Shorter communicationReligiousness and obsessive–compulsive cognitions and symptoms in an Italian population
Introduction
Obsessive–compulsive disorder (OCD) is a well-known form of psychopathology which is characterized by persistent, intrusive, and distressing obsessions (persistent thoughts, impulses, or images) or compulsions (repetitive, excessive behaviors or mental acts). In addition, both obsessive/compulsive phenomena appear to be quite prevalent in normal populations (Rachman & de Silva, 1978). In Western countries, especially Anglo-Saxon and Anglo-Celtic countries, rates of OCD (in terms of lifetime prevalence) are remarkably consistent at about 1–2%, whereas rates vary across Asian and other ethnic groups (Pigott, 1998, Samuels & Nestadt, 1997).
Research regards cognitive contents and processes as etiologically important in OCD and in other anxiety disorders (e.g., Clark, 1986, Ehlers & Clark, 2000, Rachman, 1997, Tallis, 1995, Wells, 1995). An international group of investigators recently identified six cognitive domains particularly relevant to OCD: inflated responsibility, overimportance of thoughts, excessive concern about the importance of controlling one's thoughts, overestimation of threat, intolerance of uncertainty, and perfectionism (Obsessive Compulsive Cognitions Working Group, 1997, Obsessive Compulsive Cognitions Working Group, 2001). However, available evidence casts doubt upon the universal cultural relevance of theories asserting the etiologic role of specific beliefs and appraisals in the development of OCD. In a recent study Sica, Novara, Sanavio, Coradeschi, and Dorz (in press) compared Greek, Italian, and US students by means of anxiety, depression, OC cognitions and symptoms measures. The results showed that in Greek students anxiety, contamination, and checking were not related at all to cognitive measures, whereas in Italian students, cognitive measures were consistently associated with depression and with all OC symptom scales. In addition, cognitive appraisal scores were less correlated with symptoms in Italians than in US students. Overall, with few exceptions, US students showed the highest correlations between OC cognitions and symptoms, Greek students the lowest, with Italians the middle. Thus, the predictive and/or causal role of these cognitions over OC symptoms seems apparently moderated by cultural factors (see also Bernstein, 1997, Good & Kleinman, 1985).
One cultural factor that may play a role in OCD is religiousness. Rachman (1997, p. 798) hypothesized that “people who are taught, or learn, that all their value-laden thoughts are of significance will be more prone to obsessions — as in particular types of religious beliefs and instructions”. Some evidence supports Rachman's claim. Steketee, Quay, and White (1991) examined the relationships among type and severity of OC symptoms, degree of religiosity and guilt in 33 OCD and 24 patients with other anxiety disorders. The OCD individuals were not significantly more religious or more guilty than other anxious subjects. Nonetheless, religiosity in OCD patients was significantly positively correlated with measures of obsessive–compulsive symptoms but not with measures of general and social anxiety and depression, suggesting some specific association of religiosity and OCD symptoms. In addition, those with religious obsessions were more religious than those who did not report such obsessions. Lastly, the degree of religious devotion was significantly positively correlated with OCD subjects' guilt, whereas guilt and religiosity did not correlate significantly for subjects with anxiety disorders other than OCD. In a study assessing OC symptoms in 34 Israeli patients, symptoms linked to religious practices were found in 13 of the 19 ultraorthodox subjects and in only one of the 15 non-ultraorthodox subjects (Greenberg & Witzum, 1994). The authors reported four main topics of religious symptomatology: prayer, dietary practices, menstrual practices, and cleanliness before prayer. In addition, the forms of the religious obsessions and the associated rituals in the ultraorthodox subjects were similar to the presentation of OCD in the non ultraorthodox subjects. Okasha, Saad, Khalil, El-Dawla, and Yehia (1994) considered OC phenomenology in 90 Egyptian, 82 Indian, 45 England and 10 Israeli OCD patients. Obsessions of the Egyptians and Israeli patients were concerned mostly with religious matters, whereas common themes between the Indian and the British samples were mostly related to orderliness and aggressive issues. The authors concluded that in Egyptian patients both obsessions and compulsions were influenced by the Moslem culture, which emphasizes cleanliness and ritual purity and where the sexual matters can be an issue of prohibition, sin and shame.
Thus, it is reasonable to hypothesize a relation between religious practices and OC features. Actually, a few religious rituals involve decontamination and purification practices. Further, in many religions the blasphemous thoughts are warded off through repeated prayers or alleviating the guilt about committing a sin through confession. Lastly, some beliefs commonly held by religious people seem to fall within the domains considered etiologically relevant to OCD, such as overimportance of thoughts and excessive concern about the importance of controlling one's thoughts (e.g., Greenberg, Witzum, & Pisante, 1987, Rachman, 1997, Weisner & Riffel, 1960).
Clearly, more research is necessary to attain a better understanding about the influences of religiousness over OC features. The present study is aimed to further clarify the nature of relationship between religiousness and OC features (cognitions and symptoms) in an Italian population. We hypothesized that individuals with different degrees of involvement with religion would differ with respect to OC symptoms and cognitions: (a) religious individuals would report higher levels of overimportance of thoughts, excessive concern about the importance of controlling one's thoughts and responsibility compared to non-religious individuals, and (b) religious individuals would show a higher level of obsessionality compared to non-religious individuals. To our knowledge this is the first study that addressed this topic among Italian Catholic individuals.
Section snippets
Method
In order to verify our hypotheses we tried to vary the degree of religiosity across people by selecting three groups with distinct features. A high degree of religiosity was considered typical of individuals whose job was to practice religiousness. To this aim, Catholic Italian nuns and friars were enrolled in convents and nunneries. A medium degree of religiosity was considered typical of persons who regularly attended church activities and were well-grounded in religious habits and practices.
Results
Fifty-four individuals with a high degree of religiosity, 47 with a medium degree of religiosity and 64 with a low degree of religiosity completed our measures. Individuals with a high degree of religiosity scored higher than the other two groups on the BAI and the BDI (Table 1). To control for the effects of anxiety and depression we performed a covariance analysis, using BDI and BAI scores as covariate and OBQ, III and Padua scales as dependent variables (Table 2). The results showed that,
Discussion and conclusions
Our results seem to confirm the few previous studies which indicate religion as a factor potentially linked to OCD. Individuals with a high or medium degree of religiosity showed higher levels of obsessionality and OC cognitions than individuals with a low degree of religiosity of the same age, education and gender. Furthermore, the pattern of covariation between OC cognitions and symptoms across the three groups confirmed that: (a) OC cognitions were systematically related to an impaired
Acknowledgements
The authors are grateful to Randy Frost for advice on revision of the manuscript. The present study was supported by Ministero dell'Università e della Ricerca Scientifica e Tecnologica (Cofin — 1999) with a contribution of the Fondazione Salvatore Maugeri, IRCSS.
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