Treatment-Resistant Obsessive-Compulsive Disorder: Clinical and Personality Correlates

AbstractThe objective of the present study was to establish a clinical/personality profile of Turkish patients with treatment-resistant obsessive-compulsive disorder (TR-OCD). Methods. A neurocognitive/clinical test battery was administered to 17 patients with TR-OCD. Results. TR-OCD patients presented with major psychiatric syndromes (especially mood and generalized anxiety disorders) and personality disorders (particularly paranoid, avoidant, obsessive-compulsive, histrionic), and obtained higher scores on measures of core OCD symptoms (i.e., obsessional ideation, compulsive cleaning/washing, mental neutralizing), depressive symptoms, schizotypal personality features, and impulsiveness relative to normative controls. TR-OCD patients did not differ significantly from normative controls on checking, doubting, ordering, and hoarding subscales, and on measures of venturesomeness and empathy. Conclusions. Lack of insight, suspiciousness, and rigidity associated with schizotypal, paranoid, and obsessive-compulsive personality features may have contributed to treatment failure

Treatment-Resistant Obsessive-Compulsive Disorder: Neurocognitive and Clinical Correlates

AbstractThere are a number of studies examining clinical and comorbidity profiles among patients with treatment-resistant obsessive-compulsive disorder (TR-OCD); however, there have been far fewer investigations of neurocognitive function among such patients. Five patients with treatment-refractory obsessive-compulsive symptoms underwent neurocognitive and clinical/personality testing. A number of TR-OCD patients met diagnostic criteria for major axis I disorders (particularly mood and anxiety disorders) as well as clusters A, B, and C personality disorders. TR-OCD patients demonstrated significant performance deficits on neurocognitive tests of visuospatial working memory, visuoconstructive ability, and executive control as well as one test of processing speed, but not a second, relative to healthy normative controls. TR-OCD patients and normative controls did not differ significantly on measures of verbal working memory, sequencing, figure copy organization, inhibitory control, and odor identification. In addition, TR-OCD patients were directly compared to five healthy controls evaluated in our laboratory for a separate unpublished study. TR-OCD patients demonstrated significant performance deficits on tests of visuospatial working memory, information processing speed, and executive control, and obtained substantially higher scores on dimensional measures of social anxiety and depressive symptom severity, but not schizotypal personality features. Group differences of tests of verbal working memory, inhibitory control, and additional tests of executive function were not significant. In summary, patients with TR-OCD presented with comorbid axis I conditions (primarily mood and anxiety disorders) and personality disorders. TR-OCD patients demonstrated deficits on some, but not all, tests of working memory and executive control. Neurocognitive test findings lend partial support to the hypothesis that right hemisphere (particularly dorsolateral-prefrontal, but not orbitofrontal) dysfunction is associated with TR-OCD, and a number of TR-OCD patients met diagnostic criteria for major axis I disorders (particularly mood and anxiety disorders) as well as cluster A, B, and C personality disorders further complicating treatment

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This thesis aimed to examine the process of projective identification in the couple relationship by focusing on two areas of investigation: Firstly, how projective identification operates “within” an individual regarding the associations among early parenting experiences, personality and couple relationship; secondly how projective identification operates between two partners in the couple relationship regarding partners’ similarities and complementarities have been focused. Initially, several multiple regressions were run to examine the relationships among the parenting, personality and couple relationship. Afterwards, several intra-class partial pairwise correlatons were conducted to reveal similarities and complementarities of the partners regarding their early maladaptive parenting experiences, personality constructs and couple relationship variables. Paulson Daily Living Inventory, Separation-Individuation Inventory and Splitting Scale were translated into Turkish and psychometric studies were conducted. For the main study, 356 participants (178 male and 178 female), who are cohabiting partners to each other, were achieved through snowball sampling method. Early maladaptive parenting experiences of the participants were examined by Young Parenting Inventory. Personality constructs contained “separation individuation process” and “splitting defense” as the theoretical correlates of projective identification, and “early maladaptive schemas” of the individuals. Couple relationship variables were “relationship satisfaction”, “emotional dependency” and “jealousy”. Findings of the study revealed that projective identification has bidirectional relatedness with the personality and couple relationship of the individual. Multiple regression analyses showed theoretically consistent associations among an individual’s parenting experiences, personality and couple relationship. Intra-class partial pairwise correlations showed similarities and complementarities between two partners. Findings were discussed in the light of relevant literature.Ph.D. - Doctoral Progra