Prerpints.org logo
Preprint
Article

Exploring the Interplay between Complex PTSD and Obsessive-Compulsive Disorder Severity: Implications for Clinical Practice

Altmetrics

Downloads

399

Views

169

Comments

0

A peer-reviewed article of this preprint also exists.

Submitted:

13 January 2024

Posted:

16 January 2024

You are already at the latest version

Alerts
Abstract
Background: Traumatic events adversely affect the clinical course of obsessive-compulsive disorder (OCD). Our investigation explores the correlation between prolonged interpersonal trauma and the severity of symptoms related to obsessive-compulsive and anxiety disorders. Methods: The study follows a cross-sectional and observational design, employing the International Trauma Questionnaire (ITQ) to examine areas linked to interpersonal trauma, the Hamilton Anxiety Rating Scale (HAM-A), and the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) to assess anxious and obsessive-compulsive symptoms, respectively. Descriptive analysis, analysis of variance (ANOVA), and logistic regression analyses were conducted. Results: We recruited 107 OCD-diagnosed patients, categorizing them into subgroups based on the presence or absence of complex post-traumatic stress disorder (cPTSD). The ANOVA revealed statistically significant differences between the two groups in the onset age of OCD (p=0.083), psychiatric familial history (p=0.023), HAM-A, and Y-BOCS (p=0.000). Logistic regression indicated a statistically significant association between the presence of cPTSD and Y-BOCS scores (p=0.000). Conclusion: The coexistence of cPTSD in OCD exacerbates obsessive-compulsive symptoms and increases the burden of anxiety. Further advancements in this field are crucial for mitigating the impact of early trauma on the trajectory of OCD and associated anxious symptoms.
Keywords: 
Subject: Medicine and Pharmacology  -   Psychiatry and Mental Health

1. Introduction

Numerous recent investigations into psychological trauma have observed significant expansion [1]. An astounding revelation is that over 60% of young individuals report having encountered distressing experiences during childhood, which have lasting ramifications on their physical and mental well-being [2]. Consequently, prolonged exposure to traumatic events during childhood is strongly associated with an increased likelihood of developing Complex Posttraumatic Stress Disorder (cPTSD) [3]. It is noteworthy that cPTSD has gained acknowledgment as a novel diagnosis in the Eleventh International Classification of Diseases (ICD-11) [4,5]. The proposition of a repeated trauma-related disorder, as articulated by Herman, underscores the potentially profound impact of extended traumatic stressors, particularly on self-organization, with a focus on the affective and relational domains [6]. cPTSD manifests as a severe mental condition that arises in response to traumatic life events, involving a set of symptoms originating from the accumulation of interpersonal traumas experienced during developmental stages [7]. Importantly, cPTSD is characterized by three primary clusters of post-traumatic symptoms, alongside chronic, pervasive disturbances in emotion regulation, identity, and relationships [7]. A growing body of literature demonstrates how traumas serve as causal factors for a range of outcomes, including emotional dysregulation, behavioral dysfunction, challenges in interpersonal relationships, and dissociative symptoms in adulthood [8]. cPTSD often ensues from unstable and distressing environmental contexts that negatively impact a child's self-regulation skills, emotional equilibrium, psychological well-being, and interpersonal bonds [9]. Notably, particular attention has been devoted to the manifestation of self-organization disorders (DSO) observed within this condition, encompassing symptomatology spanning affective dysregulation, negative self-concept, and disrupted relationships [5]. Moreover, alterations in consciousness and the emergence of dissociative symptoms disorganize individuals' functioning across various levels, encompassing the biological, physiological, relational, and behavioral domains [10]. Individuals afflicted with cPTSD typically undergo prolonged or recurrent exposures to interpersonal trauma, such as childhood abuse or domestic violence [11,12,13,14]. The lifetime prevalence of Post-Traumatic Stress Disorder (PTSD) varies from 3 to 9% within the adult population, contingent upon the nature and frequency of traumas experienced. Meanwhile, the prevalence of cPTSD ranges from 1 to 8% in the general population, escalating to 50% within mental health settings [15]. Notably, childhood trauma has been associated with the onset of obsessive-compulsive disorder (OCD). Scientific literature posits that predisposing factors for this disorder, such as genetic vulnerability and typical OCD characteristics, interact with prolonged exposure to stressful and traumatic events during a child's formative years [16,17,18,19,20]. Psychological distress often manifests as intrusive thoughts (flashbacks, nightmares) related to the traumatic experience, occasionally leading to anxiety, fear, aggression, anger, or depressive symptoms [20,21]. Recent studies suggest that OCD can emerge as a response to profoundly distressing events, with individuals exposed to trauma being more susceptible to developing OCD [17,22,23]. Childhood trauma exerts a profound impact on the development, progression, and severity of obsessive-compulsive symptoms, encompassing diverse clinical presentations [24]. Furthermore, previous trauma exposure among individuals with OCD has been correlated with greater functional impairment [25,26,27]. Traumatic experiences, particularly those occurring during childhood, represent the most extensively studied etiological factor in the development of dissociation [8]. In clinical contexts, dissociation constitutes a core symptom across various disorders, including obsessive-compulsive disorder and Complex Posttraumatic Stress Disorder [28]. Dissociative phenomena serve as defense mechanisms against external traumatic experiences, with obsessions and compulsions often arising as responses to thoughts that intensify dissociation [8]. Psychological trauma is recognized as a risk factor in the development of dissociation, with numerous empirical studies substantiating the association between dissociation and trauma, especially severe childhood maltreatment [29,30,31,32]. This study aims to determine whether the presence of cPTSD is linked to heightened obsessive-compulsive symptoms and related anxiety symptomatology. Given that cPTSD represents a substantial domain of symptoms within the spectrum of psychiatric disorders, unraveling this correlation is believed to assist clinicians in optimizing treatment strategies for OCD in the context of this comorbidity.

