Association of Depression with Phenomenology and Insight Among Patients with Obsessive-Compulsive Disorder

Main Article Content

Vasu Mishra
Navratan Suthar
Mukesh Kumar Swami

Keywords

Depression, Insight, Obsessive-Compulsive Disorder, OCD , Phenomenology, Predictors of Depression Severity

Abstract

Background: The phenomenology of obsessive-compulsive disorder (OCD) is influenced by culture; its understanding can enhance case identification. Insight levels and depressive symptoms may vary with OCD phenomenology, affecting management and outcomes. This study assessed the association of depression with phenomenology and insight among patients with OCD and predictors of comorbid depression severity.


Methodology: This observational study enrolled 146 participants after receiving ethical approval and consent. Obsession and compulsion were assessed using the Yale-Brown Obsessive Compulsive Scale (YBOCS). Insight and depression were assessed with the Over Valued Ideas Scale (OVIS) and the Hamilton Depression Rating Scale (HDRS). Linear regression was employed to identify predictors of the severity of depression.


Results: The sample consisted of 68.5% males, with a mean age of 31.5 years. The mean duration of OCD was 63 months. Contamination was the most common obsession; while washing or cleaning was the most frequent compulsion. Aggressive, sexual, and religious obsessions were more prevalent in males. Notably, 73.2% of patients experienced depression. Those with depression exhibited longer and more severe OCD. The severity of depression had a significant positive correlation with the duration of OCD, the YBOCS score, and the OVIS score. Female gender and higher OVIS scores were significant predictors of the severity of depression, with gender being the most important predictor.


Conclusion: Depression is quite common among patients with OCD, particularly those experiencing longer and more severe illnesses. Being female and having lower insight significantly predict the severity of depression.

Abstract 20 | PDF Downloads 18 EPUB Downloads 30

References

1. Zai G, Barta C, Cath D, Eapen V, Geller D, Grünblatt E. New insights and perspectives on the genetics of obsessive-compulsive disorder. Psychiatr Genet. 2019 Oct;29(5):142-151. doi: 10.1097/YPG.0000000000000230.

2. Denys D. Obsessionality & compulsivity: a phenomenology of obsessive-compulsive disorder. Philos Ethics Humanit Med. 2011 Feb 1;6(1):3. https://doi.org/10.1186/1747-5341-6-3

3. Akhtar S, Wig NN, Varma VK, Pershad D, Verma SK. A phenomenological analysis of symptoms in obsessive-compulsive neurosis. Br J Psychiatry. 1975 Oct;127:342-8. doi: 10.1192/bjp.127.4.342.

4. Kamaradova D, Prasko J, Latalova K, Ociskova M, Mainerova B, Sedlackova Z, et al. Correlates of insight among patients with obsessive compulsive disorder. Act Nerv Super Rediviva 2015;57:98‑104.

5. Cherian AV, Narayanaswamy JC, Viswanath B, Guru N, George CM, Bada Math S, et al. Gender differences in obsessive-compulsive disorder: findings from a large Indian sample. Asian J Psychiatr. 2014 Jun;9:17-21. doi: 10.1016/j.ajp.2013.12.012.

6. Khanna S, Channabasavanna SM. Phenomenology of obsessions in obsessive-compulsive neurosis. Psychopathology. 1988;21(1):12-8. doi: 10.1159/000284534.

7. Sharma E, Sharma LP, Balachander S, Lin B, Manohar H, Khanna P, et al. Comorbidities in Obsessive-Compulsive Disorder Across the Lifespan: A Systematic Review and Meta-Analysis. Front Psychiatry. 2021 Nov 11;12:703701. doi: 10.3389/fpsyt.2021.703701.

8. Keeley ML, Storch EA, Merlo LJ, Geffken GR. Clinical predictors of response to cognitive-behavioral therapy for obsessive-compulsive disorder. Clin Psychol Rev. 2008 Jan;28(1):118-130. doi: 10.1016/j.cpr.2007.04.003.

9. Exner C, Kohl A, Zaudig M, Langs G, Lincoln TM, Rief W. Metacognition and episodic memory in obsessive-compulsive disorder. J Anxiety Disord. 2009 Jun;23(5):624-31. doi: 10.1016/j.janxdis.2009.01.010.

10. Catapano F, Sperandeo R, Perris F, Lanzaro M, Maj M. Insight and resistance in patients with obsessive-compulsive disorder. Psychopathology. 2001 Mar-Apr;34(2):62-8. doi: 10.1159/000049282.

