Hostname: page-component-848d4c4894-nr4z6 Total loading time: 0 Render date: 2024-05-26T03:38:19.630Z Has data issue: false hasContentIssue false
  • English
  • Français

Overlapping features between social anxiety and obsessive-compulsive spectrum in a clinical sample and in healthy controls: toward an integrative model

Published online by Cambridge University Press:  02 October 2019

Barbara Carpita Open the ORCID record for Barbara Carpita [Opens in a new window] ,
Dario Muti ,
Alessandra Petrucci ,
Francesca Romeo ,
Camilla Gesi ,
Donatella Marazziti Open the ORCID record for Donatella Marazziti [Opens in a new window] ,
Claudia Carmassi  and
Liliana Dell’Osso
Barbara Carpita
Affiliation:
Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Italy
Dario Muti
Affiliation:
Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Italy
Alessandra Petrucci
Affiliation:
Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Italy
Francesca Romeo
Affiliation:
Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Italy
Camilla Gesi
Affiliation:
Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Italy
Donatella Marazziti
Affiliation:
Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Italy
Claudia Carmassi*
Affiliation:
Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Italy
Liliana Dell’Osso
Affiliation:
Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Italy
*
* Claudia Carmassi, MD, PhD, Email: ccarmassi@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Background.

While the literature frequently highlighted an association between social anxiety disorder (SAD) and obsessive-compulsive disorder (OCD), few studies investigated the overlapping features of these conditions. The presented work evaluated the relationship between SAD and OCD spectrum in a clinical population and in healthy controls (HC).

Methods.

Fifty-six patients with OCD, 51 with SAD, 43 with major depressive disorder (MDD), and 59 HC (N = 209) were assessed using the Mini International Neuropsychiatric Interview, the Social Phobia Spectrum (SCI-SHY), and the Obsessive-Compulsive Spectrum (SCI-OBS).

Results.

SAD patients scored significantly higher than other groups on all SCI-SHY domains and total score; OCD patients scored significantly higher than HC. MDD patients scored significantly higher than HC on the SCI-SHY total, Behavioral inhibition, and Interpersonal sensitivity domains. OCD patients scored significantly higher than other groups on all SCI-OBS domains except Doubt, for which OCD and SAD scored equally high. SAD patients scored significantly higher than HC on the SCI-OBS total, Childhood/adolescence, Doubt, and Hypercontrol domains. MDD patients scored significantly higher than HC on the Hypercontrol domain. SCI-OBS and SCI-SHY were widely correlated among groups, although lower correlations were found among OCD patients. Stronger correlations were observed between SCI-SHY Interpersonal sensitivity and SCI-OBS Doubt, Obsessive-compulsive themes, and Hypercontrol; between SCI-SHY Specific anxieties/phobic features and SCI-OBS Obsessive-compulsive themes; and between SCI-SHY Behavioral inhibition and SCI-OBS Doubt, with slightly different patterns among groups.

Conclusion.

OCD and SAD spectrums widely overlap in clinical samples and in the general population. Interpersonal sensitivity and obsessive doubts might represent a common cognitive core for these conditions.

