The Relationship Between Intolerance of Uncertainty and Relationship Obsessive-Compulsive Disorder Symptoms: The Mediating Role of Ego Strength
Subject Areas : Clinical psychologyvahideh dehaqin 1 , Mohammad Ali Besharat 2 , Masoud Gholamali Lavasani 3 , Zahra Naghsh 4
1 - Department of Educational Psychology and Counseling, Faculty of Psychology and Educational Sciences, University of Tehran, Tehran, Iran.
2 - استاد دانشکده روانشناسی و علوم تربیتی، دانشگاه تهران.
3 - Associate Professor, Department of Educational Psychology and Counseling, Faculty of Psychology, University of Tehran, Tehran, Iran.
4 - Assistant Professor, Department of Educational Psychology and Counseling, Faculty of psychology, University of Tehran, Tehran, Iran.
Keywords: obsessive-compulsive disorder (OCD), relationship obsessive-compulsive disorder (ROCD), ego-strength, intolerance of uncertainty,
Abstract :
Relationship obsessive-compulsive disorder (ROCD) is a specific subtype of obsessive-compulsive disorder (OCD) in which symptoms are focused on intimate and/or close relationships one has with her/his spouse or partner. The study aimed to investigate the mediating role of ego strength in the relationship between intolerance of uncertainty and ROCD symptoms. The population comprised all students at the University of Tehran and the sample group consisted of 430 students (324 female, 106 male) who administered the Ego Strength Scale (ESS; Besharat, 2017), Intolerance of Uncertainty Scale (IUS; Carleton et al. 2007), and Relationship Obsessive-Compulsive Disorder Inventory (ROCI; Doron et al., 2012). The hypothesized mediation model provided fit to the data, The correlation between intolerance of uncertainty and ROCD symptoms was significantly positive, and between ego strength and ROCD symptoms was significantly negative. The study findings suggest that ego strength mediated the association between intolerance of uncertainty and ROCD symptoms. According to the results of this study, it can be concluded that intolerance of uncertainty and ego strength can predict the severity of ROCD symptoms. Considering these variables may be important in the processes of prevention, diagnosis, and treatment of ROCD symptoms.
Besharat, M. A., & Mirjalili, R. S. (2014). The simple and multiple relations of cognitive characteristics and worry in patients with generalized anxiety and obsessive-compulsive disorders. Journal of Devel- opmental Psycholog: Iranian Psychologists, 11(41) 3-17. [In Persian].
Besharat, M. A., Mirjalili, R., & Bahrami Ehsan, H. (2015). The moderating role of metacognitive be- liefs and deficit in cognitive emotion regulation in relationship between intolerance of uncertainty and worry in patients with obsessive-compulsive disor- der. Journal of Modern Psychological Researches, 10(37), 1-24. [In Persian].
Besharat, M. A., Ramesh, S., & Moghimi, E. (2018). Spiritual health mediates the relationship between ego-strength and adjustment to heart disease. Health Psychology Open, 5(1), 1-8.
Birrell, J., Meares, K., Wilkinson, A., & Freeston, M. (2011). Toward a definition of intolerance of uncer- tainty: A review of factor analytical studies of the In- tolerance of Uncertainty Scale. Clinical Psychology Review, 31(7), 1198-1208.
Carleton, R. N. (2016). Into the unknown: A review and synthesis of contemporary models involving uncertain- ty. Journal of Anxiety Disorders, 39(2), 30-43.
Carleton, R.N., Norton, P. J., & Asmundson, G. J. G. (2007). Fearing the unknown: A short version of the Intolerance of Uncertainty Scale. Journal of Anxiety Disorders, 21, 105-117.
Çelik, S., & Köse, G. G. (2021). Mediating effect of intolerance of uncertainty in the relationship between coping styles with stress during pandemic (CO- VID-19) process and compulsive buying behavior.
Progress in Neuro-Psychopharmacology and Bio- logical Psychiatry, 110, 110321.