2. Materials and Methods

The current investigation is structured as an observational cross-sectional study conducted in a clinical environment. It entails the consecutive inclusion of individuals diagnosed with obsessive-compulsive disorder (OCD) at the Psychiatry Unit of the "Magna Graecia" University of Catanzaro, spanning from January 2021 to April 2022. All participants received comprehensive information regarding the research protocol's objectives, data protection, privacy, and the maintenance of anonymity. Their involvement was voluntary and contingent upon providing formal written consent after a thorough explanation of the study's goals and design. The study adhered to the most recent iteration of the Declaration of Helsinki and obtained approval from the Ethics Committee of the University of Catanzaro (Ethics Committee Approval No. 307/2020). Inclusion criteria encompassed:
  • Patients diagnosed with OCD based on DSM-5 criteria, as determined by clinical interviews and psychometric assessments (Structured Clinical Interview for DSM-5 - Clinical Version, SCID-5-CV).
  • Patients aged between 18 and 75 years.
The exclusion criteria were:
  • Patient refusal to participate.
  • Presence of significant neurological or psychiatric disorders (e.g., epilepsy, cognitive disability, genetic syndromes with psychiatric symptoms).
  • Any condition hindering comprehensive assessment
Following that, participants underwent a series of clinical and psychopathological assessments during outpatient clinical visits. Researchers, medical trainees, and PhD students conducted psychometric rating scales and collected sociodemographic data. OCD diagnoses were determined based on DSM-5 criteria, utilizing the SCID-5-CV. Each enrolled patient underwent a semi-structured clinical interview to collect clinical and anamnestic information. Sociodemographic and clinical data were acquired using a tailored medical history questionnaire developed within our department. Administered by trained personnel, this questionnaire comprised two sections: the first concentrated on gathering sociodemographic information, and the second on the patient's psychiatric history. The evaluation instruments used included the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the International Trauma Questionnaire (ITQ), and the Hamilton Anxiety Scale (HAM-A). Y-BOCS, acknowledged as the gold standard for evaluating obsessive-compulsive symptoms, consists of a comprehensive symptom checklist categorized into various groups. It also incorporates a 10-item severity scale assessing time, interference, discomfort, resistance, and symptom control [33,34]. Each item is rated on a scale of 0 to 4, resulting in a total score ranging from 0 to 40, where higher scores indicate more severe OCD symptoms [35]. ITQ is an 18-item self-administered questionnaire designed to explore interpersonal traumas and their impact on an individual's development, distinguishing between post-traumatic stress disorder (PTSD) and complex PTSD (cPTSD) [36]. Following ICD-11 principles, this questionnaire provides both categorical diagnostic scores and dimensional severity scores [37]. HAM-A, a 14-item rating scale, assesses the severity of anxiety symptoms, covering both psychological and somatic manifestations [38]. Each item is scored from 0 (absent) to 4 (severe), resulting in a total score ranging from 0 to 56. Severity levels are categorized as mild (<17), mild to moderate (18-24), and moderate to severe (25/30) [39]. All variable data were input into an electronic dataset. Descriptive statistical analyses were conducted to evaluate the distributional characteristics of sociodemographic and clinical variables within the sample. Continuous variables were presented as means with standard deviations (SD), while categorical variables were expressed as frequencies and percentages (%). The sample was divided into two groups: those with a history of cPTSD (cPTSD+) and those without (cPTSD-). Analysis of variance (ANOVA) was used to compare variances among the means of different groups, considering p<0.005 as statistically significant. A regression analysis was performed to explore the association between cPTSD and the Y-BOCS scale score. Statistical Package for the Social Sciences version 26 (SPSS, Chicago, IL, USA) was used for statistical analyses.

