Presenting a Pathological Model of Obsessive-Compulsive Disorder Based on Maladaptive Perfectionism and Sensitivity to Threat in Nonclinical Population: Mediating Role of Intolerance of Uncertainty

Document Type : Research Paper

Authors

1 Department of psychology, Faculty of education and psychology, Tabriz Branch Islamic Azad, Tabriz, ,Iran

2 Department of psychology, Faculty of Education and Psychology, Tabriz Branch Islamic Azad, Tabriz, Iran

3 Department of Psychology, Faculty of Education and Psychology, Tabriz Branch Islamic Azad, Tabriz, ,Iran

Abstract

The purpose of the present study was to investigate the mediating role of Intolerance of Uncertainty (IU) in the relationship between maladaptive perfectionism and Sensitivity to threat with obsessive-compulsive disorder (OCD), using structural equation modeling (SEM). The research design was descriptive-correlation study. The participants were 586 students of Islamic Azad University Tabriz Branch, University of Tabriz and Azarbaijan Shahid Madani University in Iran. They were selected using cluster sampling method. Data were collected by Obsessive Compulsive Inventory Revised (OCI-R), Frost Perfectionism Scale, BIS/BAS scales, and Intolerance of Uncertainty Scale. SEM confirmed the proposed model (χ2 /df = 2.32, RMSEA = 0.05, CFI = 0.95, GFI = 0.94, AGFI = 0.92) and indicated that maladaptive perfectionism and Sensitivity to threat with standardized coefficients of 0.32 and 0.38, respectively, have a significant effect on OCD by the mediation of IU at the P˂0.05 level. The findings, supporting the theoretical model, proposes a suitable framework for psychopathology of the disorder that emphasizes high maladaptive perfectionism and high sensitivity to threat by the mediation of IU due OCD. These findings, can be useful in developing etiology and efficacious therapeutic interventions for OCD.

Keywords


اکبری، م. (1396). بررسی سهم نسبی سازه‌های فراتشخیصی در پیش‌بینی اختلال وسواسی اجباری در یک جمعیت بالینی: عدم تحمل بلاتکلیفی، همجوشی شناختی، عدم تحمل آشقتگی. روا‌ن‌شناسی بالینی و شخصیت. 15(2)، 177-167.
اکبری، م.، حمیدپور، ح.، و اندوز، ز. (1389). بررسی عوامل پیش‌بینی‌کننده نگرانی پاتولوژیک در دانشجویان. پنجمین سمینار سراسری بهداشت روانی دانشجویان، 22-24 اردیبهشت، دانشگاه علوم پزشکی تهران.
بی‌طرف، ش.، شعیری، م. ر.، و حکیمجوادی، م. (1389). هراس اجتماعی، سبک‌های والدگری و کمال‌گرایی. روان‌شناسی تحولی (روان‌شناسان ایرانی). 7(25)، 83-75.
حسنی، ج.، بیگدلی، ا. ‌ا.، و قوشچیان، س. (1386). مقایسه فعالیت سیستم‌های مغزی رفتاری بیماران مبتلا به اختلال وسواس و افراد بهنجار. تازه‌های علوم شناختی. 9(4)، 25-16.
خانجانی، ز.، محمدی، ف.، هاشمی، ت.، بخشی‌پور، ع.، و بیرامی، م. (1393). تأثیر سیستم‌های مغزی رفتاری و عواطف بر نشانه‌های ابعادی وسواسی جبری. مجله دانشگاه علوم پزشکی کرمانشاه (بهبود). 18(2)، 91-80.
عارف‌نیا، ر.، و خشنودی، ک. (۱۳۹۶). رابطه بین کمال‌گرایی با افکار وسواسی در دانشجویان روان‌شناسی دانشگاه آزاد اسلامی کرج. سومین کنفرانس روان‌شناسی و علوم رفتاری، تهران.
علی‌یاری، ن.، و محمودعلیلو، م. (۱۳۹۶). پیشبینی نشانههای اختلال وسواسی- اجباری براساس سیستمهای مغزی رفتاری. کنگره بین‌المللی بهداشت روان و علوم روان‌شناختی، تهران.
محمدی، ن. ا. (1387). ویژگی‌های روان‌سنجی مقیاس‌های سیستم بازداری و فعال‌سازی رفتار در دانشجویان دانشگاه شیراز. روان‌شناسی بالینی و  شخصیت (دانشور رفتار سابق). 15(28)، 68-61.
میز، ک. ا.، گامست، گ.، و و گارینو، ا. ج. (1396). پژوهش چندمتغیری کاربردی (طرح و تفسیر)، ترجمه حسن پاشا شریفی و همکاران، نوبت 5. تهران: رشد.
هومن، ح. ع. (1380). تحلیل داده‌های چندمتغیری در پژوهش‌های رفتاری. تهران: پارسا.
هومن، ح. ع. (1388). مدل‌یابی معادلات ساختاری با کاربرد نرم‌افزار لیزرل. تهران: سمت.
 