Keywords

Social anxiety spectrumobsessive/compulsive spectrumDSM-5comorbiditymajor depressive disorder.
Type
Original Research
Information
CNS Spectrums , Volume 25 , Issue 4 , August 2020 , pp. 527 - 534
Copyright
© Cambridge University Press 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Baldwin, DS, Brandish, EK, Meron, D. The overlap of obsessive-compulsive disorder and social phobia and its treatment. CNS Spectrums. 2008;13(9 Suppl 14):47–53.Google Scholar
Assunção, MC, Lucas da Conceição Costa D, De Mathis MA, et al. Social phobia in obsessive-compulsive disorder: prevalence and correlates. J Affect Disord. 2012;143(1-3):138–47.Google Scholar
Bruce, SE, Yonkers, KA, Otto, MW, et al.Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study. Am J Psychiatry. 2005;162(6):1179–1187.Google Scholar
Marazziti, D, Abelli, M, Baroni, S, et al.Recent findings on the pathophysiology of social anxiety disorder. Clinical Neuropsychiatry. 2014;11(2):91–100.Google Scholar
Dell’Osso, L, Abelli, M, Pini, S, et al.Dimensional assessment of DSM-5 social anxiety symptoms among university students and its relationship with functional impairment. Neuropsychiatr Dis Treat. 2014;10:1325–1332.Google Scholar
Marazziti, D, Abelli, M, Baroni, S, et al.Neurobiological correlates of social anxiety disorder: an update. CNS Spectrums. 2015;20(2):100–111.Google Scholar
Dell’Osso, L, Abelli, M, Pini, S, et al.The influence of gender on social anxiety spectrum symptoms in a sample of university students. Riv Psichiatr. 2015;50(6):295–301.Google Scholar
Torres, AR, Fontenelle, LF, Shavitt, RG, et al.Comorbidity variation in patients with obsessive-compulsive disorder according to symptom dimensions: Results from a large multicentre clinical sample. J Affect Disord. 2016;190:508–516.Google Scholar
Isomura, K, Brander, G, Chang, Z, et al.Metabolic and Cardiovascular Complications in Obsessive-Compulsive Disorder: A Total Population, Sibling Comparison Study With Long-Term Follow-up . Biol Psychiatry. 2018;84(5):324–331.Google Scholar
Bartz, JA, Hollander, E. Is obsessive-compulsive disorder an anxiety disorder? Neuro-Psychopharmacol Biol Psychiatry. 2006;30:338–352.Google Scholar
Ruscio, AM, Stein, DJ, Chiu, WT, et al.The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Mol Psychiatry. 2010;15:53–63.Google Scholar
Janowitz, D, Grabe, HJ, Ruhrmann, S, et al.Early onset of obsessive-compulsive disorder and associated comorbidity. Depress Anxiety. 2009;26(11):1012–1017.Google Scholar
Masi, G, Millepiedi, S, Perugi, G, et al.A naturalistic exploratory study of the impact of demographic, phenotypic and comorbid features in pediatric obsessive-compulsive disorder. Psychopatology. 2010;43(2):69–78.Google Scholar
Samuels, J, Grados, MA, Riddle, MA, et al.Hoarding in Children and Adolescents with Obsessive-Compulsive Disorder. J Obsessive Compuls Relat Disord. 2014;3(4):325–331.Google Scholar
Hannah Frank, BA, Elyse Stewart, BA, Walther, Met al.Hoarding behavior among young children with obsessive-compulsive disorder. J Obsessive Compuls Relat Disord. 2014;3(1):6–11.Google Scholar
Nestadt, G, Addington, A, Samuels, J, et al.The identification of OCD-related subgroups based on comorbidity. Biol Psychiatry. 2003;53:914–920.Google Scholar
Nestadt, G, Di, CZ, Riddle, MA, et al.Obsessive-compulsive disorder: subclassification based on co-morbidity. Psychol Med. 2009;39:1491–1501.Google Scholar
Storch, EA, Larson, MJ, Merlo, LJ, et al.Comorbidity of Pediatric Obsessive-Compulsive Disorder and Anxiety Disorders: Impact on Symptom Severity and Impairment. J Psychopathol Behav Assess. 2008;30:111–120.Google Scholar
Carrasco, JL, Hollander, E, Schneier, FR, et al.Treatment outcome of obsessive compulsive disorder with comorbid social phobia. J Clin Psychiatry. 1992;53(11):387–391.Google Scholar
Grabe, HJ, Meyer, C, Hapke, U, et al.Lifetime-comorbidity of obsessive-compulsive disorder and subclinical obsessive-compulsive disorder in Northern Germany. Eur Arch Psychiatry Clin Neurosci. 2001;251(3):130–135.Google Scholar
Overbeek, T, Schruers, K, Vermetten, E, et al.Comorbidity of obsessive-compulsive disorder and depression: prevalence, symptom severity, and treatment effect. J Clin Psychiatry. 2002;63(12):1106–1112.Google Scholar
Shetti, CN, Reddy, YC, Kandavel, T, et al.Clinical predictors of drug nonresponse in obsessive-compulsive disorder. J Clin Psychiatry. 2005;66(12):1517–1523.Google Scholar
Hasler, G, LaSalle-Ricci , VH, Ronquillo, JG, et al.Obsessive-compulsive disorder symptom dimensions show specific relationships to psychiatric comorbidity. Psychiatry Res. 2005;135(2):121–132.Google Scholar
