Psychopathology - Grade: B+ PDF

Preview

Summary

The purpose of this study is to find the distress level difference between people with OCD
who show sexual orientation obsession and live in countries which have negative attitudes toward LGBT community and people with OCD who show sexual orientation obsession and live in countries which have ...

Description

Abstract The purpose of this study is to find the distress level difference between people with OCD who show sexual orientation obsession and live in countries which have negative attitudes toward LGBT community and people with OCD who show sexual orientation obsession and live in countries which have positive attitude toward LGBT community. Our participants will be obtained from mental health care services in Netherland and Turkey. In this study we will use Sexual Orientation Obsessive-Compulsive Scale and Subjective Units of Distress Scale. We are expecting to find a significant difference between the distress level of Netherland and Turkey. We will use t-test to investigate whether there is a significant difference or not. There are not enough studies about the effect of culture on distress that occurs with the disorder, treatment process. Since this study is a correlational study we can say that there is a relationship between attitudes and distress level but we cannot assume that this relationship is a causal relationship. keywords: sexual orientation obsession, sexual orientation, sexual obsession, obsessive-compulsive disorder, sexual orientation obsessive-compulsive disorder, culture, distress.

Introduction Obsessive compulsive disorder (OCD) is characterized by the occurrence of persistent thoughts, urges, or images that are experienced as intrusive and unwanted (obsessions), and compulsive actions that the individual feels driven to perform in response to an obsession, which are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation from occurring (American Psychiatric Association [APA], 2013). The estimate of lifetime prevalence of OCD is %1.9-2.5 in the general population. Sexual obsessions are common symptom of OCD. Whatever is most important and cherished gets transformed into its opposite, producing ego-dystonic, blasphemous obsessions (Baer, 2001). Common themes in sexual obsessions include unfaithfulness, incest, pedophilia, unusual behaviors, AIDS, profane thoughts combining religion and sex, and, of course, homosexuality (Williams, 2008). Sexual orientation obsession is subtype of sexual obsession in OCD. While the prevalence of sexual obsession in people with OCD is %9.5, the %11.9 of them also have sexual orientation obsession (SO-OCD). Patients with a history of sexual orientation obsession were twice as likely to be male than female, with moderate OCD severity (Williams, Farris, 2011). Also age is not important factor for sexual orientation obsessions because no significant relationship was found between sexual orientation obsessions and age. SO-OCD may include worries of experiencing an unwanted change in sexual orientation, fears that others may perceive one as a member of the lesbian/gay/bisexual/transgendered

(LGBT) community, or fear that one has hidden same-sex desires (Williams, Slimowicz, Tellawi, Wetterneck, 2014). Obsessions are thought to be a result of flawed cognitive appraisals about an unwanted sexual thought, image, or impulse (e.g., Rachman, 1998), resulting in fears about the future of the individual’s sexual orientation. SO-OCD sufferers want to get rid of these repetitive thoughts and feel distress and guilt. According to a previous research this distress and guilt do not mean that SO-OCD is not caused by homophobia/heterosexism, as the individual may or may not have negative feelings toward LGBT individuals (Williams, 2008). The reason why people feel distress about their sexual orientation obsessions is that being gay is not accepted by many societies because it is considered as immoral. Being in a relationship with opposite sex and thinking about the same sex at the same time would be devastating. All of these factors are correlated with distress. Previous research found that those with SO-OCD, %91had levels of distress ranging from “much” to “ suicidal” as a result of their sexual orientation obsession. This is an alarming percentage that underscores the importance of recognizing and assessing these symptoms. People with OCD are highly upset by such obsessions, many to the point of considering ending their lives (Williams, Wetterneck, Tellawi, Duque, 2014). Patients with SO-OCD may experience compulsions after they experience obsessions. These compulsions can be checking for sexual arousal when around others or mental reminders about being heterosexual. Compulsions may include avoidance, such as not watching television shows in which there is an LGBT character or keeping physical distance from others of the same sex. The individual may watch pornography with same sex themes to check their sexual arousal. They also show reassurance seeking.It can be sought in many forms, including asking others for reassurance, self-assurance, searching the Internet for answers, or the need to confess to others (Williams et al.,2011).