Results

Table 1 presents the clinical and sociodemographic characteristics of the study sample. The final cohort for our investigation comprised 107 individuals diagnosed with obsessive-compulsive disorder (OCD), with 50 of them (46.7%) additionally diagnosed with comorbid Complex Post-Traumatic Stress Disorder (cPTSD). The sociodemographic profile of the sample exhibited homogeneity, with 54 (50.5%) male participants. 84 subjects (78.5%) had attained a diploma. Patients with a co-occurrence of OCD and cPTSD exhibited a familial psychiatric history prevalence of 69.2%. Within this segmented sample, the average age among OCD patients was 45.75 years (SD ± 13.9). From a psychopathological perspective, patients scored an average of 11.50 (SD ± 9.9) on the Hamilton Anxiety Rating Scale (HAM-A), while the score reflecting obsessive-compulsive symptoms on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was approximately 10.49 (SD ± 6.9).
Table 2 shows the analysis of variance (ANOVA). Significative differences emerged between the two groups in the age of onset of the OCD (p=0.083), psychiatric familiarity (p=0.023), HAM-A total score (p=0.000), and Y-BOCS (p=0.000).
In Table 3 is reported the logistic regression analysis that revealed a statistically significant association between the presence of cPTSD and the Y-BOCS total score (p=0.000).

3. Discussion

The present study addresses a topic of great interest that is still little debated, probing the intriguing nexus between Complex Post-Traumatic Stress Disorder (cPTSD) and the clinical severity of the obsessive-compulsive disorder (OCD). Our statistical analysis has unveiled a compelling correlation between the presence of cPTSD and a notably exacerbated clinical trajectory of OCD, as evidenced by higher scores on the Hamilton Anxiety Rating Scale (HAM-A) and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). These findings are in line with existing literature, reinforcing the notion that cPTSD predisposes individuals to compromised outcomes across a spectrum of psychiatric disorders [19]. Furthermore, our logistic regression analysis has demonstrated a significant association between Y-BOCS scores and the International Trauma Questionnaire (ITQ), underscoring the profound influence of cPTSD on the augmentation of obsessive-compulsive symptoms. This revelation warrants elucidation, as it implies that exposure to traumatic stressors during critical phases of psychological development may catalyze the intensification of affective disturbances and relational challenges. These disturbances, in turn, give rise to disruptions in self-organization, thereby exacerbating obsessive symptoms. This alignment with prior literature substantiates the association between traumatic stressors and the severity of OCD symptomatology [6,40]. The multifaceted consequences of trauma on OCD encompass a spectrum of distressing phenomena, including dissociative symptoms, intrusive thoughts and images, profound anxiety, a sense of helplessness, and heightened vigilance, all of which contribute to the chronicity and severity of the disorder [41]. Empirical studies have reported that traumas, especially when occurring during childhood, disproportionately impact the obsessive dimension of OCD. Trauma types encompass sexual abuse, adverse living conditions, bullying, and exposure to traumatic events such as bereavement [42,43]. Notably, prolonged exposure to such trauma has been correlated with the emergence of Complex Post-Traumatic Stress Disorder (cPTSD), with higher incidence rates among individuals exposed to chronic abuse or neglect [44]. It is pertinent to highlight that interpersonal trauma assumes a pivotal role in the psychopathology of both cPTSD and OCD [17,41]. Compared to non-interpersonal trauma, interpersonal trauma has a more profound impact on self-regulation, frequently inducing dissociation [45]. Aligned with current literature, elevated occurrences of childhood trauma are positively associated with heightened levels of dissociation, acting as an intermediary element between exposure to trauma and psychiatric symptoms. [8,46]. This can be attributed to patients with OCD, who have experienced multiple traumatic events, exhibiting a greater propensity for decompensation, a lack of functional and cognitive recovery, and the onset of dissociative symptoms [47,48]. In addition to cognitive-behavioral and pharmacological interventions, trauma-focused treatments have been recommended for managing OCD, highlighting the necessity of addressing trauma within the therapeutic framework. Modalities such as mindfulness, sensorimotor psychotherapy, and Eye Movement Desensitization and Reprocessing (EMDR) have shown promise [49]. Recognizing the complexities introduced by prior prolonged trauma is paramount, as individuals may exhibit resistance to traditional OCD treatment and may resort to alternative maladaptive coping mechanisms to mitigate the distress associated with traumatic memories [23,50]. An in-depth exploration of the physical, emotional, and psychological turmoil stemming from trauma is essential for tailoring therapeutic approaches, ultimately enhancing the quality of life for patients [17]. Future investigations should focus on elucidating how complex trauma influences an individual's quality of life and interpersonal functioning. This knowledge can inform psychosocial interventions, including rehabilitation activities aimed at fostering relationships and mitigating social isolation. Identifying optimal strategies for enhancing cognitive functioning and managing behavioral disorders holds the promise of improving the well-being of patients and their families.
This research acts as a stimulus to enhance investigative endeavors into the intricate interplay between intricate trauma and the intensity of OCD symptoms. The scarcity of studies investigating this crucial connection demands further exploration, underscoring the pressing need for ongoing research. Furthermore, our findings shed light on the earlier manifestation of cPTSD, likely linked to extended or recurrent exposure to interpersonal traumas, such as childhood abuse or domestic violence. Importantly, the current study reaffirms the familial aspect in psychiatric disorders, particularly in instances of early-onset OCD. [51,52].