Lochner, C, Stein, DJ. Obsessive-compulsive spectrum disorders in obsessive-compulsive disorder and other anxiety disorders. Psychopathology. 2010;43(6):389–396.Google Scholar
Tolin, DF, Meunier, SA, Frost, RO, et al.G. Hoarding among patients seeking treatment for anxiety disorders. J Anxiety Disord. 2011;25(1):43–48.Google Scholar
Egan, SJ, Wade, TD, Shafran, R. Perfectionism as a transdiagnostic process: a clinical review. Clin Psychol Rev. 2011;31(2):203–212.Google Scholar
de Vries, HT, Nakamae, T, Fukui, K, et al.Problematic internet use and psychiatric co-morbidity in a population of Japanese adult psychiatric patients. BMC Psychiatry. 2018;18(1):9.Google Scholar
Kessler, RC, Berglund, P, Demler, O, et al.The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA. 2003;289(23):3095–3105.Google Scholar
Adams, GC, Balbuena, L, Meng, Xet al.When social anxiety and depression go together: A population study of comorbidity and associated consequences. J Affect Disord. 2016;206:48–54.Google Scholar
Merikangas, KR, Merikangas, JR. Combination monoamine oxidase inhibitor and beta-blocker treatment of migraine, with anxiety and depression. Biol Psychiatry. 1995;38(9):603–610.Google Scholar
Pini, S, Cassano, GB, Simonini, E, et al.Prevalence of anxiety disorders comorbidity in bipolar depression, unipolar depression and dysthymia. J Affect Disord. 1997;42(2):145–153.Google Scholar
Cassano, GB, Pini, S, Saettoni, M, et al.Multiple anxiety disorder comorbidity in patients with mood spectrum disorders with psychotic features. Am J Psychiatry. 1999;156(3):474–476.Google Scholar
Stein, MB, Fuetsch, M, Muller, N. Social anxiety disorder and the risk of depression: a prospective community study of adolescents and young adults. Arch Gen Psychiatry. 2001;58(3):251–256.Google Scholar
Ohayon, MM, Schatzberg, AF. Social phobia and depression: Prevalence and comorbidity. J Psychosom Res. 2010;235–243.Google Scholar
Murphy, DL, Moya, PR, Fox, MA, et al.Anxiety and affective disorder comorbidity related to serotonin and other neurotransmitter systems: obsessive-compulsive disorder as an example of overlapping clinical and genetic heterogeneity. Philos Trans R Soc Lond B Biol Sci. 2013;368(1615):20120435.Google Scholar
Nolen-Hoeksema , S, Wisco, BE, Lyubomirsky, S. Rethinking Rumination. Perspect Psychol Sci. 2008;3(5):400–424.Google Scholar
Ruscio, AM, Seitchik, AE, Gentes, EL, et al.Perseverative thought: a robust predictor of response to emotional challenge in generalized anxiety disorder and major depressive disorder. Behav Res Ther. 2011;49(12):867–874.Google Scholar
Carmassi, C, Corsi, M, Bertelloni, CA, et al.Mothers and fathers of children with epilepsy: gender differences in post-traumatic stress symptoms and correlations with mood spectrum symptoms. Neuropsychiatr Dis Treat. 2018;14:1371–1379.Google Scholar
Sheehan, DV, Lecrubier, Y, Harnett Sheehan, K, et al.Reliability and validity of the Mini International Neuropsychiatric Interview (MINI): according to the SCID-P . Eur Psychiatry. 1997;12:232–241.Google Scholar
Sheehan, DV, Lecrubier, Y, Sheehan, KHet al.The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59(Suppl 20):22–33.Google Scholar
Dell’Osso, L, Cassano, GB, Sarno, N, et al.Validity and reliability of the structured clinical interview for the obsessive-compulsive spectrum (SCI-OBS) and for the structured clinical interview for social phobia spectrum (SCI-SHY). Int J Methods Psychiatr Res. 2000;9:11–24.Google Scholar
Lim, SW, Ha, J, Shin, YC, et al.Clinical differences between early- and late-onset social anxiety disorders. Early Interv Psychiatry. 2003;7(1):44–50.Google Scholar
Menezes, GB, Fontenelle, LF, Versiani, M. Early-onset social anxiety disorder in adults: clinical and therapeutic features. Rev Bras Psiquiatr. 2005;27(1):32–36.Google Scholar
Fang, A, Hofmann, SG. Relationship between social anxiety disorder and body dysmorphic disorder. Clin Psychol Rev. 2010;30(8):1040–1048.Google Scholar
Nagata, T, Matsunaga, H, van Vliet, I, et al.Correlations between the offensive subtype of social anxiety disorder and personality disorders. Psychiatry Clin Neurosci. 2011;65(4):341–348.Google Scholar
Nagata, T, Yamada, H, Teo, AR, et al.Comorbid social withdrawal (hikikomori) in outpatients with social anxiety disorder: clinical characteristics and treatment response in a case series. Int J Soc Psychiatry. 2013;59(1):73–78.Google Scholar
Kato, TA, Tateno, M, Shinfuku, N, et al.Does the ‘hikikomori’ syndrome of social withdrawal exist outside Japan? A preliminary international investigation. Soc Psychiatry Psychiatr Epidemiol. 2012;47(7):1061–1075.Google Scholar
