强迫症道德厌恶感及其与症状的关系☆

靳红李晓驷　朱春燕余凤琼董毅张蕾谢雯蔡春岚穆菁菁袁愫肖季平

强迫症道德厌恶感及其与症状的关系☆

靳红*李晓驷△朱春燕*余凤琼*董毅△张蕾*谢雯△蔡春岚△穆菁菁△袁愫△肖季平*

目的 探讨强迫症（obsessive-compulsive disorder，OCD）患者道德厌恶感特征，及其与患者强迫症状的关系。方法 纳入28例OCD患者和30名性别、年龄、受教育年限与患者相匹配的正常对照，以词汇判断任务测试被试对道德厌恶词、核心厌恶词、中性词进行厌恶判断的反应时、正确率及厌恶程度评级，采用耶鲁布朗强迫量表（Yale-Brown obsessive-compulsive scale，Y-BOCS）、帕多瓦量表—华盛顿州立大学修订版（Padua inventory-Washington State University revision，PI-WSUR）评估患者强迫症状。结果 OCD组对核心厌恶词［（762.69± 128.25）ms vs.（648.69±162.66）ms］和道德厌恶词［（798.73±115.26）ms vs.（727.00±106.06）ms］的反应时较对照组长，对核心厌恶词［（6.38±1.78）vs.（5.03±1.64）］和道德厌恶词［（7.08±1.23）vs.（5.77±1.44）］的厌恶程度亦高于对照组，且差异均有统计学意义（P＜0.05）。OCD组对两类厌恶词的厌恶程度与Y-BOCS总分及Y-BOCS强迫思维分、强迫行为分、PI-WSUR总分及污染/清洗强迫因子、穿衣/打扮强迫因子、检查强迫因子、伤害他人/自己的强迫想法、伤害他人/自己的强迫冲动得分均呈正相关（P＜0.05）。多因素线性回归分析示，只有污染/清洗强迫因子分别与核心厌恶词（β=0.61，P＜0.01）和道德厌恶词（β=0.54，P＜0.01）厌恶程度有关联。结论 OCD患者道德厌恶感及核心厌恶感均较对照组更强烈。道德厌恶感与强迫症状相关，受影响最大的是污染/强迫清洗症状。

强迫症厌恶道德厌恶核心厌恶

【Abstract】Objective This study aims to investigate the moral disgust cognitive processing of patients with obsessive-compulsive disorder（OCD）and its relationship with OCD symptoms.Methods Twenty-eight OCD and 30 healthy controls matched for gender，age and education completed lexical decision task，recording reaction time and accuracy of words and assessing the degree of disgust.Yale-Brown obsessive-compulsive scale（Y-BOCS）and Padua Inventory-Washington State University Revision（PI-WUSR）were used to assess the symptoms.Results OCD group showed significantly longer reaction time to core disgust-related words［（762.69±128.25）ms vs.（648.69±162.66）ms］and moral disgust-related words［（798.73±115.26）ms vs.（727.00±106.06）ms］than the healthy controls（P＜0.05）.OCD group showed significantly higher aversion degree to core disgust-related words［（6.38±1.78）vs.（5.03±1.64）］and moral disgust-related words［（7.08±1.23）vs.（5.77±1.44）］than control group（P＜0.05）.Y-BOCS total score，Y-BOCS obsessive thoughts score，Y-BOCS compulsive behavior score，total score of PI-WUSR，cleaning/pollution force factor score，hurting themselves and others force factor were positively correlated with two types of disgust-related words in patients group （P＜0.05）.Multiple stepwise regression analysis between disgust words and Y-BOCS/PI-WUSR scores pointed that onlyCWCF influenced disgust degree of core disgust-related words（β=0.61，P＜0.01）and moral disgust-related words（β= 0.54，P＜0.01），respectively.Conclusion The core disgust and moral disgust of OCD are stronger compared to controls.

【Key words】Obsessive-compulsive disorderDisgust Core disgust Moral disgust

焦虑、恐惧一直是强迫症（obsessive-compulsive disorder，OCD）患者的主要情绪问题，近年发现OCD患者厌恶情绪也存在异常。临床观察可见，OCD怕脏、反复清洗等常见症状与厌恶情绪密切相关，厌恶情绪在OCD的发病过程中扮演重要角色［1-3］。……