title: Toward understanding the heterogeneity in obsessive-compulsive disorder: Evidence from narratives in adult patients.
abstract: BACKGROUND
  Current attempts at understanding the heterogeneity in obsessive-compulsive disorder have relied on quantitative methods. The results of such work point toward a dimensional structure for obsessive-compulsive disorder. Existing qualitative work in obsessive-compulsive disorder has focused on understanding specific aspects of the obsessive-compulsive disorder experience in greater depth. However, qualitative methods are also of potential value in furthering our understanding of obsessive-compulsive disorder heterogeneity by allowing for open-ended exploration of the obsessive-compulsive disorder experience and correlating identified subtypes with patient narratives.
  
  
  OBJECTIVE
  We explored variations in patients' experience prior to, during and immediately after performing their compulsions.
  
  
  METHODS
  Semi-structured interviews were conducted with 20 adults with obsessive-compulsive disorder, followed by inductive thematic analysis. Participant responses were not analyzed within the context of an existing theoretical framework, and themes were labeled descriptively.
  
  
  RESULTS
  The previous dichotomy of 'anxiety' vs 'incompleteness' emerged organically during narrative analysis. In addition, we found that some individuals with obsessive-compulsive disorder utilized their behaviors as a way to cope with stress and anxiety more generally. Other participants did not share this experience and denied finding any comfort in their obsessive-compulsive behaviors. The consequences of attentional difficulties were highlighted, with some participants describing how difficulty focusing on a task could influence the need for it to be repeated multiple times.
  
  
  CONCLUSIONS
  The extent to which patients use obsessive-compulsive disorder as a coping mechanism is a relevant distinction with potential implications for treatment engagement. Patients may experience ambivalence about suppressing behaviors that they have come to rely upon for management of stress and anxiety, even if these behaviors represent symptoms of a psychiatric illness.
authors: Department of Psychiatry, Yale University, New Haven, CT, USA.
authors: Gerrit I
authors: GI
authors: Van Schalkwyk
authors: Department of Psychiatry, Yale University, New Haven, CT, USA.
authors: Ish P
authors: IP
authors: Bhalla
authors: Department of Psychiatry, Yale University, New Haven, CT, USA.
authors: Matthew
authors: M
authors: Griepp
authors: Department of Psychiatry, Yale University, New Haven, CT, USA.
authors: Benjamin
authors: B
authors: Kelmendi
authors: Department of Psychiatry, Yale University, New Haven, CT, USA Yale Program for Recovery and Community Health, Yale University, New Haven, CT, USA.
authors: Larry
authors: L
authors: Davidson
authors: Department of Psychiatry, Yale University, New Haven, CT, USA Department of Psychology, Yale University, New Haven, CT, USA Child Study Center, Yale University, New Haven, CT, USA Interdepartmental Neuroscience Program, Yale University, New Haven, CT, USA Christopher.pittenger@yale.edu.
authors: Christopher
authors: C
authors: Pittenger
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001007:Anxiety / Q000523:psychology*; D001288:Attention; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D033262:Narration; D009771:Obsessive-Compulsive Disorder / Q000523:psychology*; D036301:Qualitative Research; D013315:Stress, Psychological / Q000523:psychology*; D055815:Young Adult
keywords: Obsessive-compulsive disorder; anxiety; attention; phenomenology