청년기 정체성 혼미의 관점에서 고찰한 강박 장애와 강박서사와의 관계

김미영 한국문학치료학회 2011 문학치료연구 Vol.20 No.-

강박 장애는 “의식 내용이 어처구니없고, 불합리하다.”라고 자신도 생각하고 있으면서도 강박 관념에서 빠져나가지 못하고 고뇌하거나, 강박 행위를 반복하는 병의 용태를 특징으로 한다. 강박 관념이나 강박 행위에는 여러 가지 것이 있지만, 대표적인 것으로는 “확인 강박(checking compulsion)”과 “세정 강박(cleaning compulsion)”이란 것이 있다. 강박 행위의 목적은 즐거움을 얻는 것이 아니고, 불안을 경감하는 것에 있다. 강박 행위에 저항하려고 시도했을 때, 불안 또는 긴장의 고조를 느낀다. 강박 장애자에게 강박 행위는 불안이나 공포에 대처하기 위한 하나의 방법이다. 강박 관념과 강박 행위에 대해 무력한 것에서부터 우울한 기분이 된다. 본 논문에서는 강박 장애의 특성에 근거해서 강박 장애와 강박서사와의 호응관계를 고찰했다. 정체성 혼미의 관점에서 고찰한 결과, 강박 장애와 강박서사는 부전감과 완전욕구라는 2개의 모순된 성격 구조의 측면에서 서로 호응하고 있음을 알 수 있었다. 강박 장애는 내적 불확실성에서 기인하는 것이므로 전인적 자아 긍정에 의한 자신감 결핍의 해소와 거기에 따른 자아 정체성 확립, 정신적 거점 확보라는 마음의 자세가 증상의 예방을 위해서도 중요하다고 생각할 수 있다. Even if they thought that obsessive-compulsive disorder was that is irrational nor absurd by oneself, they can not get out from obsession that they are make repeat to compulsive behavior. There are variety obsession or compulsive behavior. Important of them that is the checking compulsion and a cleaning compulsion. The purpose of compulsive behavior do is not to obtain pleasure, it is to mitigation of anxiety. If you tried to resist the compulsion and you feel heightened anxiety or stress. Obsessive-compulsive behavior to people with obsessive-compulsive disorder that is to cope with the anxiety and fear is one way. You feel the depressed mood, because you can not fight against to an obsession and compulsion. Obsessive-compulsive behavior to people with obsessive-compulsive disorder that is to cope with the anxiety and fear is one way. You feel the depressed mood, because you can not fight against to an obsession and compulsion. This papers be based in the theory of obsessive-compulsive disorder, about the correlation of obsessive-compulsive disorder and obsessive-compulsive epic were discussed. From the perspective of adolescent identity confusion which was examined the relationship between obsessive-compulsive disorder and obsessive-compulsive epic. As a result, the two symptoms are compatible each other. Incompletely a sense and desire of completion that is structure of contradictory personality appears in obsessive-compulsive disorder and obsessive-compulsive epic. The obsessive-compulsive disorder is attributed from inner uncertainty. Therefore, supplement to lack of self-confidence by self-holistic positive, and the establishment of identity is very important.