4. Conclusions

In conclusion, our investigation has shed light on the intricate web connecting cPTSD and the severity of OCD. While we acknowledge limitations, including sample size and study design, our findings underscore the imperative for a holistic understanding of how trauma shapes the trajectory of OCD. This knowledge is instrumental in devising effective interventions that consider the complexities of trauma and its profound impact on individuals' lives. Future research endeavors should build upon these insights, providing a comprehensive framework for enhancing the well-being of those grappling with the confluence of complex trauma and obsessive-compulsive challenges.

Author Contributions

Conceptualization, L.S.J.; methodology, L.S.J, M.V.; formal analysis, E.L., A.M.I., G.V., G.L., V.D.S, and L.S.; data curation, M.D, E.L.; writing original draft, A.M.I., M.V., C.S., and L.S.J.; L.S.J.; investigation, review and editing, M.D., G.L., G.V., C.S., L.S., A.M.I., and L.S.J. All authors have read and agreed to the published version of the manuscript.

Funding

This study did not receive any external financial support.

Institutional Review Board Statement

The study was carried out in compliance with the principles outlined in the Declaration of Helsinki and received approval from the Ethics Committee of the University of Catanzaro. (protocol code 307/2020).

Informed Consent Statement

All participants in the study provided informed consent. Written consent has been acquired from the participant(s) for the publication of this paper.

Data Availability Statement

The data supporting the conclusions of this study can be obtained from the corresponding author upon a reasonable request.

Conflicts of Interest

The authors state that they have no conflicts of interest.