It is difficult for therapists to diagnose SO-OCD because there are not enough research and scales in literature but to make a true diagnosis is important, since mental health professionals who do not typically treat OCD patients may fail to properly diagnose a patient complaining of unwanted sexual obsessions. Therapists may attribute the symptoms to an unconscious wish, emerging homosexuality, or difficulties with sexual identity formation. This conceptualization of the problem may cause panic in an already distressed individual, resulting in the patient becoming even more upset and confused. Also there are not enough treatments providers. Cognitive behavior therapy (CBT) produce clinically significant improvement but remission is the exception. Exposure and ritual/response prevention (EX/RP) has emerged as a CBT treatment of choice for obsessivecompulsive disorder (OCD), with an extensive body of literature to support its efficacy in both pediatric and adult populations. CBT includes psychoeducation, in vivo exposure, imaginal exposure, ritual/response prevention and mindfulness/acceptance approaches. !

Psychoeducation provides a rationale for the type of treatment to be provided and

socializes the patient into the treatment process. " !

In an in vivo exposure, the clinician and the patient work collaboratively to identify

specific obsessional triggers to complete the hierarchy, and rank each item based on projected Subjective Units of Distress Scale (SUDS) levels. Although every patient’s hierarchy will be somewhat different, Table 1 lists a sample hierarchy developed for SO-OCD concerns. Imaginal exposures are designed to allow patients to confront the feared catastrophe related to their obsessions that they generally could not otherwise confront. To conduct an imaginal exposure, the therapist and patient develop a detailed story about the worst outcome of the patient’s obsession. The story will describe a catastrophe that is a direct result of failing

to perform rituals, and the patient is instructed to close their eyes and imagine the scenario as vividly as possible while being confronted with the narrative over and over. Response prevention involves not engaging in the rituals used to decrease anxiety about an obsession. Response prevention serves to increase exposure time to the stimulus that provokes anxiety, and it is the conjunction of exposure and response prevention together that creates the most effective treatment for OCD. Mindfulness and acceptance-based approaches emphasize taking a non-judgmental stance toward inner experience and focusing on the present moment, despite the present moment including thoughts and feelings that are unwanted. These approaches do not emphasize altering or getting rid of unwanted thoughts. Instead, they encourage the individual to accept such thoughts as a necessary part of human existence. The purpose of this study to prove that the distress level of patients with sexual orientation obsession is related to cultural attitudes toward LGBT community so we hypothesized that the distress level of people with SO-OCD and live in the countries which have negative attitude toward LGBT community have higher distress level than people with SO-OCD and live in the countries which have positive attitude toward LGBT community. In this hypothesis attitude of countries toward LGBT community will be predictive variable and the distress level of patients with SO-OCD will be criterion variable. Method 1.Participants The participants will be obtained from two different countries. These participants will be residents in mental health care services and diagnosed with OCD. The numbers of both sample will be determined based on G-power. Our samples will be obtained from Turkey and Netherlands. The reason why we chose these countries is that Netherlands has high LGBT

Global Acceptance Index (GAI) score which is 8.6 and Turkey has low GAI score which is 4.4 according to Social Acceptance of LGBT People in 174 Countries and its 2014-2017 data. 2. Scales Since our samples are patients with OCD we need to identify whether they also have SO-OCD symptoms. To be able to do that we will use : 2.1 Sexual Orientation Obsessive-Compulsive Scale ( SO-OCS) The sexuality questionnaire consisted of 70 items generated by psychologists with extensive experience treating OCD. Items were based on the clinical observation people with SO-OCD tend to have worries in three main areas: fears of becoming or being LGBT, worries that others may think one is LGBT, and experiencing unwanted same-sex thoughts (Williams, 2008). Items were developed to assess these worries and also to separate people with SOOCD from those with other forms of OCD and people without OCD. Each item was rated on a scale of 1-5, with greater numbers corresponding to greater agreement by the participant. Lower ratings corresponded to responses indicative of greater distress. Table 2 shows items in this scale. 2.2 Clinical Interview !

The assessment of SO-OCD in a clinical interview is how the disorder first comes to

the attention of most clinicians. 2.3 Subjective Units of Distress Scale (SUDS) A Subjective Units of Distress (SUDS – also called a Subjective Units of Disturbance Scale) is a scale of 0 to 10 for measuring the subjective intensity of disturbance or distress currently experienced by an individual. The individual self assesses where they are on the scale. Table 3 shows items of this scale.