청년기 정체성 혼미의 관점에서 고찰한 강박 장애와 강박서사와의 관계

김미령 ( Kim Mi-ryoung ) 한국문학치료학회 2011 문학치료연구 Vol.20 No.-

강박 장애는 “의식 내용이 어처구니없고, 불합리하다.”라고 자신도 생각하고 있으면서도 강박 관념에서 빠져나가지 못하고 고뇌하거나, 강박 행위를 반복하는 병의 용태를 특징으로 한다. 강박 관념이나 강박 행위에는 여러 가지 것이 있지만, 대표적인 것으로는 “확인 강박(checking compulsion)”과 “세정 강박(cleaning compulsion)”이란 것이 있다. 강박 행위의 목적은 즐거움을 얻는 것이 아니고, 불안을 경감하는 것에 있다. 강박 행위에 저항하려고 시도했을 때, 불안 또는 긴장의 고조를 느낀다. 강박 장애자에게 강박 행위는 불안이나 공포에 대처하기 위한 하나의 방법이다. 강박 관념과 강박 행위에 대해 무력한 것에서부터 우울한 기분이 된다. 본 논문에서는 강박 장애의 특성에 근거해서 강박 장애와 강박서사와의 호응관계를 고찰했다. 정체성 혼미의 관점에서 고찰한 결과, 강박 장애와 강박서사는 부전감과 완전욕구라는 2개의 모순된 성격 구조의 측면에서 서로 호응하고 있음을 알 수 있었다. 강박 장애는 내적 불확실성에서 기인하는 것이므로 전인적 자아 긍정에 의한 자신감 결핍의 해소와 거기에 따른 자아 정체성 확립, 정신적 거점 확보라는 마음의 자세가 증상의 예방을 위해서도 중요하다고 생각할 수 있다. Even if they thought that obsessive-compulsive disorder was that is irrational nor absurd by oneself, they can not get out from obsession that they are make repeat to compulsive behavior. There are variety obsession or compulsive behavior. Important of them that is the checking compulsion and a cleaning compulsion. The purpose of compulsive behavior do is not to obtain pleasure, it is to mitigation of anxiety. If you tried to resist the compulsion and you feel heightened anxiety or stress. Obsessive-compulsive behavior to people with obsessive-compulsive disorder that is to cope with the anxiety and fear is one way. You feel the depressed mood, because you can not fight against to an obsession and compulsion. Obsessive-compulsive behavior to people with obsessive-compulsive disorder that is to cope with the anxiety and fear is one way. You feel the depressed mood, because you can not fight against to an obsession and compulsion. This papers be based in the theory of obsessive-compulsive disorder, about the correlation of obsessive-compulsive disorder and obsessive-compulsive epic were discussed. From the perspective of adolescent identity confusion which was examined the relationship between obsessive-compulsive disorder and obsessive-compulsive epic. As a result, the two symptoms are compatible each other. Incompletely a sense and desire of completion that is structure of contradictory personality appears in obsessive-compulsive disorder and obsessive-compulsive epic. The obsessive-compulsive disorder is attributed from inner uncertainty. Therefore, supplement to lack of self-confidence by self-holistic positive, and the establishment of identity is very important.

섭식장애 환자의 섭식장애 증상, 우울, 강박성이 자해행동에 미치는 영향

공성숙 한국간호과학회 2009 Journal of Korean Academy of Nursing Vol.39 No.4

Purpose: The purpose of the study was to investigate psychological factors such as eating psychopathology, depression, and obsessive-compulsion that might influence self-harm behavior in patients with eating disorders. Methods: Patients with eating disorders (n=135) who visited “M” clinic for eating disorders participated in the study. Data were collected from March to August 2007 using the Eating Disorder Inventory-2, Beck Depression Inventory, Maudsley Obsessional-Compulsive Inventory, and Self-Harm Inventory (SHI). Results: The participants scored high on self-harm as well as on depression and obsessive-compulsion. On the SHI, a high frequency of self harm behavior such as ‘torturing self with self-defeating thoughts’, ‘abused alcohol’, ‘hit self’, and ‘suicide attempt’ were found for the participants. There were significant correlations between most eating psychopathology variables, depression, obsessive-compulsion, and self-harm behavior. ‘Interoceptive awareness’ (eating psychopathology), depression, and ‘checking’ (obsessive-compulsion) were significant predictors of self-harm behavior. Conclusion: Future interventions for patients with eating disorders should focus on assessing the possibility of self-harm and suicidal attempts, especially in those patients with high levels of eating psychopathology, depression, or obsessive-compulsion. Early intervention for depression and obsessive-compulsion could contribute to preventing self-harm and suicide in patients with eating disorders. Purpose: The purpose of the study was to investigate psychological factors such as eating psychopathology, depression, and obsessive-compulsion that might influence self-harm behavior in patients with eating disorders. Methods: Patients with eating disorders (n=135) who visited “M” clinic for eating disorders participated in the study. Data were collected from March to August 2007 using the Eating Disorder Inventory-2, Beck Depression Inventory, Maudsley Obsessional-Compulsive Inventory, and Self-Harm Inventory (SHI). Results: The participants scored high on self-harm as well as on depression and obsessive-compulsion. On the SHI, a high frequency of self harm behavior such as ‘torturing self with self-defeating thoughts’, ‘abused alcohol’, ‘hit self’, and ‘suicide attempt’ were found for the participants. There were significant correlations between most eating psychopathology variables, depression, obsessive-compulsion, and self-harm behavior. ‘Interoceptive awareness’ (eating psychopathology), depression, and ‘checking’ (obsessive-compulsion) were significant predictors of self-harm behavior. Conclusion: Future interventions for patients with eating disorders should focus on assessing the possibility of self-harm and suicidal attempts, especially in those patients with high levels of eating psychopathology, depression, or obsessive-compulsion. Early intervention for depression and obsessive-compulsion could contribute to preventing self-harm and suicide in patients with eating disorders.