Conceição Costa, DL, Chagas Assunção, M, Arzeno Ferrão, Y, et al.Body dysmorphic disorder in patients with obsessive-compulsive disorder: prevalence and clinical correlates. Depress Anxiety. 2012;29(11):966–975.Google Scholar
Spinhoven, P, Van Hemert, AM, Penninx, BW. Repetitive negative thinking as a mediator in prospective – disorder associations between anxiety and depression disorders and their symptoms. J Behav Therapy Exp Psychiatry. 2019;63:6–11.Google Scholar
Lyubomirsky, S, Nolen-Hoeksema , S. Effects of self-focused rumination on negative thinking and interpersonal problem solving. J Pers Soc Psychol. 1995;69(1):176–190.Google Scholar
Lyubomirsky, S, Caldwell, ND, Nolen-Hoeksema , S, et al.Effects of ruminative and distracting responses to depressed mood on retrieval of autobiographical memories. J Pers Soc Psychol. 1998;75(1):166–177.Google Scholar
Watkins, E, Baracaia, S. Rumination and social problem-solving in depression. Behav Res Ther. 2002;40(10):1179–1189.Google Scholar
Donaldson, C, Lam, D. Rumination, mood and social problem-solving in major depression. Psychol Med. 2004;34(7):1309–1318.Google Scholar
Watkins, E, Moulds, M. Distinct modes of ruminative self-focus: impact of abstract versus concrete rumination on problem solving in depression. Emotion. 2005;5(3):319–328.Google Scholar
Ward, A, Lyubomirsky, S, Sousa, L, et al.Can’t quite commit: rumination and uncertainty. Pers Soc Psychol Bull. 2003;29(1):96–107.Google Scholar
Lyubomirsky, S, Kasri, F, Chang, O, et al.Ruminative Response Styles and Delay of Seeking Diagnosis for Breast Cancer Symptoms. J Soc Clin Psychol. 2006;25(3):276–304.Google Scholar
Lyubomirsky, S, Nolen-Hoeksema , S. Self-perpetuating properties of dysphoric rumination. J Pers Soc Psychol. 1993;65(2):339–349.Google Scholar
Ansari, TL, Derakshan, N, Richards, A. Effects of anxiety on task switching: evidence from the mixed antisaccade task. Cogn Affect Behav Neurosci. 2008;8(3):229–238.Google Scholar
Joormann, J, Gotlib IH Updating the contents of working memory in depression: interference from irrelevant negative material. J Abnorm Psychol. 2008;117(1):182–192.Google Scholar
Meiran, N, Diamond, GM, Toder, D, et al.Cognitive rigidity in unipolar depression and obsessive ompulsive disorder: examination of task switching, Stroop, working memory updating and post-conflict adaptation. Psychiatry Research. 2011;185(1-2):149–156.Google Scholar
Kashdan, TB, Roberts, JE. Social anxiety, depressive symptoms, and post-event rumination: affective consequences and social contextual influences. J Anxiety Disord. 2007;21(3):284–301.Google Scholar
Dell’Osso, L, Dalle Luche, R, Maj, M. Adult autism spectrum as a transnosographic dimension. CNS Spectr. 2016;21(2):131–133.Google Scholar
Dell’Osso, L, Abelli, M, Carpita, B, et al.Historical evolution of the concept of anorexia nervosa and relationships with orthorexia nervosa, autism, and obsessive-compulsive spectrum. Neuropsychiatr Dis Treat. 2016;12:1651–1660.Google Scholar
Dell’Osso, L, Conversano, C, Corsi, M, et al.Polysubstance and behavioral addictions in a patient with bipolar disorder: role of lifetime subthreshold autism spectrum. Case Rep Psychiatry. 2018;2018:1547975.Google Scholar
Dell’Osso, L, Carpita, B, Muti, D, et al.Prevalence and characteristics of orthorexia nervosa in a sample of university students in Italy. Eat Weight Disord. 2018;23(1):55–65.Google Scholar
Dell’Osso, L, Carpita, B, Cremone, IM, Muti, D, et al.The mediating effect of trauma and stressor related symptoms and ruminations on the relationship between autistic traits and mood spectrum. Psychiatry Res. 2018; S0165–1781(18):30826–30836.Google Scholar
Carpita, B, Muti, D, Dell’Osso, L. Oxidative stress, maternal diabetes, and autism spectrum disorders. Oxid Med Cell Longev. 2018;2018:3717215.Google Scholar
Dell’Osso, L, Cremone, IM, Carpita, B, et al.Correlates of autistic traits among patients with borderline personality disorder. Compr Psychiatry. 2018;83:7–11.Google Scholar
Dell’Osso, L, Bertelloni, CA, Di Paolo, M, et al.Problematic internet use in university students attending three superior graduate schools in Italy: is autism spectrum related to suicide risk? Int J Environ Res Public Health. 2019;16(7):E1098.Google Scholar
Dell’Osso, L, Carpita, B, Muti, D, et al.Mood symptoms and suicidality across the autism spectrum. Compr Psychiatry. 2019;91:34–38.Google Scholar
Dell’Osso, L, Muti, D, Carpita, B, et al.The Adult Autism Subthreshold Spectrum (AdAS) model: A neurodevelopmental approach to mental disorders. J Psychopathol. 2018;24(3):118–124.Google Scholar