Obsesif-kompulsif bozukluk (OKB), bireylerin işlevselliğinde gözle görülür bozulmaya sebep olan oldukça yaygın anksiyete bozukluklarından biridir. Bilişsel modellere göre OKB semptomlarının şiddetlenmesinde, istem dışı girici (intrusif) düşüncelerin işlevsel olmayan inançlar sonucunda hatalı olarak yorumlanması ve bu düşüncelere atfedilen önem, önemli bir rol oynamaktadır. İşlevsel olmayan inançların oluşumunda rol oynayan bağlanma örüntüsü ve ebeveyn tutumları gibi gelişimsel faktörlerin incelenmesi ve altta yatan süreçlerin de anlaşılmasıyla birlikte bilişsel modeller temelinde oluşturulan tedavi yöntemlerinin geliştirilebileceği öne sürülmektedir. Bu makalede, bazı temel terminolojik açıklamalarla birlikte, obsesif-kompulsif belirtiler ile kişilerin bağlanma örüntüleri ve benlik algıları arasındaki ilişki ampirik çalışmalardan elde edilen bulgular ve klinik deneyim bazında incelenmiştir. Son kısımda ise, OKB tanısı ile takip edilen bir vaka anlatılarak, bu konunun psikoterapi açısından önemi ve uygulamanın nasıl yapılacağı tartışılmıştır.

Obsessive-compulsive disorder (OCD) is one of the most disabling and highly prevalent anxiety disorders. Cognitive models of OCD propose that negative evaluation of intrusions occur as a consequence of underlying maladaptive beliefs, such as inflated responsibility, overestimation of threat, intolerance for uncertainty, perfectionism, the need to control thoughts, and over-importance of thoughts. Although cognitive models have enhanced the knowledge and treatment of OCD, they have been criticized for focusing largely on maintaining and exacerbating factors of OCD-related beliefs and neglecting the developmental and motivational factors, such as early attachment and parenting behaviors (Doron & Kyrios, 2005; O'Kearney, 2001). It is argued that consideration of underlying vulnerabilities, such as attachment insecurities and early experiences of parenting may lead to a broader understanding of the development and maintenance of OCD-related beliefs and symptoms. Thus, the current paper consists of four main parts reviewing the roles of attachment insecurities, self-views, and parental attitudes in the development of obsessive-compulsive symptomatology. In order to demonstrate the importance of understanding these factors while dealing with a patient having OCD, the case of Ms. D. is illustrated. Ms. D., who is directed into our clinic with the diagnosis of obsessive-compulsive disorder, is a 21 years old, second-year university student. Her obsessions have involved the theme of contamination and that her entire body would be invaded by germs. In response to these obsessions, her compulsions have involved washing hands, using disinfectants, and cleaning the furniture in her house with a rigid routine after coming from the outside. Following the discussion of some basic terminological issues about attachment system and adult functioning, the current paper proceeds to a review of the association between OCD-related symptoms, patient’s attachment insecurity, and perception of self based on both findings of empirical studies and experiences obtained from clinical practice. The evidence indicates that attachment insecurities together with other early influences, such as parental overprotection, can contribute to the development of main schemas in OCD (e.g. inflated sense responsibility, overestimation of threat, perfectionism etc.), which in turn result in obsessive-compulsive symptoms. The evidence also indicates a link between attachment representations, sensitive self-structures perceptions of others and the world, and obsessive-compulsive phenomena. Likewise, it is important to note that the sense of attachment security may play a protective role against OCD-related processes of the activation of feared self-cognitions and dysfunctional beliefs following events that challenge self domains (Doron et. al., 2009). Moreover, in order to reject the negative self and overemphasize the positive self, the child develops specific schemas including perfectionism, need for certainty, or inflated responsibility, which is accepted as the core vulnerability in OCD. Additionally, these schemas are reinforced by the inflexible and controlling attitudes of parents concerning morality and responsibility (Kempke & Luyten, 2007). Clearly, the theoretical link between attachment types, internal representations of self and vulnerability in OCD offers a potentially rich area for intervention. The knowledge of attachment insecurities in relation to development of OCD-related beliefs is particularly helpful to psychotherapists in their practices (Liotti, 2011). Therefore, at times of facing with resistance, this knowledge could assist therapists to explore whether the present adversity grounded in the activation of implicit attachment interactions and distorted sense of self in therapeutic relationship. It is explained in detail by giving examples from the relationship between Ms. D. and her therapist. The