강박장애와 연관된 장애들

정인과 大韓神經精神醫學會 1994 신경정신의학 Vol.33 No.4

It was only a decade ago that obsessive-compulsive disorder was thought as a rare disorder with poor prognosis. Now it is recognized as a common psychiatric disorder. but current diagnostic classification systems are struggling with a possible over lap of obsessive compulsive disorder with several related disorders, including body dysmorphic disorder, depersonalization, anorexia nervosa, hypochondriasis, trichotillomania, Tourette's syndrome, sexual compulsion, pathological gambling, and impulsive personality disorders. These obsessive compulsive related disorders may share various characteristics, including clinical symptoms, associated feature, presumed etiology, genetic familial transmission, and response to selective pharmacological or behavioral treatment. However, overlap between obsessive compulsive disorder and these various disorders on these features is not uniform. Although this overlap does not established a definite relationship between disorders, it does provide confirmatory evidence to support a presumed relationship. Further research on the relationship of obsessive compulsive disorder to its related disorder is required. These relationship may be investigated using phenomenological studies, family data, neurochemical & neuroanatomical studies, and pharmacotherapeutic dissection. Exploration of the obsessive compulsive related disorder will be in turn coutribute to our understanding of obsessive compulsive disorder and will lead to new ways of characterizing this important and complex disorder.

Triple X 증후군(47,XXX) 환자에서의 강박장애 1례

김종훈,진영호,장기용 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.5

Triple X 증후군은 비교적 드물게 나타나는 성염색체이상증후군으로 아직까지 특정 정신병리현상과의 연관성은 충분히 알려져 있지 않은 상태이다. 본 저자들은 핵형 분석으로 검증된 47, XXX triple X 증후군에서 강박장애가 동반된 증례 1례를 경험하였다. 환자는 불완전한 성적발달, 내분비적 이상, 무월경과 함께 복합적인 강박증상, 강박행동을 나타내었다. 뇌자기공명영상촬영 결과 환자의 좌측 후두엽피질하 백질 부위에서 고신호 광도 병변이 관찰되었다. 환자의 강박증상, 강박행동들은 고용량의 fluoxetine과 buspirone약물요법 및 인지행동치료에 부분적 반응을 보였으나, 환자의 전반적인 심리 사회적 기능은 치료후 크게 호전되었다. 본 증례 및 관련문헌에 대한 고찰을 통해, 본 저자들은 triple X 증후군과 같은 X염색체의 이수배수체질환(X chromosome aneuploidy)이 강박스펙트럼장애(obsessive-compulsive spectrum disorders)혹은 강박장애에 취약할 가능성이 있음을 제시하고자 한다. Triple X syndrome is a relatively rare sex chromosomal anomaly, and its association with psychopathology is not well understood. The authors report one case of obsessive-compulsive disorder(OCD) with karyotype-confirmed triple X syndrome, 47, XXX. She had incomplete sexual development, secondary amenorrhea and multiple obsessive-compulsive symptoms. Magnetic resonance imaging of the brain revealed left occipital white matter hyperintensity lesion. The patient's multiple obsessive-compulsive symptoms were responded partially with fluoxetine and adjunctive buspirone treatment, however, her overall psychological functions were much improved. With the literature reviews, the authors suggest the possibility that a certain type of sex chromosome aneuploidy might be susceptible to obsessive-compulsive spectrum disorders(OCSDs) or ODC.