Abramowitz, J. S., Fabricant, L. E., Taylor, S., Deacon, B. J., McKay, D., & Storch, E. A. (2014). The relevance of analogue studies for understanding obsessions and compulsions. Clinical Psychology Review. 34(3), 206-217.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
Anderson, J. C., & Gerbing, D. W. (1988). Structural equation modeling in practice: A review and recommended two-step approach. Psychological Bulletin. 103(3), 411-?
Angelakis, I., Gooding, P., Tarrier, N., & Panagioti, M. (2015). Suicidality in obsessive compulsive disorder (OCD): a systematic review and meta-analysis. Clinical Psychology Review. 39(1), 1-15.
Barlow, D. H., & Durand, V. M. (2011). Abnormal psychology: An integrative approach. Nelson Education.
Barrett, P. (2007). Structural equation modelling: Adjudging model fit. Personality and Individual Differences. 42(5), 815-824.
Beran, T. N., & Violato, C. (2010). Structural equation modeling in medical research: a primer. BMC Research Notes. 3(1), 267-277.
Berger, U., & Anaki, D. (2014). The behavioral inhibition system (BIS) mediates major aspects of the relationship between disgust and OCD symptomology. Journal of Obsessive-Compulsive and Related Disorders. 3(3), 249-256.
Blanchard, D. C., Griebel, G., Pobbe, R., & Blanchard, R. J. (2011). Risk assessment as an evolved threat detection and analysis process. Neuroscience & Biobehavioral Reviews. 35(4), 991-998.
Boomsma, A. (2000). Reporting analyses of covariance structures. Structural Equation Modeling. 7(3), 461-483.
Brennan, B. P., Rauch, S. L., Jensen, J. E., & Pope Jr, H. G. (2013). A critical review of magnetic resonance spectroscopy studies of obsessive-compulsive disorder. Biological Psychiatry. 73(1), 24-31.
 Brown, L. A., Wakschal, E., Russman-Block, S., Boisseau, C. L., Mancebo, M. C., Eisen, J. L., & Rasmussen, S. A. (2019). Directionality of change in obsessive compulsive disorder (OCD) and suicidal ideation over six years in a naturalistic clinical sample. Journal of Affective Disorders. 245(4), 841-847.
Buhr, K., & Dugas, M. J. (2002). The intolerance of uncertainty scale: Psychometric properties of the English version. Behaviour Research and Therapy. 40(8), 931-945.
Buhr, K., & Dugas, M. J. (2006). Investigating the construct validity of intolerance of uncertainty and its unique relationship with worry. Journal of Anxiety Disorders. 20(2), 222-236.
Byrne, B. M. (2016). Structural equation modeling with AMOS: Basic concepts, applications, and programming. Routledge.
Calleo, J. S., Hart, J., Björgvinsson, T., & Stanley, M. A. (2010). Obsessions and worry beliefs in an inpatient OCD population. Journal of Anxiety Disorders. 24(8), 903-908.
Campbell-Sills, L., Liverant, G. I., & Brown, T. A. (2004). Psychometric evaluation of the behavioral inhibition/behavioral activation scales in a large sample of outpatients with anxiety and mood disorders. Psychological Assessment. 16(3), 244-254.
Carleton, R. N. (2012). The intolerance of uncertainty construct in the context of anxiety disorders: Theoretical and practical perspectives. Expert Review of Neurotherapeutics. 12(8), 937-947.
Carleton, R. N. (2016). Into the unknown: A review and synthesis of contemporary models involving uncertainty. Journal of Anxiety Disorders. 39(2), 30-43.
Carver, C. S., & White, T. L. (1994). Behavioral inhibition, behavioral activation, and affective responses to impending reward and punishment: the BIS/BAS scales. Journal of Personality and Social Psychology. 67(2), 319-333.
Chou, C. P., & Bentler, P. M. (1995). Estimates and tests in structural equation modeling.
Clark, D. A. (2004). Cognitive-behavioral therapy for OCD. Guilford Press.
 Counsell, A., Furtado, M., Iorio, C., Anand, L., Canzonieri, A., Fine, A., ... & Katzman, M. A. (2017). Intolerance of uncertainty, social anxiety, and generalized anxiety: Differences by diagnosis and symptoms. Psychiatry Research. 252(2), 63-69.
