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Otojen ve reaktif tip obsesif kompulsif bozukluk'ta bağlanma biçimleri, içgörü, zihinselleştirme ve empati becerileri arasındaki ilişkinin incelenmesi

An examination of the relationship between attachment styles, insight, mentalization, and empathy skills in autogenous and reactive type obsessive-compulsive disorde

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  1. Tez No: 942441
  2. Yazar: ŞEYMA NUR ATAK
  3. Danışmanlar: DOÇ. DR. SİNAY ÖNEN
  4. Tez Türü: Tıpta Uzmanlık
  5. Konular: Psikiyatri, Psychiatry
  6. Anahtar Kelimeler: Belirtilmemiş.
  7. Yıl: 2025
  8. Dil: Türkçe
  9. Üniversite: Sağlık Bilimleri Üniversitesi
  10. Enstitü: Bursa Tıp Fakültesi
  11. Ana Bilim Dalı: Ruh Sağlığı ve Hastalıkları Ana Bilim Dalı
  12. Bilim Dalı: Belirtilmemiş.
  13. Sayfa Sayısı: 80

Özet

Amaç: Obsesif Kompulsif Bozukluk (OKB), yalnızca semptom çeşitliliğiyle değil, aynı zamanda bilişsel algısal süreçler ve klinik seyir açısından da belirgin bir heterojenlik sergileyen karmaşık bir ruhsal bozukluktur. Çalışmamızda OKB tanılı bireylerin otojen ve reaktif alt tiplerine göre bağlanma biçimleri, içgörü, sosyal biliş, empati ve zihinselleştirme becerileri arasındaki ilişkinin incelenmesi amaçlanmıştır. Gereç ve Yöntemler: Araştırmaya, Sağlık Bilimleri Üniversitesi Bursa Yüksek İhtisas Eğitim ve Araştırma Hastanesi Psikiyatri Kliniği'e başvuran, DSM-5 tanı ölçütlerine göre OKB tanı kriterlerini karşılayan 100 hasta ve 50 sağlıklı kontrol dahil edilmiştir. Hastalar, klinik görüşme ve Yale Brown Obsesyon Kompulsiyon Değerlendirilme Ölçeği belirti listesine göre otojen (n=50) ve reaktif (n=50) alt tip olmak üzere iki gruba ayrılmıştır. Tüm katılımcılara tanıyı doğrulamak ve ek tanıları dışlamak için SCID-I, sosyodemografik veri formu, Temel Empati Ölçeği, Brown İnançların Değerlendirilmesi Ölçeği, Zihinselleştirme Ölçeği, Gözlerden Zihin Okuma Testi ve Erişkin Bağlanma Biçimi Ölçeği uygulanmıştır. Bulgular: Otojen ve Reaktif OKB grupları arasında ZÖ-S puanları bakımından anlamlı bir fark olduğu (p=0,018), ZÖ toplam, YBOKÖ, TEÖ, BİDÖ, EBBÖ ve GZOT toplam puanları bakımından istatistiksel olarak anlamlı bir fark olmadığı (p>0,05) görüldü. Otojen OKB grubunda ZÖ-S puanları, hem reaktif OKB grubuna hem de kontrol grubuna kıyasla anlamlı düzeyde düşük bulundu (F=11,93, p

Özet (Çeviri)