강박장애환자의 인지행동치료프로그램 참여경험에 대한 질적사례연구

박제인,김수진 한국질적탐구학회 2016 질적탐구 Vol.2 No.1

본 연구는 강박장애환자의 인지행동치료프로그램 참여 경험을 탐색하기 위한 질적 사례연구이다. 연구 참여자는 강박장애를 진단 받은 만 20세 이상의 성인이며 교육내용과 질문내용을 이해하고 의사소통이 가능하며 본 연구의 참여를 동의한 자이다. 자료수집은 G시 소재의 J 정신병원 강박증 클리닉에 참여한 7명의 연구 참여자를 대상으로 2012년 7월부터 2013년 1월까지 실시하였다. 수집된 자료는 Stake(1995)가 제시한 범주합산과 유형 만들기 분석기법을 활용하여 분석 하였으며 3개의 유형, 13개의 범주, 49개의 의미단위가 도출되었다. 연구 결과 강박장애환자의 특성을 파악하였고, 인지행동치료프로그램에 참여한 환자의 경험을 탐색하였으며 인지행동치료프로그램이 강박장애환자의 강박사고 및 강박행동을 감소시킴으로써 그들의 삶에 변화를 가져올 수 있는 효과적인 중재방안임을 확인하였다. 또한 본 연구에서 제시하고 있는 강박장애환자들의 인지행동치료프로그램 참여 경험은 강박장애환자를 이해하는데 도움이 되며 강박장애환자 대상 간호중재 개발을 위한 기초자료로 활용될 수 있으리라 사료된다. The purpose of this study was to find out if the cognitive behavior therapy program for patients with obsessive-compulsive disorder made the meaningful difference in the lives of patients with obsessive-compulsive disorder and to explore their experiences during their participation in the program. Data were collected during the period from July, 2012 to January 2013 throughout in-depth personal interviews, participant observation and instruments. The subjects were 7 patients with obsessive-compulsive disorder participated in cognitive behavior therapy program at a obsessive compulsive disorder clinic in J Mental Hospital, located in G City. Collected data were analyzed by the data analysis method, suggested by Stake (1995). In conclusion, the experiences of patients were divided into 3 patterns, 13 categories, 49 meaningful units. The cognitive behavior therapy programme could reduce the obsessive thinking and compulsive behavior of patients with obsessive-compulsive disorder. The study is expected to be the foundation to develop nursing interventions to understand and help patients with obsessivecompulsive disorder, based on in-depth understanding of their vivid experiences.

삼전요법의 강박증 치료에 대한 중국 임상연구 동향

홍정민,조성훈 대한스트레스학회 2018 스트레스硏究 Vol.26 No.4

Background: This study was performed to review the research trends in the treatment of obsessive- compulsive disorder with Morita therapy in China. Methods: We searched articles in the China National Knowledge Infrastructure (CNKI) regarding Morita therapy and “obsessive-compulsive disorder” in medicine and the public health field. And 23 studies were selected and classified. Five before-after comparison studies and 18 randomized controlled trials were performed in patients with obsessive-compulsive disorder in China. Results: Morita therapy and western medicine were used for the treatment of obsessive-compulsive disorder. Most of the studies reported that groups treated with Morita therapy as well as western medicine showed much positive results than those groups treated with western medicine alone. Conclusions: According to this study, Morita therapy for obsessive-compulsive disorder would be an effective and safe intervention. Further clinical studies on the use of Morita therapy in the treatment of obsessive-compulsive disorder should be done in Korea in the near future. 본 연구의 목적은 중국에서 강박증 치료에 삼전요법이 얼마나 효과가 있는지 살펴보는 것이다. 삼전 요법은 도교, 불교 선종은 물론 고대 한방정신요법의 특색을 두루 담고 있는 심리치료 방법이다. 최근 국내 연구 결과에 따르면 전체 인구의 1.5%가 강박증을 앓고 있어 강박증 치료에 많은 관심이 쏠리고 있다. 중국의 임상연구 결과에 따르면 삼전요법과 양약치료를 병행한 경우 강박증 치료에 유의미한 효과 를 얻었다. 삼전요법 치료만으로도 양약치료보다 강박증에 유의한 치료 효과를 거두었다. 강박증 치료를 위해 삼전요법의 활성화가 필요하다.