3.Procedure This study will be a correlational study. We are planning to compare the distress levels of patients with SO-OCD who are from Turkey and Netherlands. The reason why we chose correlational study we do not have any chance to manipulate the attitudes of countries toward LGBT so we have to study with attitudes that are already present. We will give patients distress scale before SO-OCS not to increase their existing distress levels. Then we will use ttest to investigate whether there is a significant difference or not. Discussion In this study we purposed to identify differences in distress level of patients with SO-OCD from different countries so we conducted a cross-cultural study which involves patients from Turkey and Netherlands according to LGBT Global Acceptance Index (GAI). This index describes updates to the LGBT GAI, which seeks to measure the relative level of acceptance of LGBT people and issues in each country during a specific time period (2000-2003, 2004-2008, 2009-2013, 2014-2017), (Flores, 2019). Netherlands is at the second place among the countries which have positive attitudes toward LGBT community. Unfortunately, Turkey is at the 85th place in this ranking. Considering the existing literature, these patients with SOOCD already experience distress. Besides this fact; we assumed that, being aware of these negative attitudes toward LGBT community increases their distress level. We have not encountered any studies that account for the effect of culture on experiencing distress level among patients with SO-OCD. We conducted a cross-cultural study to make a contribution to literature. If our hypothesis gets confirmed this study may decrease the distress level of patients with SO-OCD by changing societies’ negative attitudes toward LGBT community. Since this study is a correlational study we can say that there is a relationship between attitudes and distress level but we cannot assume that this relationship is a causal relationship.

While the prevalence of sexual obsession in people with OCD is %9.5, the %11.9 of them also have sexual orientation obsession (SO-OCD). Considering this epidemiological fact, it can be hard for us to find participants for the study. Since we planned to conduct this study in two countries, financial issues may occur. After being informed about relationship between culture and distress level, patients who live in country which has negative attitude toward LGBT community might lose their belief about dealing with their disorder because they may be aware of resistance of attitudes. Also, not having a chance to change the country they live in contributes to trigger this feeling. This situation might undermine and protract the process of treatment. It is a major ethical issue. There are no available translations of any scale that we planned to use in local language.

References Baer, L. (2001). The imp of the mind. New York: Penguin. Flores A. R. (2019). Social Acceptance of LGBT People in 174 Countries, 1981 to 2017 !

(Report No. 90095-1476). Los Angeles CA: The Williams Institute, UCLA School of Law.

Gordon, W. M. (2002). Sexual obsession and OCD. Sexual and Relationship Therapy, 17, 343-354. Rachman, S., (1998). A cognitive theory of obsessions: elaborations. Behavior Research and Therapy, 36, 385-401. Williams, M. T., Crozier, M., & Powers, M. (2011). Treatment of sexual-orientation obsession in obsessive-compulsive disorder using exposure and ritual prevention. Clinical Case Studies, 10, 53-66. Williams, M. T., & Farris, S. G. (2011). Sexual orientation obsessions in obsessive compulsive disorder: Prevalence and correlates. Psychiatry Research, 187, 156-159. Williams, M. T. (2008). Homosexuality anxiety: A misunderstood form of OCD. In L. V. Sebeki (Ed.), Leading-edge Health Education Issues (pp. 195-205). New York: Nova Science. Williams, M. T., Tellawi, G., Davis, D. M., & Slimowicz, J.C. (2015). Assessment and treatment of sexual orientation obsessions in obsessive-compulsive disorder. Australian Clinical Psychology, 1, 12-18. Williams, M. T., Wetterneck, C., Tellawi, G., & Duque, G. (2014). Domains of distress among people with sexual orientation obsession. Archives of sexual behavior, 44, 783-789. Williams, M. T., Slimowicz, J. C., Tellawi, G., & Wetterneck, C. (2014). Sexual orientation symptoms in obsessive-compulsive disorder: Assessment and treatment with cognitive

behavioral therapy. Directions in psychiatry, 34. https://dictionary.apa.org/obsessive-compulsive-disorder

APPENDIX A

APPENDIX B Table 2

Table 2 (cont.)

APPENDIX C Table 3...