KISEP Original Article J Korean Neuropsychiatr Assoc Vol 43, No 1 강박장애의증상차원과공존인격병리의관련성에관한연구 서울대학교의과대학정신과학교실, 1 축령복음병원, 2 성신여자대학교심리학과 3 하태현 1 윤탁 2 노규식 1 김명선 3 권준수 1 Symptom Dimensions of Obsessive-Compulsive Disorder and Their Relation to Comorbid Personality Pathology Tae Hyon Ha, MD 1, Tak Youn, MD 2, Kyu Sik Rho, MD 1, Myung-Sun Kim, PhD 3 and Jun Soo Kwon, MD, PhD 1 Department of Psychiatry, 1 Seoul National University College of Medicine, Seoul, Chook Ryoung Evangelical Hospital, 2 Namyangju, Department of Psychology, 3 Sungshin Women s University, Seoul, Korea Objectives:A great deal of attention has been paid to comorbid personality disorders in obsessive-compulsive disorder not only from the theoretical perspectives but also from the clinical aspects related to the prediction of the treatment response. The purpose of the current study was to investigate the relations of the symptoms dimensions in OCD to the comorbid personality pathology. Methods:One-hundred thirty subjects with OCD completed Yale-Brown Obsessive Compulsive Scale (YBOCS) and Personality Disorder Questionnaire-4+ (PDQ-4+). Factor scores of symptom dimensions yielded from a factor analysis of 13 categories in YBOCS symptom checklist were inspected how to be related with the presence of any personality disorder and the PDQ scores for cluster A, B, and C personality pathology. Results:The PDQ total score was significantly correlated with aggressive/sexual/religious obsessions, hoarding, and symmetry/ordering dimensions. The hoarding and repeating/counting dimensions were correlated with cluter A pathology, the symmetry/ordering dimension was with cluster B pathology, while the obsessions dimension was globally related to personality disorders of all the clusters. Conclusion:These findings add the evidence of the heterogeneity of OCD. The presence of pure obsessions, hoarding, and symmetry/ordering dimensions may need a close screening for comorbid personality disorders and individualized therapeutic strategies. (J Korean Neuropsychiatr Assoc 2004;43(1):46-53) KEY WORDS:Obsessive-compulsive disorder Personality disorders Symptom dimensions. 46 서 - 론 -
T.H. Ha, et al 강박증상과공존인격병리 연구대상 - - 평가도구 Table 1. Clinical variables of 130 patients male89, female41 with OCD Variables Minimum Maximum Mean SD Age Onset age Illness duration YBOCS score 15 07 01 55 50 30 28.6 20.0 08.1 8.5 7.8 6.4 Obsessions 00 20 12.5 4.2 Compulsions 00 19 11.2 4.8 Total score 05 39 23.7 7.5 YBOCSyale-brown obsessive compulsive scale 방 법 47
강박증상과공존인격병리 T.H. Ha, et al - - 통계분석 결과 강박증상의빈도및요인분석결과 - Table 2. Frequencies of the major symptom categories of the yale-brown obsessive compulsive scale symptom checklist Men n89 Women n41 All patients n130 Symptom category Major symptom Present symptom* Major symptom Present symptom* Major symptom Present symptom* N N N N N % N % Obsessions Aggressive 17 57 09 22 26 20.0 79 60.8 Contamination 19 52 18 31 37 28.5 83 63.8 Sexual 06 35 02 12 08 06.2 47 36.2 Hoarding 02 24 03 10 05 03.8 34 26.2 Religious 04 27 01 17 05 03.8 44 33.8 Symmetry 06 48 02 19 08 06.2 67 51.5 Somatic 12 45 09 20 21 16.2 65 50.0 Compulsions Cleaning 27 51 20 28 47 36.2 79 60.8 Checking 42 78 22 30 64 49.2 108 83.1 Repeating 28 64 13 21 41 31.5 85 65.4 Counting 09 32 02 17 11 08.5 49 37.7 Ordering 10 28 02 08 12 09.2 36 27.7 Hoarding 01 15 01 07 2 01.5 22 16.9 Including major symptom 48
T.H. Ha, et al 강박증상과공존인격병리 Factor 1 Factor 2 Factor 3 Factor 4 Factor 5 Aggressive 0.71 Obsessions loadings Contamination 0.93 Symmetry 0.81 Sexual 0.78 Hoarding 0.86 Compulsions loadings Cleaning 0.89 Ordering 0.84 Religious 0.52 Hoarding 0.86 Counting 0.83 Repeating 0.79 Fig. 1. Five factors identified by principal component analysis with varimax rotation of 13 major symptom categories from 130 patients with OCD. Table 3. Distribution of comorbid personality disorders in 130 patients with OCD No. of patients Percent % Any 114 87.7 Cluster A Paranoid 045 34.6 Schizoid 036 27.7 Schizotypal 038 29.2 Cluster B Histrionic 036 27.7 Narcissistic 021 16.2 Borderline 047 36.2 Antisocial 012 09.2 Cluster C Avoidant 087 66.9 Dependent 044 33.8 Obsessive-compulsive 067 51.5 Other Negativistic 054 41.5 Depressive 064 49.2 None 016 12.3 공존인격장애의빈도및인구학적특성 - 공존인격병리와강박증상간의상관성 49
강박증상과공존인격병리 T.H. Ha, et al - - Personality disorders F1 Symptom dimensions and symptom severity F2 F3 F4 F5 YBOCS Paranoid A Schizoid Schizotypal Histrionic B Narcissistic Borderline Antisocial Avoidant C Dependent Obsessivecompulsive Negativistic Depressive Significant difference in the factor scores or YBOCS scores between groups with and without a specific personality disorder in a Mann- Whitney U test p0.05 Significant correlation between the factor scores or YBOCS scores and the presence of a specific personality disorder or PDQ scores in a logistic or multiple regression analysis p0.05 Fig. 2. The relation of symptom dimensions and symptom severity to the comorbid personality pathology in OCD. F 1-5Factor scores of symptom dimensions. YBOCS total score of Yale Brown Obsessive Compulsive Scale. 50
T.H. Ha, et al 강박증상과공존인격병리 고찰 - - 51
강박증상과공존인격병리 T.H. Ha, et al - - 결론 52
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