강박증에 대한 프로이트적 정의와 원인에 대한 비판적 분석

문장수(Moun, Jean-Sou),심재호(Shim, Jae-Ho) 새한철학회 2015 哲學論叢 Vol.82 No.4

프로이트는 1894년에 히스테리와 함께 강박증을 가장 중요한 신경증의 한 형태로 분류함으로써 강박증 임상에 초석을 놓았다. 그러나 강박증에 대한 프로이트의 정의는 그렇게 명료하지 못하다. 왜냐하면, 신경증자들은 도착증적 행동을 자주 하며, 도착증의 증상을 가지고 있는 사람들도 많은 경우엔 정상인처럼 행동하기 때문이다. 또한 강박증자도 때때로 신체상의 통증을 가지는 히스테리 증상을 가지며, 또한 사디즘적 행동을 하는 자도 때때로 마조히즘적 행동을 하기 때문이다. 이러한 차원에서 증상에 근거한 프로이트적 정의에 만족하지 못한 라캉은 구조적 관점에서 강박증에 대한 정의를 시도했다. 그러나 필자가 보기에 라캉의 이러한 구조적 정의도 그렇게 설득력이 있다고 보이지 않는다. 왜냐하면, 부명의 기능과 욕망의 작동 양상에 근거한 라캉의 구조적 정의는 검증할 수 없는 형이상학적가설에 근거하기 때문이다. 이러한 맥락에서 강박증에 대한 보다 엄밀한 정의와 원인을 탐구하고자 하는 것이 본 글의 목적이다. 단적으로 말하면, 강박증을 포함해서 인간의 모든 정신적 증상들은 상징계에 의해서 왜곡된 실재에서 살아남기 위한 인간의 불가피한 의식행동(ritual)이라는 것이 필자의 최종적 결론이다. In fact, the term Obsessive Compulsive Disorder(OCD) is not a unfamiliar idea in the modern society where psychoanalytical discourse is being generalized. In 1894, Freud laid the foundation stone of Obsessive Compulsive Disorder clinic by classifying it as a type of the most important neurosis along with hysteria. However, Freud"s definition of Obsessive Compulsive Disorder is not much clear. Because neurotic patients often behave in a perversive way and even those who have the symptom of perversion behave, in many cases, like normal persons. Also because Obsessive Compulsive Disorder patients sometimes have hysteria which contains physical pain, and those who have sadistic tendency sometimes behave in a masochistic way. At this level, Lacan who was not satisfied with Freud"s definition based on its symptom attempted the definition of Obsessive Compulsive Disorder in a structural perspective. But in this writer"s opinion, this structural definition of Lacan also seems not to be persuasive. Because Lacan"s structural definition based on the function of Father"s order and the operating aspects of Desire is on the hypothesis that cannot be verified. In this context, the purpose of this paper is just to research the stricter definition and cause on Obsessive Compulsive Disorder. simply speaking, this writer"s final conclusion is that all the mental symptoms including OCD is only human inevitable ritual to survive the Real distorted by the Symbolic.