Dalgleish, T., Taghavi, R., Neshat-Doost, H., Moradi, A., Canterbury, R., & Yule, W. (2003). Patterns of processing bias for emotional information across clinical disorders: A comparison of attention, memory, and prospective cognition in children and adolescents with depression, generalized anxiety, and posttraumatic stress disorder. Journal of Clinical Child and Adolescent Psychology. 32(1), 10-21.
Dash, S. R., & Davey, G. C. (2012). An experimental investigation of the role of negative mood in worry: The role of appraisals that facilitate systematic information processing. Journal of Behavior Therapy and Experimental Psychiatry. 43(2), 823-831.
Dugas, M. J., Gosselin, P., & Ladouceur, R. (2001). Intolerance of uncertainty and worry: Investigating specificity in a nonclinical sample. Cognitive Therapy and Research. 25(5), 551-558.
Dugas, M. J., Hedayati, M., Karavidas, A., Buhr, K., Francis, K., & Phillips, N. A. (2005). Intolerance of uncertainty and information processing: Evidence of biased recall and interpretations. Cognitive Therapy and Research. 29(1), 57-70.
Egan, S. J., Wade, T. D., & Shafran, R. (2011). Perfectionism as a transdiagnostic process: A clinical review. Clinical Psychology Review. 31(2), 203-212.
 Foa, E. B., Huppert, J. D., Leiberg, S., Langner, R., Kichic, R., Hajcak, G., & Salkovskis, P. M. (2002). The Obsessive-Compulsive Inventory: development and validation of a short version. Psychological Assessment. 14(4), 485-496.
 Foa, E. B., Kozak, M. J., Salkovskis, P. M., Coles, M. E., & Amir, N. (1998). The validation of a new obsessive–compulsive disorder scale: The Obsessive–Compulsive Inventory. Psychological Assessment. 10(3), 206-214.
Freeston, M. H., Rhéaume, J., Letarte, H., Dugas, M. J., & Ladouceur, R. (1994). Why do people worry? Personality and Individual Differences. 17(6), 791-802.
Frost, R. O., Marten, P., Lahart, C., & Rosenblate, R. (1990). The dimensions of perfectionism. Cognitive Therapy and Research. 14(5), 449-468.
Frost, R. O., Novara, C., & Rhéaume, J. (2002). Perfectionism in obsessive compulsive disorder. In Cognitive approaches to obsessions and compulsions (pp. 91-105).
Garson, G. D. (2011). Structural equation modeling. Statnotes: topics in multivariate analysis. North Carolina State University.
Ghassemzadeh, H., Khamseh, A., & Ebrahimkhani, N. (2005). Demographic variables and clinical features of obsessive-compulsive disorder in Iran: A second report. In BE Ling (Ed.), Obsessive compulsive disorder research (pp. 243–271): Hauppauge, NY: Nova Science Publishers.
Gillett, C. B., Bilek, E. L., Hanna, G. L., & Fitzgerald, K. D. (2018). Intolerance of uncertainty in youth with obsessive-compulsive disorder and generalized anxiety disorder: A transdiagnostic construct with implications for phenomenology and treatment. Clinical Psychology Review. 60(1), 100-108.
 Gomez, A., & Gomez, R. (2002). Personality traits of the behavioural approach and inhibition systems: Associations with processing of emotional stimuli. Personality and Individual Differences. 32(8), 1299-16.
 Gomez, R., Watson, S., & Gomez, A. (2016). Interrelationships of the Rothbart's temperament model constructs with revised-reinforcement sensitivity theory constructs. Personality and Individual Differences. 99(3), 118-121.
Gray, J. A. (1981). A critique of Eysenck’s theory of personality. In A model for personality (pp. 246-276). Springer, Berlin, Heidelberg.
Gray, J. A. (2014). Framework for a taxonomy of psychiatric disorder. In Emotions (pp. 43-74). Psychology Press.
Gray, J. A., & McNaughton, N. (2000). Fundamentals of the septo-hippocampal system. The Neuropsychology of Anxiety: An Enquiry into the Functions of Septo-hippocampal System, 2nd ed. Oxford University Press, Oxford, 204-232.
Gray, J., & McNaughton, N. (2003-06-05). (Ed.), The Neuropsychology of Anxiety: An enquiry into the function of the septo-hippocampal system: Oxford University Press,. Retrieved 11 Feb. 2019, from http://www.oxfordscholarship.com/view/10.1093/acprof:oso/9780198522713.001.0001/acprof-9780198522713.
 Hair, J. F., Ringle, C. M., & Sarstedt, M. (2011). PLS-SEM: Indeed a silver bullet. Journal of Marketing Theory and Practice. 19(2), 139-152.