Counsell, A., Furtado, M., Iorio, C., Anand, L., Canzo- nieri, A., Fine, A., & Katzman, M. A. (2017). Intoler- ance of uncertainty, social anxiety, and generalized anxiety: Differences by diagnosis and symptoms. Psychiatry Research, 252(2), 63-69.
Donnellan, M. B., & Robins, R. W. (2010). Resilient, overcontrolled, and undercontrolled personality types: Issues and controversies. Social and Personal- ity Psychology Compass, 4(11), 1070-1083.
Doron, G., & Derby, D. (2017). Assessment and treatment of relationship‐related OCD symptoms (ROCD). A modular approach. The Wiley handbook of obsessive-compulsive disorders, 1, 547-564.
Doron, G., & Szepsenwol, O. (2015). Partner-focused obsessions and self-esteem: An experimental investi- gation. Journal of Behavior Therapy and Experimen- tal Psychiatry, 49, 173-179.
Doron, G., Derby, D. S., & Szepsenwol, O. (2014). Re- lationship obsessive-compulsive disorder (ROCD): A conceptual framework. Journal of Obsessive-Com- pulsive and Related Disorders, 3(2), 169-180.
Doron, G., Derby, D. S., Szepsenwol, O., & Talmor, D. (2012). Tainted love: Exploring relationship-centered obsessive-compulsive symptoms in two non-clinical cohorts. Journal of Obsessive-Compulsive and Re- lated Disorders, 1(1), 16-24.
Doron, G., Derby, D., Szepsenwol, O., Nahaloni, E., & Moulding, R. (2016). Relationship obsessive-com- pulsive disorder: Interference, symptoms, and mal- adaptive beliefs. Frontiers in Psychiatry, 7(58), 1-9.
Dugas, M. J., Buhr, K., & Ladouceur, R. (2004). The role of intolerance of uncertainty in etiology and mainte- nance. In R. G. Heimberg, C. L. Turk, & D. S. Mennin (Eds.), Generalized anxiety disorder: Advances in re- search and practice (pp. 143–163). The Guilford Press.
Eidelson, R. J., & Epstein, N. (1982). Cognition and relationship maladjustment: Development of a mea- sure of dysfunctional relationship beliefs. Journal of Consulting and Clinical Psychology, 50(5), 715-720.
Erikson, E. H. (1956). The problem of ego identity.
Journal of the American Psychoanalytic Associa- tion, 4(1), 56-121.
Faleer, H. E., Fergus, T. A., Bailey, B. E., & Wu, K. D. (2017). Examination of an experimental manipulation of intolerance of uncertainty on obsessive-compulsive outcomes. Journal of Obsessive-Compulsive and Re- lated Disorders, 15, 64-73.
Foa, E. B., Huppert, J. D., Leiberg, S., Langner, R., Kichic, R., & Hajcak, G., et al. (2002). The Obses- sive–Compulsive Inventory: Development and vali- dation of a short version. Psychological Assessment, .496–485 ,14
Foa, E. B., Kozak, M. J., Salkovskis, P. M., Coles, M. E., & Amir, N. (1998). The validation of a new obses- sive–compulsive disorder scale: The Obsessive–Com- pulsive Inventory. Psychological Assessment, 10(3), .206-214
Freud, S. (1923). The Ego and the Id. The standard edi- tion of the complete psychological works of Sigmund Freud, Volume XIX (1923-1925): The Ego and the Id and Other Works, 1-66.
Gfellner, B. M., & Cordoba, A. I. (2017). Identity prob- lems, ego strengths, perceived stress, and adjustment during contextual changes at university. Identity, .25-39 ,)1(17
Ghomian, S., Shaeiri, M. R., & Farahani, H. (2019). Psychometric features of relationship Obsessive- Compulsive Inventory: A scale in the field of rela- tionship obsessive-compulsive disorder. International Journal of Behavioral Sciences, 12(4), 154-161.
