualitative research method; counter-method 2 (practical processes and procedures in qualitative methodology). Hamedan: Jame’e shenasan publication; 2011. [In Persian].
40. Bhar S S & Kyrios M. Cognitive personality styles associated with depressive and obsessive compulsive phenomena in a non-clinical sample. Behav Cogn Psychother 1999; 27(04): 329-43.
41. Starcevic V, Berle D, Brakoulias V, Sammut P, Moses K, Milicevic D & Hannan A. Interpersonal reassurance seeking in obsessive-compulsive disorder and its relationship with checking compulsions. Psychiatry Res 2012; 200(2): 560-7.
42. May R. Man’s search for himself. Translated by Seyed Mahdi Sorayya. Tehran: Danjeh Publication, 2010. [In Persian].
43. Moritz S, Kempke S, Luyten P, Randjbar S & Jelinek L. Was Freud partly right on obsessive–compulsive disorder (OCD)? Investigation of latent aggression in OCD. Psychiatry Res 2011; 187(1): 180-4.
44. Didonna F. Mindfulness and obsessive-compulsive disorder: developing a way to trust and validate one's internal experience. In Clinical handbook of mindfulnesss. New York: Springer; 2009. pp. 189-219. [Online]. [cited 2016 March 10]; Available from: http://link.springer.com/chapter/10.1007/978-0-387-09593-6_12
45. Phares E J, Trull T J. Clinical psychology: concepts, methods, and profession. Translated by: Mehrdad Firouzbakht. Tehran: Roshd, 2011. [In Persian].
46. Bowins B. Psychological defense mechanisms: A new perspective. Am J Psychoanal 2004; 64(1): 1-26.
47. Hamidi F & Motlagh S S. Comparison of Irrational Beliefs and Defence Mechanisms in Patients with Obsessive Compulsive Disorder and Normal Individuals. Procedia-Social and Behavioral Sciences 2010; 5: 1620-1624.
48. Shabanpour R, Zahiroddin A R, Janbozorgi M & Ghaeli P. Assessment of Defense Styles and Mechanisms in Iranian Patients Suffering from Obsessive Compulsive or Panic Disorders versus Normal Controls using Persian Version of Defense Style Questionnaire-40. Iran J Psychiatry 2012; 7(1): 31-5.
49. Farjad M, Mohammadi N. Investigating defense mechanisms and personality organization of individuals with obsessive-compulsive symptoms, depressive and normal individuals. Thesis for Master Course of Study, Shiraz University, 2011. [In Persian].
50. Afzali M H, Fathi Ashtiani A, Azad Fallah P. The Study of defense styles & mechanisms in patients with Obsessive -compulsive disorder, generalized anxiety disorder& social phobia disorder. J Clin Psychol 2009; 1(1):79-93. [In Persian].
51. Briggs E S & Price I R. The relationship between adverse childhood experience and obsessive-compulsive symptoms and beliefs: the role of anxiety, depression, and experiential avoidance. J Anxiety Disord 2009; 23(8): 1037-46.
52. Gillan C M, Morein-Zamir S, Urcelay G P, Sule A, Voon V, Apergis-Schoute A M, ... & Robbins T W. Enhanced avoidance habits in obsessive-compulsive disorder. Biol Psychiatry 2014; 75(8): 631-8.
53. Mayers A M, Naples N A & Nilsen R D. Existential issues and coping: A qualitative study of low-income women with HIV. Psychology & Health 2005; 20(1): 93-113.
54. Kelsey K. The gift of loneliness. Spirituality Today 1984; 36(2): 100–108. [Online]. [cited 2016 April 20]; Available from: http://opcentral.org/resources/2015/01/12/kelley-kelsey-the-gift-of-loneliness/
55. Collins W E. A sermon from hell: Toward a theology of loneliness. J Relig Health 1989; 28(1): 70-79.
56. Moustakas C E. Loneliness and love. Englewood Cliffs: Prentice-Hall; 1972. In: Ettema E J, Derksen L D & van Leeuwen E. Existential loneliness and end-of-life care: a systematic review. Theor Med Bioeth 2010; 31(2): 141-69. 57.
)