 Harrington, D. (2009). Confirmatory factor analysis. Oxford university press.
 Hecht, D. (2013). The neural basis of optimism and pessimism. Experimental Neurobiology. 22(3), 173-199.
Heym, N., & Lawrence, C. (2010). The role of Gray’s revised RST in the P–psychopathy continuum: The relationships of Psychoticism with a lack of fear and anxiety, and increased impulsivity. Personality and Individual Differences. 49(8), 874-879.
Hong, R. Y., & Cheung, M. W. L. (2015). The structure of cognitive vulnerabilities to depression and anxiety: Evidence for a common core etiologic process based on a meta-analytic review. Clinical Psychological Science. 3(6), 892-912.
Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: a Multidisciplinary Journal. 6(1), 1-55.
Kawamoto, T., & Furutani, K. (2018). The mediating role of intolerance of uncertainty on the relationships between perfectionism dimensions and psychological adjustment/maladjustment among mothers. Personality and Individual Differences. 122(1), 62-67.
Kessler, R. C., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Wittchen, H. U. (2012). Twelve‐month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. International Journal of Methods in Psychiatric Research. 21(3), 169-184.
 Kim, H., Seo, J., Namkoong, K., Hwang, E. H., Sohn, S. Y., Kim, S. J., & Kang, J. I. (2016). Alexithymia and perfectionism traits are associated with suicidal risk in patients with obsessive–compulsive disorder. Journal of Affective Disorders. 192(1), 50-55.
Kim, L. E., Chen, L., MacCann, C., Karlov, L., & Kleitman, S. (2015). Evidence for three factors of perfectionism: Perfectionistic strivings, order, and perfectionistic concerns. Personality and Individual Differences. 84(4), 16-22.
Kline, R. B. (2015). Principles and practice of structural equation modeling. Guilford publications.
 Koran, L. M., Leventhal, J. L., Fireman, B., & Jacobson, A. (2000). Pharmacotherapy of obsessive-compulsive disorder in a health maintenance organization. American Journal of Health-System Pharmacy. 57(21), 1972-78.
 Kyrios, M., Hordern, C., & Fassnacht, D. B. (2015). Predictors of response to cognitive behaviour therapy for obsessive-compulsive disorder. International Journal of Clinical and Health Psychology. 15(3), 181-190.
 McFall, M. E., & Wollersheim, J. P. (1979). Obsessive-compulsive neurosis: A cognitive-behavioral formulation and approach to treatment. Cognitive Therapy and Research. 3(4), 333-348.
 McKay, D. (2018). Obsessive-compulsive disorder research: Growing in scope, advances unclear. Journal of Anxiety Disorders. 56(?), 5-7.
 Mihić, L., Čolović, P., Ignjatović, I., Smederevac, S., & Novović, Z. (2015). Anxiety between personality and cognition: The gray zone. Personality and Individual Differences. 78(2), 19-23.
Obsessive Compulsive Cognitions Working Group. (2001). Development and initial validation of the obsessive beliefs questionnaire and the interpretation of intrusions inventory. Behavior Research and Therapy. 39(8), 987-1006.
Osland, S., Arnold, P. D., & Pringsheim, T. (2018). The prevalence of diagnosed obsessive compulsive disorder and associated comorbidities: A population-based Canadian study. Psychiatry Research. 268(3), 137-142.
 Pinto, A., Dargani, N., Wheaton, M. G., Cervoni, C., Rees, C. S., & Egan, S. J. (2017). Perfectionism in obsessive-compulsive disorder and related disorders: What should treating clinicians know? Journal of Obsessive-Compulsive and Related Disorders. 12(2), 102-108.
 Pinto, A., Liebowitz, M. R., Foa, E. B., & Simpson, H. B. (2011). Obsessive compulsive personality disorder as a predictor of exposure and ritual prevention outcome for obsessive compulsive disorder. Behaviour Research and Therapy. 49(8), 453-458.
Pinto, A., Mancebo, M. C., Eisen, J. L., Pagano, M. E., & Rasmussen, S. A. (2006). The Brown Longitudinal Obsessive Compulsive Study: clinical features and symptoms of the sample at intake. The Journal of Clinical Psychiatry. 67(5), 703-711.
 Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods. 40(3), 879-891.
Rasmussen, S. A., & Eisen, J. L. (1992). The epidemiology and differential diagnosis of obsessive-compulsive disorder. In Zwangsstörungen/obsessive-compulsive disorders (pp. 1-14). Springer, Berlin, Heidelberg.
 Rector, N. A. (2001). Innovations in cognitive therapy for obsessive-compulsive disorder. Psychiatry Rounds. 5(2), 1-6.
Reuther, E. T., Davis III, T. E., Rudy, B. M., Jenkins, W. S., Whiting, S. E., & May, A. C. (2013). Intolerance of uncertainty as a mediator of the relationship between perfectionism and obsessive‐compulsive symptom severity. Depression and Anxiety. 30(8), 773-777.
 Rhéaume, J., Freeston, M. H., Dugas, M. J., Letarte, H., & Ladouceur, R. (1995). Perfectionism, responsibility and obsessive-compulsive symptoms. Behaviour Research and Therapy. 33(7), 785-794.
Rice, K. G., & Stuart, J. (2010). Differentiating adaptive and maladaptive perfectionism on the MMPI–2 and MIPS Revised. Journal of Personality Assessment. 92(2), 158-167.
 Romero-Sanchiz, P., Nogueira-Arjona, R., Godoy-Ávila, A., Gavino-Lázaro, A., & Freeston, M. H. (2015). Narrow specificity of responsibility and intolerance of uncertainty in obsessive-compulsive behavior and generalized anxiety symptoms. International Journal of Cognitive Therapy. 8(3), 239-257.
Rotge, J. Y., Langbour, N., Dilharreguy, B., Bordessoulles, M., Guehl, D., Bioulac, B., ... & Burbaud, P. (2015). Contextual and behavioral influences on uncertainty in obsessive-compulsive disorder. Cortex. 62(1), 1-10.
Salkovskis, P. M., & Kobori, O. (2015). Reassuringly calm? Self-reported patterns of responses to reassurance seeking in obsessive compulsive disorder. Journal of Behavior Therapy and Experimental Psychiatry. 49(4), 203-208.
Sheikhmoonesi, F., Hajheidari, Z., Masoudzadeh, A., Mohammadpour, R. A., & Mozaffari, M. (2014). Prevalence and severity of obsessive-compulsive disorder and their relationships with dermatological diseases. Acta Medica Iranica. 52(7), 511-514
Slaney, R. B., Rice, K. G., & Ashby, J. S. (2002). A programmatic approach to measuring perfectionism: The Almost Perfect Scales.
 Starcevic, V., & Berle, D. (2006). Cognitive specificity of anxiety disorders: a review of selected key constructs. Depression and Anxiety. 23(2), 51-61.
 Steiger, J. H. (2007). Understanding the limitations of global fit assessment in structural equation modeling. Personality and Individual Differences. 42(5), 893-898.
Stein, D. J., & Nesse, R. M. (2011). Threat detection, precautionary responses, and anxiety disorders. Neuroscience & Biobehavioral Reviews. 35(4), 1075-79.
 Stöber, J. (1998). The Frost Multidimensional Perfectionism Scale revisited: More perfect with four (instead of six) dimensions. Personality and Individual Differences. 24(4), 481-491.
Stoeber, J., & Gaudreau, P. (2017). The advantages of partialling perfectionistic strivings and perfectionistic concerns: Critical issues and recommendations. Personality and Individual Differences. 104(1), 379-386.
Tabachnick, B. G., & Fidell, L.S. (2013). Using multivariate statistics (6th Ed.). Harlow, England: Pearson Education.
Taghavi, M. R., Dalgleish, T., Moradi, A. R., Neshat‐Doost, H. T., & Yule, W. (2003). Selective processing of negative emotional information in children and adolescents with generalized anxiety disorder. British Journal of Clinical Psychology. 42(3), 221-230.
Tolin, D. F., Abramowitz, J. S., Brigidi, B. D., & Foa, E. B. (2003). Intolerance of uncertainty in obsessive-compulsive disorder. Journal of Anxiety Disorders. 17(2), 233-242.
Wheaton reliability and stability in panel mo, B., Muthen, B., Alwin, D. F., & Summers, G. F. (1977). Assessing dels. Sociological methodology. 8(1), 84-136.
Wong, S. F., Aardema, F., & Grisham, J. R. (2019). Inverse Reasoning Processes in Obsessive-Compulsive Disorder: Replication in a Clinical Sample. Journal of Anxiety Disorders. 63, 1-8.
Yuan, K. H., Lambert, P. L., & Fouladi, R. T. (2004). Mardia's multivariate kurtosis with missing data. Multivariate Behavioral Research. 39(3