11. World Health Organization. (2022). ICD-11: International classification of diseases (11th revision). https://icd.who.int/

12. Frost RO, Steketee G, Krause MS, Trepanier KL. The relationship of the Yale-Brown Obsessive Compulsive Scale (YBOCS) to other measures of obsessive compulsive symptoms in a nonclinical population. J Pers Assess. 1995 Aug;65(1):158-68. doi: 10.1207/s15327752jpa6501_12.

13. Neziroglu F, McKay D, Yaryura-Tobias JA, Stevens KP, Todaro J. The Overvalued Ideas Scale: development, reliability and validity in obsessive-compulsive disorder. Behav Res Ther. 1999 Sep;37(9):881-902. doi: 10.1016/s0005-7967(98)00191-0.

14. Vindbjerg E, Makransky G, Mortensen EL, Carlsson J. Cross-Cultural Psychometric Properties of the Hamilton Depression Rating Scale. Can J Psychiatry. 2019 Jan;64(1):39-46. doi: 10.1177/0706743718772516.

15. Elm E von, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. Annals of Internal Medicine [Internet]. 2007 Oct;147(8):573–7.

16. Prasad C, Gupta B, Nischal A, Agarwal M, Singh S. A comparative study of psychopathology and functioning in patients of obsessive–compulsive disorder with good and poor insight from a tertiary care center in North India. Indian Journal of Health Sciences and Biomedical Research kleu. 2020 May 1;13(2):140-6. doi: 10.4103/kleuhsj.kleuhsj_297_19

17. Nicolini H, Salin-Pascual R, Cabrera B, Lanzagorta N. Influence of Culture in Obsessive-compulsive Disorder and Its Treatment. Curr Psychiatry Rev. 2017 Dec;13(4):285-292. doi: 10.2174/2211556007666180115105935.

18. Hunt C. Demographic differences in OCD symptom presentations: a quantitative review of studies using the Y-BOCS symptom checklist. J Obsessive Compuls Relat Disord 2020 July;26:100533. doi: 10.1016/j.jocrd.2020.100533

19. Kapugama C, Silva V de. Phenomenology of obsessive compulsive disorder in a Sri Lankan patient population. Sri Lanka J Psychiatry. 2014 Jun 27;5(1):18–20. doi: http://dx.doi.org/10.4038/sljpsyc.v5i1.7077

20. Tripathi A, Avasthi A, Grover S, Sharma E, Lakdawala BM, Thirunavukarasu M, et al. Gender differences in obsessive-compulsive disorder: Findings from a multicentric study from India. Asian J Psychiatr. 2018 Oct;37:3-9. doi: 10.1016/j.ajp.2018.07.022.

21. Jaisoorya TS, Reddy YC, Srinath S, Thennarasu K. Sex differences in Indian patients with obsessive-compulsive disorder. Compr Psychiatry. 2009 Jan-Feb;50(1):70-5. doi: 10.1016/j.comppsych.2008.05.003.

22. Algin S, Sajib MWH, Arafat SMY. Phenomenology of obsessive compulsive disorder in Bangladesh: A cross-sectional observation. Asian J Psychiatr. 2018 Apr;34:18-20. doi: 10.1016/j.ajp.2018.04.011.

23. Sivabalan E, Amritha Prasad, Thirunavukarasu M. A cross-sectional study of
the phenomenology of obsessive-compulsive disorder. Int. J. Res. Pharm. Sci. 2020 11(4):7572-7576. doi:10.26452/ijrps.v11i4.3964

24. Grover S, Ghosh A, Kate N, Sarkar S, Chakrabarti S, Avasthi A. Concordance of assessment of insight by different measures in obsessive-compulsive disorder: An outpatient-based study from India. Indian J Psychiatry. 2021 Sep-Oct;63(5):439-447. doi: 10.4103/indianjpsychiatry.indianjpsychiatry_1380_20.

25. Jakubovski E, Pittenger C, Torres AR, Fontenelle LF, do Rosario MC, Ferrão YA, et al. Dimensional correlates of poor insight in obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2011 Aug 15;35(7):1677-81. doi: 10.1016/j.pnpbp.2011.05.012.

26. Sinha N, Ram D, Singh KK, Pattojoshi A. A study of clinical correlates and predictors of insight in obsessive compulsive disorder. Indian J Psychiatry. 2024 Jul;66(7):656-659. doi: 10.4103/indianjpsychiatry.indianjpsychiatry_432_23.

27. Guillén-Font MA, Cervera M, Puigoriol E, Foguet-Boreu Q, Arrufat FX, Serra-Millàs M. Insight in Obsessive-Compulsive Disorder: Relationship With Sociodemographic and Clinical Characteristics. J Psychiatr Pract. 2021 Nov 5;27(6):427-438. doi: 10.1097/PRA.0000000000000580.