focus of the therapy with Ms. D. and the nature of therapeutic relationship is discussed in the psychotherapy part of the article. Finally, it can be concluded that enhancing the conceptualization of cognitive models of OCD with the understanding of developmental factors would provide a useful framework about mental representations that negatively influencing patient’s cognitions and symptomatic behaviors. AYNA Klinik Psikoloji Dergisi 2014, 1(1), 26-40 Filiz Özekin Üncüer Summary A Review of The Contributions of Adulthood Attachment Orientations to Development of Obsessive-Compulsive Disorder: An Illustration of Psychotherapy Integration Obsessive-compulsive disorder (OCD) is one of the most disabling and highly prevalent anxiety disorders. Cognitive models of OCD propose that negative evaluation of intrusions occur as a consequence of underlying maladaptive beliefs, such as inflated responsibility, overestimation of threat, intolerance for uncertainty, perfectionism, the need to control thoughts, and over-importance of thoughts. Although cognitive models have enhanced the knowledge and treatment of OCD, they have been criticized for focusing largely on maintaining and exacerbating factors of OCD-related beliefs and neglecting the developmental and motivational factors, such as early attachment and parenting behaviors (Doron & Kyrios, 2005; O'Kearney, 2001). It is argued that consideration of underlying vulnerabilities, such as attachment insecurities and early experiences of parenting may lead to a broader understanding of the development and maintenance of OCD-related beliefs and symptoms. Thus, the current paper consists of four main parts reviewing the roles of attachment insecurities, self-views, and parental attitudes in the development of obsessive-compulsive symptomatology. In order to demonstrate the importance of understanding these factors while dealing with a patient having OCD, the case of Ms. D. is illustrated. Ms. D., who is directed into our clinic with the diagnosis of obsessive-compulsive disorder, is a 21 years old, second-year university student. Her obsessions have involved the theme of contamination and that her entire body would be invaded by germs. In response to these obsessions, her compulsions have involved washing hands, using disinfectants, and cleaning the furniture in her house with a rigid routine after coming from the outside. Following the discussion of some basic terminological issues about attachment system and adult functioning, the current paper proceeds to a review of the association between OCD-related symptoms, patient’s attachment insecurity, and perception of self based on both findings of empirical studies and experiences obtained from clinical practice. The evidence indicates that attachment insecurities together with other early influences, such as parental overprotection, can contribute to the development of main schemas in OCD (e.g. inflated sense responsibility, overestimation of threat, perfectionism etc.), which in turn result in obsessive-compulsive symptoms. The evidence also indicates a link between attachment representations, sensitive self-structures perceptions of others and the world, and obsessive-compulsive phenomena. Likewise, it is important to note that the sense of attachment security may play a protective role against OCD-related processes of the activation of feared self-cognitions and dysfunctional beliefs following events that challenge self domains (Doron et. al., 2009). Moreover, in order to reject the negative self and overemphasize the positive self, the child develops specific schemas including perfectionism, need for certainty, or inflated responsibility, which is accepted as the core vulnerability in OCD. Additionally, these schemas are reinforced by the inflexible and controlling attitudes of parents concerning morality and responsibility (Kempke & Luyten, 2007). Clearly, the theoretical link between attachment types, internal representations of self and vulnerability in OCD offers a potentially rich area for intervention. The knowledge of attachment insecurities in relation to development of OCD-related beliefs is particularly helpful to psychotherapists in their practices (Liotti, 2011). Therefore, at times of facing with resistance, this knowledge could assist therapists to explore whether the present adversity grounded in the activation of implicit attachment interactions and distorted sense of self in therapeutic relationship. It is explained in detail by giving examples from the relationship 40 between Ms. D. and her therapist. The focus of the therapy with Ms. D. and the nature of therapeutic relationship is discussed in the psychotherapy part of the article. Finally, it can be concluded that enhancing the conceptualization of cognitive models of OCD with the understanding of developmental factors would provide a useful framework about mental representations that negatively influencing patient’s cognitions and symptomatic behaviors.