References

  1. Singh, J.; Prakash, J.; Yadav, P.; Bharti, A.; Chatterjee, K. Complex Psychological Trauma. Ind Psychiatry J 2021, 30, 305. [Google Scholar] [CrossRef] [PubMed]
  2. Benjet, C.; Bromet, E.; Karam, E.G.; Kessler, R.C.; McLaughlin, K.A.; Ruscio, A.M.; Shahly, V.; Stein, D.J.; Petukhova, M.; Hill, E.; et al. The Epidemiology of Traumatic Event Exposure Worldwide: Results from the World Mental Health Survey Consortium. Psychol Med 2016, 46, 327–343. [Google Scholar] [CrossRef] [PubMed]
  3. Karatzias, T.; Shevlin, M.; Fyvie, C.; Grandison, G.; Garozi, M.; Latham, E.; Sinclair, M.; Ho, G.W.K.; McAnee, G.; Ford, J.D.; et al. Adverse and Benevolent Childhood Experiences in Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD): Implications for Trauma-Focused Therapies. Eur J Psychotraumatol 2020, 11. [Google Scholar] [CrossRef] [PubMed]
  4. Cruz, D.; Lichten, M.; Berg, K.; George, P. Developmental Trauma: Conceptual Framework, Associated Risks and Comorbidities, and Evaluation and Treatment. Front Psychiatry 2022, 13, 800687. [Google Scholar] [CrossRef] [PubMed]
  5. Shevlin, M.; Hyland, P.; Roberts, N.P.; Bisson, J.I.; Brewin, C.R.; Cloitre, M. A Psychometric Assessment of Disturbances in Self-Organization Symptom Indicators for ICD-11 Complex PTSD Using the International Trauma Questionnaire. Eur J Psychotraumatol 2018, 9, 1419749. [Google Scholar] [CrossRef] [PubMed]
  6. Cloitre, M.; Garvert, D.W.; Brewin, C.R.; Bryant, R.A.; Maercker, A. Evidence for Proposed ICD-11 PTSD and Complex PTSD: A Latent Profile Analysis. Eur J Psychotraumatol 2013, 4. [Google Scholar] [CrossRef] [PubMed]
  7. Maercker, A.; Cloitre, M.; Bachem, R.; Schlumpf, Y.R.; Khoury, B.; Hitchcock, C.; Bohus, M. Complex Post-Traumatic Stress Disorder. Lancet 2022, 400, 60–72. [Google Scholar] [CrossRef]
  8. Boyer, S.M.; Caplan, J.E.; Edwards, L.K. Trauma-Related Dissociation and the Dissociative Disorders:: Neglected Symptoms with Severe Public Health Consequences. Dela J Public Health 2022, 8, 78–84. [Google Scholar] [CrossRef]
  9. Dvir, Y.; Ford, J.D.; Hill, M.; Frazier, J.A. Childhood Maltreatment, Emotional Dysregulation, and Psychiatric Comorbidities. Harv Rev Psychiatry 2014, 22, 149–161. [Google Scholar] [CrossRef] [PubMed]
  10. Seligman, R.; Kirmayer, L.J. Dissociative Experience and Cultural Neuroscience: Narrative, Metaphor and Mechanism. Cult Med Psychiatry 2008, 32, 31–64. [Google Scholar] [CrossRef]
  11. Giourou, E.; Skokou, M.; Andrew, S.P.; Alexopoulou, K.; Gourzis, P.; Jelastopulu, E. Complex Posttraumatic Stress Disorder: The Need to Consolidate a Distinct Clinical Syndrome or to Reevaluate Features of Psychiatric Disorders Following Interpersonal Trauma? World J Psychiatry 2018, 8, 12–19. [Google Scholar] [CrossRef]
  12. Daniunaite, I.; Cloitre, M.; Karatzias, T.; Shevlin, M.; Thoresen, S.; Zelviene, P.; Kazlauskas, E. PTSD and Complex PTSD in Adolescence: Discriminating Factors in a Population-Based Cross-Sectional Study. Eur J Psychotraumatol 2021, 12. [Google Scholar] [CrossRef] [PubMed]
  13. Sareen, J. Posttraumatic Stress Disorder in Adults: Impact, Comorbidity, Risk Factors, and Treatment; 2014; Vol. 59;
  14. van Dijke, A.; Hopman, J.A.B.; Ford, J.D. Affect Dysregulation, Psychoform Dissociation, and Adult Relational Fears Mediate the Relationship between Childhood Trauma and Complex Posttraumatic Stress Disorder Independent of the Symptoms of Borderline Personality Disorder. Eur J Psychotraumatol 2018, 9, 1400878. [Google Scholar] [CrossRef] [PubMed]
  15. Carbone, E.A.; Menculini, G.; de Filippis, R.; D’Angelo, M.; Zebi, L.; Steardo, L. Sleep Disturbances in Panic Disorder with Comorbid Complex PTSD: A Possible Relationship and Different Psychopathology? Life 2023, 13. [Google Scholar] [CrossRef] [PubMed]