강박장애 환자에서 강박증상차원에 부합하는 12문항 강박증상목록의 심리측정적 특성

서호석,최미나,이승재 대한불안의학회 2023 대한불안의학회지 Vol.19 No.1

Objective : The 18-item Obsessive-Compulsive Inventory-Revised (OCI-R) is widely employed to assess symptoms of obsessive-compulsive disorder (OCD). However, this instrument’s factor structure does not align with contemporary dimensional models of OCD. Therefore, the objective of this study was to examine psychometric properties of the 12-item Korean OCI (OCI-12) on four obsessive-compulsive symptom dimen- sions, in patients with OCD. Methods : A total of 157 patients with OCD and 51 healthy controls completed psychological measures, in- cluding the OCI-R, Dimensional Obsessive-Compulsive Scale (DOCS), and scales evaluating anxiety and de- pressive symptoms. Pychometric characteristics of the OCI-12 with three neutralizing and three hoarding items eliminated from the OCI-R, were analyzed. Results : All OCI-12 items registered excellent internal consistency at 0.83. Confirmatory factor analysis revealed strong association between individual items and their proposed latent factors (i.e., subscales). Con- vergent validity was appropriate. A high correlation was particularly observed for the DOCS score (r=0.71, p<0 .001). Moreover, the OCI-12 was as sensitive as the OCI-R for determining effects of empirically support- ed treatment for OCD. Conclusion : The OCI-12 is a 12-item measure that adheres to the prevailing 4-factor model of OCD di- mensions. Like OCI-R, it possesses good to excellent psychometric properties, including reliability, validity, and sensitivity to treatment. (Anxiety and Mood 2023;19(1):10-18)

韓國 精神障碍의 疫學的 調査 研究(XIII) ᅳ 強迫障碍의 有病率 ᅳ

李定均 대한신경정신의학회 1994 신경정신의학 Vol.33 No.1

A nationwide epidemiological study of mental disorders including obsessive-compulsive disorder in Korea using DIS-III Korean version was conducted in the Capital City o f Korea (Seoul) and 20 rural areas and the results were compared with those o f 6 other countries. The results were as follows : 1) The lifetime prevalence rate of obsessive-compulsive disorder was 2.14%, 2.299% in seoul and 1.90% in rural areas. 2) As for sex, the lifetime prevalence rate was higher in females, than in males, 2.03% in male and 2.38% in female. 3) The most prevalent age group was 18—24 yrs. old group(2.45%). 4) The lifetime prevalence rates of OCD of seven countries (Korea, USA, Canada, Puero Rico, New Zealand, Germany and Taiwan) were remarkably consistent across the cross-national sites. Most of the sites fall within the range of 1.9% (Korea) to 2.5% (Puerto Rico). The annual rate of OCD was also fairly consistent across sites, ranging from 1.8 (Puerto Rico) to 1.1 % (Korea and New Zealand). 5) Mean age of onset of OCD was in the mid-to late twenties to early thirties, with the earliest mean age at Canada(21.9yrs) and the latest at Puerto Rico(35.5 years). 6) The lifetime rate by sex, was generally higher in females as compared to males, except for Germany where males had a higher rate than females. In New Zealand, females had the highest rate among all of the females(3.4%) and in Germany males had the highest rate among all of the males(2.5%), The female to male ratios were consistent for Korea(1.2), Puerto Rico(1.2), Canada(1.3),USA(1.6) and Taiwan(1.8). 7) Proportion of persons with only obsession, only compulsion and both were also compared. In USA, Canada, Puerto Rico and New Zealand there was a larger proportion of persons with only obsession as compared to only compulsion. In Germany and Taiwan the proportion were equal and in Kroea there was a higher proportion of persons with compulsion only, just the opposite trend seen in most of the other sites. 8) Germany had the highest proportion of persons with both obsessions and compulsions. Most of th countries fall within the 13% to 26% range, with Puerto Rico slightly higher. 9) Comorbidity with major depression and any anxiety disorders (panic disorder or any phobia) in persons with and without OCD for the cross-national sites were compared. Persons with OCD were at a risk substantially greater than chance of also having comorbid major depression or any anxiety disorders as compared to persons without OCD across all sites, even though the comorbidity rates and the magnitude of risk vary by sites. The proportion of persons with OCD and any anxiety disorder were higher than that proportion with major depression. Persons with OCD at Munich (Germany) seemed to have higher proportion with major depression and anxiety disorder and are at greater risk than persons without OCD compared to the other sites.