A phenomenological study of OCD : formative experiences and the dialectic of shame and obsession

This qualitative study used a modified Giorgian (Giorgi, 1985, 2009) approach to descriptive phenomenology to explore four primary areas of inquiry: 1) how individuals conceptualize or make meaning of their experience living with OCD, 2) common core fears that may underlie obsessions, 3) formative experiences shared by people with OCD, and 4) internal self-representations, which included how self-concept effects and is affected by OCD. Various dynamic processes potentially implicated in the development and maintenance of OCD were examined through a series of 9 in-depth interviews, including whether individuals with OCD share qualitatively similar formative experiences, self-perceptions, and core fears. It also interrogated the role of shame in OCD; specifically, whether certain obsessions are accompanied by feelings of shame and if these feelings ultimately reinforce the condition. Analysis of interview data revealed seven primary themes: 1) lack of understanding, 2) meanings, manifestations & metaphors, 3) duality of mind, 4) formative and traumatic experiences, 5) impact of OCD on self, 6) impact of OCD on relationships, and 7) coping strategies. One primary theme, formative and traumatic experiences, included five subordinate themes: impaired familial communication, experiences of being an outsider, traumatic experiences, family instability, and parental expectations and overcontrol.
All participants described phenomena consistent with of OCD symptomology and universally reported experiencing obsessions and compulsions. Obsessions were consistent with widely recognized subtypes (i.e., aggressive/harm obsessions, contamination, sexual obsessions, hypermorality and scrupulosity), and the most commonly reported were contamination obsessions, followed by hypermorality/scrupulosity and aggressive obsessions. Similarly, compulsions were easily identified within existing categories (i.e., overt and covert checking behavior, symmetry/counting and repetitive movement, washing/cleaning, and anxious avoidance). The most commonly described compulsion was checking/reassurance-seeking, followed by anxious avoidance and symmetry/counting & repetitive movement. The majority recalled experiencing anxiety and obsessive tendencies beginning at an early age, while several identified precipitating factors leading up to symptom onset, most notably stressful events and increasing levels of anxiety. More than half described a sudden onset of symptoms. Symptom course was described as lifelong, pervasive, and waxing-and-waning. Narratives generally revealed that obsessions tended to change over time and that symptoms, and the ability to manage them, gradually improved.