28. Matsunaga H, Kiriike N, Matsui T, Oya K, Iwasaki Y, Koshimune K, et al. Obsessive-compulsive disorder with poor insight. Compr Psychiatry. 2002 Mar-Apr;43(2):150-7. doi: 10.1053/comp.2002.30798.

29. Ravi Kishore V, Samar R, Janardhan Reddy YC, Chandrasekhar CR, Thennarasu K. Clinical characteristics and treatment response in poor and good insight obsessive-compulsive disorder. Eur Psychiatry. 2004 Jun;19(4):202-8. doi: 10.1016/j.eurpsy.2003.12.005.

30. Altintaş E, Taşkintuna N. Factors Associated with Depression in Obsessive-Compulsive Disorder: A Cross-Sectional Study. Noro Psikiyatr Ars. 2015 Dec;52(4):346-353. doi: 10.5152/npa.2015.7657.

31. Klein KP, Harris EK, Björgvinsson T, Kertz SJ. A network analysis of symptoms of obsessive compulsive disorder and depression in a clinical sample. J Obsessive-Compuls Relat Disord. 2020;27:100556. doi: 10.1016/j.jocrd.2020.100556

32. McNally RJ, Mair P, Mugno BL, Riemann BC. Co-morbid obsessive-compulsive disorder and depression: a Bayesian network approach. Psychol Med. 2017 May;47(7):1204-1214. doi: 10.1017/S0033291716003287.

33. Diniz JB, Rosario-Campos MC, Shavitt RG, Curi M, Hounie AG, Brotto SA, et al. Impact of age at onset and duration of illness on the expression of comorbidities in obsessive-compulsive disorder. J Clin Psychiatry. 2004 Jan;65(1):22-7. doi: 10.4088/jcp.v65n0104.

34. Perugi G, Akiskal HS, Pfanner C, Presta S, Gemignani A, Milanfranchi A, et al. The clinical impact of bipolar and unipolar affective comorbidity on obsessive-compulsive disorder. J Affect Disord. 1997 Oct;46(1):15-23. doi: 10.1016/s0165-0327(97)00075-x.

35. Dell'Osso B, Benatti B, Rodriguez CI, Arici C, Palazzo C, Altamura AC, et al. Obsessive-compulsive disorder in the elderly: A report from the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS). Eur Psychiatry. 2017 Sep;45:36-40. doi: 10.1016/j.eurpsy.2017.06.008.

36. Juang YY, Liu CY. Phenomenology of obsessive-compulsive disorder in Taiwan. Psychiatry Clin Neurosci. 2001 Dec;55(6):623-7. doi: 10.1046/j.1440-1819.2001.00915.x.

37. Hathway T, McDonald S, Melkonian M, Karin E, Titov N, Dear BF, et al. Correlates of depression in individuals with obsessive compulsive disorder. Cogn Behav Ther. 2024 Nov;53(6):661-680. doi: 10.1080/16506073.2024.2368518.

38. Hasler G, LaSalle-Ricci VH, Ronquillo JG, Crawley SA, Cochran LW, Kazuba D, et al. Obsessive-compulsive disorder symptom dimensions show specific relationships to psychiatric comorbidity. Psychiatry Res. 2005 Jun 15;135(2):121-32. doi: 10.1016/j.psychres.2005.03.003.

39. Besiroglu L, Uguz F, Saglam M, Agargun MY, Cilli AS. Factors associated with major depressive disorder occurring after the onset of obsessive-compulsive disorder. J Affect Disord. 2007 Sep;102(1-3):73-9. doi: 10.1016/j.jad.2006.12.007.

40. Altintaş E, Taşkintuna N. Factors Associated with Depression in Obsessive-Compulsive Disorder: A Cross-Sectional Study. Noro Psikiyatr Ars. 2015 Dec;52(4):346-353. doi: 10.5152/npa.2015.7657.

41. Benatti B, Celebre L, Girone N, Priori A, Bruno A, Viganò C, et al. Clinical characteristics and comorbidity associated with female gender in obsessive-compulsive disorder. J Psychiatr Res. 2020 Dec;131:209-214. doi: 10.1016/j.jpsychires.2020.09.019.

42. Torresan RC, Ramos-Cerqueira AT, Shavitt RG, do Rosário MC, de Mathis MA, Miguel EC, et al. Symptom dimensions, clinical course and comorbidity in men and women with obsessive-compulsive disorder. Psychiatry Res. 2013 Sep 30;209(2):186-95. doi: 10.1016/j.psychres.2012.12.006.

43. Mathis MA, Alvarenga Pd, Funaro G, Torresan RC, Moraes I, Torres AR, et al. Gender differences in obsessive-compulsive disorder: a literature review. Braz J Psychiatry. 2011 Dec;33(4):390-9. doi: 10.1590/s1516-44462011000400014.