首诊强迫症患者的临床特点与心理防御机制研究

目的：探讨首次诊断为强迫症（OCD）患者的临床特点及其与心理防御机制的关系。方法：42例强迫症患者用耶鲁-布朗强迫评定量表（Y—BOCS）、汉米顿焦虑量表（HAMA）、汉米顿抑郁量表（HAMD）、防御方式问卷（DSQ）和艾森克人格问卷（EPQ）进行评定并与42例正常对照者比较。结果：强迫症患者以强迫观念或强迫行为为主要表现的和混合状态的各占近一半，强迫检查和强迫联想出现的频率较高，约5／6的患者有两种以上的症状，混合型的患者病程长且症状较重：强迫症患者与对照组相比更多地使用被动攻击、潜意识显现、分裂、幻想、退缩等不成熟防御机制和中间型防御机制．而较少使用升华等成熟防御机制：强迫症患者EPQ中的神经质标准分（N）显著高于对照组，而内-外向标准分（E）则低于对照组。三种不同类型的强迫症患者之间的心理防御机制以及EPQ问卷各因子的标准分的差异无显著性、结论：三组首诊的OCD患者具有不同的临床特征；不同类型的OCD均较多的使用不成熟和中间的防御机制且多具有内向、神经质的个性。

A Study on Clinical Characteristics and Defense Mechanism of Obsessive Compulsive Disorder Diagnosticated Firstly

Objective: To explore the clinical characteristics and the defense mechanism of patients first diagnosticated obsessive-compulsive disorder(OCD).Methods: 42 patients with OCD were assessed with Yale-Brown obsessive compulsive Scale(Y-BOCS),Hamilton depression scale(HAMD),Hamilton anxiety scale(HAMA),Defense Style Questionnaire(DSQ) and Eysenck Personality Questionnaire(EPQ),which were compared with the normal controls.Results: The rate of patients with obsessions or compulsion was similar to that of the mixed subtype.The patients with mixed subtypes showed more compelling and longer course of disease than the control group.Compared with the normal controls,OCD patients tended to use immature mechanism and intermediate type such as passive aggression,acting out,splitting,phantasy and withdrawl,but less use mature mechanism such as sublimation etc.The scales of introversion was lower and neuroticism was higher in EPQ of patients with OCD than those of controls.There were no notable differences among the three subtypes of OCD in EPQ scores and the defense mechanism.Conclusion: The three subtypes of first diagnosticated and treated OCD may have different clinical characteristics.They all tended to use immature mechanism and intermediate types,at equal pace,with the personality of introversion and nervousness.