  16. Cromer, K.R.; Schmidt, N.B.; Murphy, D.L. An Investigation of Traumatic Life Events and Obsessive-Compulsive Disorder. Behaviour Research and Therapy 2007, 45, 1683–1691. [Google Scholar] [CrossRef] [PubMed]
  17. Dykshoorn, K.L. Trauma-Related Obsessive-Compulsive Disorder: A Review. Health Psychol Behav Med 2014, 2, 517–528. [Google Scholar] [CrossRef] [PubMed]
  18. Gershuny, B.S.; Baer, L.; Parker, H.; Gentes, E.L.; Infield, A.L.; Jenike, M.A. Trauma and Posttraumatic Stress Disorder in Treatment-Resistant Obsessive-Compulsive Disorder. Depress Anxiety 2008, 25, 69–71. [Google Scholar] [CrossRef] [PubMed]
  19. Murayama, K.; Nakao, T.; Ohno, A.; Tsuruta, S.; Tomiyama, H.; Hasuzawa, S.; Mizobe, T.; Kato, K.; Kanba, S. Impacts of Stressful Life Events and Traumatic Experiences on Onset of Obsessive-Compulsive Disorder. Front Psychiatry 2020, 11, 561266. [Google Scholar] [CrossRef] [PubMed]
  20. Vidal-Ribas, P.; Stringaris, A.; Rück, C.; Serlachius, E.; Lichtenstein, P.; Mataix-Cols, D. Are Stressful Life Events Causally Related to the Severity of Obsessive-Compulsive Symptoms? A Monozygotic Twin Difference Study. Eur Psychiatry 2015, 30, 309–316. [Google Scholar] [CrossRef]
  21. Wang, Y.; Hong, A.; Yang, W.; Wang, Z. The Impact of Childhood Trauma on Perceived Stress and Personality in Patients with Obsessive-Compulsive Disorder: A Cross-Sectional Network Analysis. J Psychosom Res 2023, 172. [Google Scholar] [CrossRef]
  22. Ojserkis, R.; Boisseau, C.L.; Reddy, M.K.; Mancebo, M.C.; Eisen, J.L.; Rasmussen, S.A. The Impact of Lifetime PTSD on the Seven-Year Course and Clinical Characteristics of OCD. Psychiatry Res 2017, 258, 78–82. [Google Scholar] [CrossRef] [PubMed]
  23. Wadsworth, L.P.; Van Kirk, N.; August, M.; Kelly, J.M.; Jackson, F.; Nelson, J.; Luehrs, R. Understanding the Overlap between OCD and Trauma: Development of the OCD Trauma Timeline Interview (OTTI) for Clinical Settings. Curr Psychol 2023, 42, 6937–6947. [Google Scholar] [CrossRef] [PubMed]
  24. Boger, S.; Ehring, T.; Schwarzkopf, W.; Werner, G.G. Potential Mediators of the Association between Childhood Maltreatment and Obsessive-Compulsive Disorder in Adulthood. J Obsessive Compuls Relat Disord 2020, 27. [Google Scholar] [CrossRef]
  25. De Silva, P.; Marks, M. The Role of Traumatic Experiences in the Genesis of Obsessive±compulsive Disorder; 1999; 1999.
  26. Destrée, L.; Brierley, M.-E.E.; Albertella, L.; Jobson, L.; Fontenelle, L.F. The Effect of Childhood Trauma on the Severity of Obsessive-Compulsive Symptoms: A Systematic Review. J Psychiatr Res 2021, 142, 345–360. [Google Scholar] [CrossRef]
  27. Nacasch, N.; Fostick, L.; Zohar, J. High Prevalence of Obsessive-Compulsive Disorder among Posttraumatic Stress Disorder Patients. European Neuropsychopharmacology 2011, 21, 876–879. [Google Scholar] [CrossRef]
  28. Krause-Utz, A. Dissociation, Trauma, and Borderline Personality Disorder. Borderline Personal Disord Emot Dysregul 2022, 9, 14. [Google Scholar] [CrossRef] [PubMed]
  29. Dalenberg, C.J.; Brand, B.L.; Gleaves, D.H.; Dorahy, M.J.; Loewenstein, R.J.; Cardeña, E.; Frewen, P.A.; Carlson, E.B.; Spiegel, D. Evaluation of the Evidence for the Trauma and Fantasy Models of Dissociation. Psychol Bull 2012, 138, 550–588. [Google Scholar] [CrossRef]
  30. Dorahy, M.J.; Brand, B.L.; Sar, V.; Krüger, C.; Stavropoulos, P.; Martínez-Taboas, A.; Lewis-Fernández, R.; Middleton, W. Dissociative Identity Disorder: An Empirical Overview. Aust N Z J Psychiatry 2014, 48, 402–417. [Google Scholar] [CrossRef]
  31. Gershuny, B.S.; Thayer, J.F. RELATIONS AMONG PSYCHOLOGICAL TRAUMA, DISSOCIATIVE PHENOMENA, AND TRAUMA-RELATED DISTRESS: A REVIEW AND INTEGRATION; 1999; Vol. 19;
  32. Lynn, S.J.; Maxwell, R.; Merckelbach, H.; Lilienfeld, S.O.; Kloet, D. van H. der; Miskovic, V. Dissociation and Its Disorders: Competing Models, Future Directions, and a Way Forward. Clin Psychol Rev 2019, 73, 101755. [Google Scholar] [CrossRef]