Gillett, C. B., Bilek, E. L., Hanna, G. L., & Fitzgerald, K. D. (2018). Intolerance of uncertainty in youth with obsessive-compulsive disorder and generalized anxi- ety disorder: A transdiagnostic construct with impli- cations for phenomenology and treatment. Clinical Psychology Review, 60(1), 100-108.
Gratz, K.L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. Jour- nal of Psychopathology and Behavioral Assessment, .41-54 ,26
Hendrick, S. S., Dicke, A., & Hendrick, C. (1998). The Relationship Assessment Scale (RAS). Journal of So- cial and Personal Relationships, 15, 137–142.
Holm, S. E. H., Hansen, B., Kvale, G., Eilertsen, T., Johnsen, B. H., Hystad, S. W., & Solem, S. (2019).
رابطۀ بین تحملناپذیری بلاتکلیفی و نشـانههای وسـواس بیاختیاری رابطهای
Dispositional resilience in treatment‐seeking patients with obsessive‐compulsive disorder and its associa- tion with treatment outcome. Scandinavian Journal of Psychology, 60(3), 243-251.
Karataş, Z., & Tagay, Ö. (2021). The relationships be- tween resilience of the adults affected by the covid pandemic in Turkey and Covid-19 fear, meaning in life, life satisfaction, intolerance of uncertainty and hope. Personality and Individual Differences, 172, .110592
Kelly, W. E. (2020). Nightmares and ego strength revis- ited: Ego strength predicts nightmares above neuroti- cism and general psychological distress. Dreaming, .29-44 ,)1(30
Lee, J. K., Orsillo, S. M., Roemer, L., & Allen, L. B. (2010). Distress and avoidance in generalized anxi- ety disorder: Exploring the relationships with intoler- ance of uncertainty and worry. Cognitive Behaviour Therapy, 39(2), 126-136.
Lovibond, P. F., & Lovibond, S. H. (1995). The struc- ture of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33(3), 335–343.
Messina, I., Scottà, F., Marchi, A., Benelli, E., Grecucci, A., & Sambin, M. (2021). Case report: Individualiza- tion of intensive transactional analysis psychotherapy on the basis of ego strength. Frontiers in Psychology, .1424
Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behavior Research and Therapy, 28, 487-495.
Moin Alghorabaie, F., Shaeeri, M. R., Sanati, M., & Fa- daee, M. (2010). Cognitive strategies in patients with mixed anxiety-depression and obsessive-compulsive disorders. Journal of Developmental Psychology: Iranian Psychologists), 7(25), 65-74. [In Persian].
Moritz, S., Niemeyer, H., Hottenrott, B., Schilling, L., & Spitzer, C. (2013). Interpersonal ambivalence in obsessive-compulsive disorder. Behavioural and Cognitive Psychotherapy, 41(5), 594-609.
Morriss, J., Zuj, D. V., & Mertens, G. (2021). The role of intolerance of uncertainty in classical threat condi- tioning: Recent developments and directions for fu-
ture research. International Journal of Psychophysiol- ogy, 166, 116-126.
Moulding, R., Anglim, J., Nedeljkovic, M., Doron, G., Kyrios, M., & Ayalon, A. (2011). The Obsessive Beliefs Questionnaire (OBQ): Examination in non- clinical samples and development of a short version. Assessment, 18, 357–374.
Nygren, M. (2004). Rorschach Comprehensive System variables in relation to assessing dynamic capacity and ego strength for psychodynamic psychotherapy. Journal of Personality Assessment, 83(3), 277-292.
Obsessive Compulsive Cognitions Working Group. (2005). Psychometric validation of the Obsessive Belief Questionnaire and Interpretation of Intrusions Inventory-Part 2: Factor analyses and testing of a brief version. Behaviour Research and Therapy, 43(11), .1527-1542
Pascual-Vera, B., Belloch, A., Ghisi, M., Sica, C., & Bottesi, G. (2021). To achieve a sense of rightness: The joint role of not just right experiences and intoler- ance of uncertainty in obsessive-compulsive disorder. Journal of Obsessive-Compulsive and Related Disor- ders, 29, 100627.