Aim: Obsessive-Compulsive Disorder (OCD) is a complex psychiatric condition characterized by significant heterogeneity, not only in terms of symptom diversity but also in cognitive-perceptual processes and clinical course. The aim of the present study is to examine the relationship between attachment styles, insight, social cognition, empathy, and mentalization abilities in individuals diagnosed with OCD, based on the distinction between autogenous and reactive subtypes. Materials and Methods: The study included 100 patients who presented to the Psychiatry Clinic and met the DSM-5 diagnostic criteria for Obsessive-Compulsive Disorder (OCD), along with 50 healthy controls. Based on clinical interviews and the symptom checklist of the Yale-Brown Obsessive Compulsive Scale, the patient group was divided into two subtypes: autogenous (n=50) and reactive (n=50). To confirm diagnoses and exclude comorbid conditions, all participants were administered the SCID-I (Structured Clinical Interview for DSM-IV), a sociodemographic data form, the Basic Empathy Scale, the Brown Assessment of Beliefs Scale, the Mentalization Scale, the Reading the Mind in the Eyes Test, and the Adult Attachment Style Questionnaire. Results: A significant difference was found between the autogenous and reactive OCD groups in terms of Mentalization Scale–Self (MENTS-S) subscale scores (p = 0.018), while no statistically significant differences were observed regarding total mentalization scores, Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Basic Empathy Scale (BES), Brown Assessment of Beliefs Scale (BABS), Adult Attachment Styles Questionnaire (AASQ), or Reading the Mind in the Eyes Test (RMET) total scores (p > 0.05). In the autogenous OCD group, MENTS-S scores were significantly lower compared to both the reactive OCD group and the control group (F = 11.93, p < 0.001). Within the autogenous OCD group, Y-BOCS obsession scores were negatively correlated with total mentalization (r = –0.491, p < 0.001), MENTS-S (r = –0.380, p = 0.006), and Mentalization Scale–Others (MENTS-O) scores (r = –0.406, p = 0.003), while AASQ avoidant attachment scores showed a positive correlation (r = 0.344, p = 0.016). Moreover, Y-BOCS compulsion scores were negatively correlated with MENTS-S scores (r = –0.351, p = 0.012), and positively correlated with AASQ secure/insecure subscale scores (r = 0.287, p = 0.048).In the reactive OCD group, both Y-BOCS obsession and compulsion scores were positively correlated only with BABS scores (r = 0.298, p = 0.036 and r = 0.513, p < 0.001, respectively). In the autogenous OCD group, AASQ avoidant attachment scores were negatively correlated with total mentalization (r = –0.325, p = 0.023) and MENTS-S scores (r = –0.373, p = 0.008). Furthermore, AASQ secure/insecure subscale scores were negatively associated with MENTS-S scores (r = –0.371, p = 0.009).In the reactive OCD group, AASQ secure/insecure subscale scores were negatively correlated with total mentalization (r = –0.396, p = 0.005), MENTS-S (r = –0.348, p = 0.015), and MENTS-O scores (r = –0.321, p = 0.026), while they were positively correlated with RMET total scores (r = 0.317, p = 0.028). In the three-step hierarchical regression model examining predictors of mentalization, it was found that, in the autogenous OCD group, 27% of the variance in mentalization scores was significantly explained by Y-BOCS and BABS scores (R² = 0.27, F = 3.55, p = 0.022). When BES and RMET scores were added, 31% of the variance was significantly explained (R² = 0.31, F = 2.76, p = 0.031). However, when the AASQ subscales for secure/insecure, avoidant, and anxious attachment were included in the model, the overall model lost statistical significance in explaining mentalization scores. Nonetheless, the predictive effect of obsession scores remained significant (β = –0.499, p = 0.019), whereas secure/insecure attachment subscale scores did not significantly predict mentalization (β = –0.093, p = 0.607). In the reactive OCD group, the three-step hierarchical regression model was not statistically significant in explaining mentalization scores. However, only the AASQ secure/insecure subscale scores were found to significantly and negatively predict total mentalization scores (β = –0.415, p = 0.019). Conclusion: Our research findings revealed that individuals with the autogenous subtype of OCD exhibit significantly impaired mentalization abilities compared to both the reactive OCD group and the healthy control group. In particular, the reduction in self-oriented mentalization was found to be associated with avoidant attachment style, and the only factor found to predict the impairment in mentalization ability was the severity of obsessions. In contrast, mentalization abilities appeared to be relatively preserved in the reactive OCD group, with only insecure attachment style emerging as a significant predictor of mentalization. These results suggest phenomenological differences between OCD subtypes and indicate that mentalization processes are more specifically affected in the autogenous subtype. Our findings highlight that psychotherapeutic interventions focusing on attachment and mentalization may be particularly effective in the treatment of patients with autogenous OCD.

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