  33. Rosario-Campos, M.C.; Miguel, E.C.; Quatrano, S.; Chacon, P.; Ferrao, Y.; Findley, D.; Katsovich, L.; Scahill, L.; King, R.A.; Woody, S.R.; et al. The Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS): An Instrument for Assessing Obsessive-Compulsive Symptom Dimensions. Mol Psychiatry 2006, 11, 495–504. [Google Scholar] [CrossRef]
  34. Deacon, B.J.; Abramowitz, J.S. The Yale-Brown Obsessive Compulsive Scale: Factor Analysis, Construct Validity, and Suggestions for Refinement. J Anxiety Disord 2005, 19, 573–585. [Google Scholar] [CrossRef]
  35. Wu, M.S.; McGuire, J.F.; Horng, B.; Storch, E.A. Further Psychometric Properties of the Yale-Brown Obsessive Compulsive Scale - Second Edition. Compr Psychiatry 2016, 66, 96–103. [Google Scholar] [CrossRef]
  36. Rossi, R.; Socci, V.; Pacitti, F.; Carmassi, C.; Rossi, A.; Di Lorenzo, G.; Hyland, P. The Italian Version of the International Trauma Questionnaire: Symptom and Network Structure of Post-Traumatic Stress Disorder and Complex Post-Traumatic Stress Disorder in a Sample of Late Adolescents Exposed to a Natural Disaster. Front Psychiatry 2022, 13. [Google Scholar] [CrossRef] [PubMed]
  37. Cloitre, M.; Hyland, P.; Prins, A.; Shevlin, M. The International Trauma Questionnaire (ITQ) Measures Reliable and Clinically Significant Treatment-Related Change in PTSD and Complex PTSD. Eur J Psychotraumatol 2021, 12. [Google Scholar] [CrossRef] [PubMed]
  38. Thompson, E. Hamilton Rating Scale for Anxiety (HAM-A). Occup Med (Lond) 2015, 65, 601. [Google Scholar] [CrossRef] [PubMed]
  39. Rabinowitz, J.; Williams, J.B.W.; Hefting, N.; Anderson, A.; Brown, B.; Fu, D.J.; Kadriu, B.; Kott, A.; Mahableshwarkar, A.; Sedway, J.; et al. Consistency Checks to Improve Measurement with the Hamilton Rating Scale for Anxiety (HAM-A). J Affect Disord 2023, 325, 429–436. [Google Scholar] [CrossRef] [PubMed]
  40. McFarlane, A.C. The Long-Term Costs of Traumatic Stress: Intertwined Physical and Psychological Consequences. World Psychiatry 2010, 9, 3–10. [Google Scholar] [CrossRef] [PubMed]
  41. van der Kolk, B. Posttraumatic Stress Disorder and the Nature of Trauma. Dialogues Clin Neurosci 2000, 2, 7–22. [Google Scholar] [CrossRef] [PubMed]
  42. Moore, S.E.; Norman, R.E.; Suetani, S.; Thomas, H.J.; Sly, P.D.; Scott, J.G. Consequences of Bullying Victimization in Childhood and Adolescence: A Systematic Review and Meta-Analysis. World J Psychiatry 2017, 7, 60. [Google Scholar] [CrossRef] [PubMed]
  43. Pinciotti, C.M.; Riemann, B.C.; Wetterneck, C.T. Trauma Type and Obsessive-Compulsive Symptom Domains: The Unique Relationship between Indirectly Experienced Trauma and Just Right Symptoms. J Obsessive Compuls Relat Disord 2021, 29. [Google Scholar] [CrossRef]
  44. Cloitre, M.; Cohen, L.R.; Edelman, R.E.; Han, H. Posttraumatic Stress Disorder and Extent of Trauma Exposure as Correlates of Medical Problems and Perceived Health among Women with Childhood Abuse. Women Health 2001, 34, 1–17. [Google Scholar] [CrossRef]
  45. Berfield, J.B.; Goncharenko, S.; Forkus, S.R.; Contractor, A.A.; Weiss, N.H. The Differential Relation of Trauma Types with Negative and Positive Emotion Dysregulation. Anxiety Stress Coping 2022, 35, 425–439. [Google Scholar] [CrossRef]
  46. Uyan, T.T.; Baltacioglu, M.; Hocaoglu, C. Relationships between Childhood Trauma and Dissociative, Psychotic Symptoms in Patients with Schizophrenia: A Case-Control Study. Gen Psychiatr 2022, 35. [Google Scholar] [CrossRef]
  47. Belli, H. Dissociative Symptoms and Dissociative Disorders Comorbidity in Obsessive Compulsive Disorder: Symptom Screening, Diagnostic Tools and Reflections on Treatment. World J Clin Cases 2014, 2, 327. [Google Scholar] [CrossRef]