Pinciotti, C. M., Riemann, B. C., & Abramowitz, J. S. (2021). Intolerance of uncertainty and obsessive- compulsive disorder dimensions. Journal of Anxiety Disorders, 81, 102417.
Pozza, A., Veale, D., Marazziti, D., Delgadillo, J., Al- bert, U., Grassi, G., & Dèttore, D. (2020). Sexual dysfunction and satisfaction in obsessive-compulsive disorder: Protocol for a systematic review and meta- analysis. Systematic Reviews, 9(1), 1-13.
Robichaud, M., & Dugas, M. J. (2012). Cognitive-be- havioral treatment for generalized anxiety disorder: From science to practice. Londen: Routledge.
Sanavio, E. (1988). Obsessions and compulsions: the Padua Inventory. Behaviour Research and Therapy, .169-177 ,)2(26
Sarawgi, S., Oglesby, M. E., & Cougle, J. R. (2013). Intolerance of uncertainty and obsessive-compulsive symptom expression. Journal of Behavior Therapy and Experimental Psychiatry, 44(4), 456-462.
Shah, N., & Kumar, N. (2021). Intolerance of uncertain-
ty and defense styles in young adults. International ۱6 Journal of Indian Psychology, 9(2), 1543-1554.
Developmental Psychology: Iranian Psychologists- Vol 20/ Issue 77/Autumn 202
Solem, S., Haaland, A., Hagen, K., Launes, G., Hansen, B., Vogel, P., & Himle, J. (2015). Interpersonal style in obsessive compulsive disorder. The Cognitive Be- haviour Therapist, 8, E29.
Soper, D. S. (2021). A-priori sample size calculator for structural equation models [Software].
Spanier, G. B. (1976). Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads. Journal of Marriage and Family, .28–15 ,)1(38
Summers, B. J., Matheny, N. L., Sarawgi, S., & Cougle, J. R. (2016). Intolerance of uncertainty in body dys- morphic disorder. Body Image, 16, 45-53.
Sun, J., Li, Z. J., Buys, N. J., Storch, E. A., & Wang, J. S. (2014). Obsessive-compulsive symptoms and personal disposition, family coherence and school environment in Chinese adolescents: A resilience approach. Journal of Affective Disorders, 168, 459-465.
Tellawi, G., Williams, M. T., & Chasson, G. S. (2016). Interpersonal hostility and suspicious thinking in obsessive-compulsive disorder. Psychiatry Research, .295-302 ,243
Vazard, J. (2021). (Un) reasonable doubt as affective ex- perience: obsessive–compulsive disorder, epistemic
anxiety and the feeling of uncertainty. Synthese, 198(7), .6917-6934
Veit, C.T. & Ware, J.E. (1983). The structure of psycho- logical distress and well-being in general population. Journal of Consulting and Clinical Psychology, 51, .730-742
Watson, D., Clarke, L.A., & Tellegen, A. (1988). Devel- opment and validation of brief measures of positive and negative affect: The PANAS Scales. Journal of Person- ality and Social Psychology, 54, 1063-1070.
Wegner, D. M., & Gray, K. (2017). The mind club: Who thinks, what feels, and why it matters. Penguin.
Weiner, I. B., Tennen, H. A., & Suls, J. M. (2012). Hand- book of psychology, personality and social psychology. New Jersey: Wiley.
Wheaton, M. G., Messner, G. R., & Marks, J. B. (2021). Intolerance of uncertainty as a factor linking obsessive- compulsive symptoms, health anxiety and concerns about the spread of the novel coronavirus (COVID-19) in the United States. Journal of Obsessive-Compulsive and Related Disorders, 28, 100605.
Yang, Q., Van den Bos, K., & Li, Y. (2021). Intolerance of uncertainty, future time perspective, and self-control. Personality and Individual Differences, 177, 110810.