Psychache and Suicidal History in Patients with Obsessive-Compulsive Disorder
Received 13 November 2019
Accepted for publication 12 December 2019
Published 24 December 2019 Volume 2019:15 Pages 3531—3539
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Roger Pinder
Mehmet Emin Demirkol,1 Zeynep Namlı,1 Özge Eriş Davul,2 Mahmut Onur Karaytuğ,3 Lut Tamam,1 Hamdi Yılmaz1
1Deparment of Psychiatry, Çukurova University School of Medicine, Adana, Turkey; 2Department of Psychiatry, Hatay State Hospital, Hatay, Turkey; 3Department of Psychiatry, Dr Ekrem Tok Hospital for Mental and Nervous Disease, Adana, Turkey
Correspondence: Lut Tamam; Mehmet Emin Demirkol
Department of Psychiatry, Çukurova University School of Medicine, Adana, Turkey
Tel + 90 533 6306006; +90 535 5849684
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Purpose: Suicide is an important cause of death in patients diagnosed with obsessive-compulsive disorder (OCD) as well as other psychiatric disorders. Early determining of risk factors provides an opportunity for intervention. The mediating effect of psychological pain (also known as psychache) on suicide has been shown in various disorders but has not been investigated in patients with OCD. In this study, we aimed to show the relationship between psychological pain and other clinical variables and suicide in OCD patients.
Patients and methods: This cross-sectional study consisted of 67 patients diagnosed with OCD according to DSM-5 criteria with no comorbid psychiatric diagnosis who applied to the psychiatric outpatient clinic of Çukurova University Faculty of Medicine and 63 healthy controls. Among the OCD patients, 12 had previous suicide attempts. In addition to the sociodemographic data form, participants filled out the Yale-Brown Obsessive Compulsive Scale (YBOCS), the Psychache Scale (PS), the Beck Scale for Suicidal Ideation (BSIS), and the Hamilton Depression Scale (HDS).
Results: OCD group’s median obsession, compulsion, and the total scores of YBOCS, and the mean PS scores were higher than the control group. There was no difference between the sociodemographic variables of OCD patients with and without previous suicide attempts such as age, gender, years of education, place of residence, marital, and occupational status. The median scores of obsession, avoidance, global severity, and indecisiveness subdimensions of YBOCS, the mean BSIS and PS scores, the rates of current aggressive, current contamination, and the past religious obsessions were higher in the suicidal group. There were moderately significant relationships in the same direction between the PS, BSIS, and total YBOCS scores. Multivariate regression analysis demonstrated that only the PS scores predicted previous suicide attempts.
Conclusion: Our results demonstrated that current aggressive, current contamination, past religious obsessions, and the higher psychological pain are related to previous suicide attempts in OCD patients. Our regression analysis supports Shneidman’s hypothesis: there would be no suicide without psychache. Relieving psychache in OCD patients may reduce suicide attempts even if there is no diagnosis of comorbid depression.
Keywords: obsessive compulsive disorder, suicide, psychological pain, psychache
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