  48. Borges, M.C.; Braga, D.T.; Igo, S.; D’Alcante, C.C.; Sidrim, I.; MacHado, M.C.; Pinto, P.S.P.; Cordioli, A. V.; Do Rosrio, M.C.; Petrib, K.; et al. Cognitive Dysfunction in Post-Traumatic Obsessivecompulsive Disorder. Australian and New Zealand Journal of Psychiatry 2011, 45, 76–85. [Google Scholar] [CrossRef] [PubMed]
  49. Coventry, P.A.; Meader, N.; Melton, H.; Temple, M.; Dale, H.; Wright, K.; Cloitre, M.; Karatzias, T.; Bisson, J.; Roberts, N.P.; et al. Psychological and Pharmacological Interventions for Posttraumatic Stress Disorder and Comorbid Mental Health Problems Following Complex Traumatic Events: Systematic Review and Component Network Meta-Analysis. PLoS Med 2020, 17. [Google Scholar] [CrossRef] [PubMed]
  50. Scelles, C.; Bulnes, L.C. EMDR as Treatment Option for Conditions Other Than PTSD: A Systematic Review. Front Psychol 2021, 12. [Google Scholar] [CrossRef] [PubMed]
  51. Do Rosario-Campos, M.C.; Leckman, J.F.; Curi, M.; Quatrano, S.; Katsovitch, L.; Miguel, E.C.; Pauls, D.L. A Family Study of Early-Onset Obsessive-Compulsive Disorder. American Journal of Medical Genetics - Neuropsychiatric Genetics 2005, 136 B, 92–97. [Google Scholar] [CrossRef]
  52. Hanna, G.L.; Himle, J.A.; Curtis, G.C.; Gillespie, B.W. A Family Study of Obsessive-Compulsive Disorder with Pediatric Probands. American Journal of Medical Genetics - Neuropsychiatric Genetics 2005, 134 B, 13–19. [Google Scholar] [CrossRef]
Table 1. Socio-Demographic Characteristics (107 Patients).
Table 1. Socio-Demographic Characteristics (107 Patients).
SEX MALE YES (N%) 54 50.5
DIPLOMA YES (N%) 84 78.5
PSYCHIATRIC FAMILIARITY YES (N%) 74 69.2
CPTSD YES (N%) 50 46.7
AGE M (SD) 45.75 13,902
HAM A_TOT M (SD) 11.50 9,999
Y-BOCS_TOT M (SD) 10.49 6,931
HAM-A: Hamilton Anxiety Rating Scale; Y-BOCS: Yale-Brown Obsessive Compulsive Scale; cPTSD: complex posttraumatic disorder; N: total number; SD: standard deviation; %: percentage.
Table 2. ANOVA Between the Two Groups (cPTSD+ and cPTSD-).
Table 2. ANOVA Between the Two Groups (cPTSD+ and cPTSD-).
CHARACTERISTIC DF F-VALUE P-VALUE
AGE OF OCD ONSET 1 3.073 0.083
FAMILIARITY WITH OTHER PATHOLOGIES 1 0.065 0.799
PSYCHIATRIC FAMILY HISTORY 1 5.333 0.023
HAM-A_TOT 1 64.803 0.000
Y-BOCS_TOT 1 38.462 0.000
HAM-A: Hamilton Anxiety Rating Scale; Y-BOCS: Yale-Brown Obsessive Compulsive Scale; OCD: obsessive-compulsive disorder. Bold p-values indicate statistical significance.
Table 3. Logistic Regression.
Table 3. Logistic Regression.
CHARACTERISTIC B STANDARD ERROR (SE) WALD STATISTIC DF P-VALUE
Y-BOCS_TOT 0.202 0.043 22.111 1 0.000
INTERCEPT -4.759 1.028 21.453 1 0.000
Y-BOCS: Yale-Brown Obsessive Compulsive Scale. Bold p-values indicate statistical significance.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.
Copyright: This open access article is published under a Creative Commons CC BY 4.0 license, which permit the free download, distribution, and reuse, provided that the author and preprint are cited in any reuse.
Exploring the Interplay between Complex PTSD and Obsessive-Compulsive Disorder Severity: Implications for Clinical Practice

Martina D'Angelo

et al.

,

2024

The Impact of Event Scale – Revised: Examining its cutoff scores among Arab psychiatric patients and healthy adults within the context of COVID-19 as a collective traumatic event

Amira M. Ali

et al.

,

2023

Symptom Severity Changes in Obsessive-Compulsive Patients during COVID-19 Pandemic Are Associated with Shorter Illness Duration and Benzodiazepine Use: Possible Evolutionary Advantage of a Psychiatric Disorder

Giordano D’Urso

et al.

,

2024

Prerpints.org logo

Preprints.org is a free preprint server supported by MDPI in Basel, Switzerland.

facebook logotwitter logolinkedin logo
MDPI Initiatives
Important Links
Subscribe

Disclaimer

Terms of Use

Privacy Policy

© 2024 MDPI (Basel, Switzerland) unless otherwise stated