El Trauma Psicológico Como Constructo Transdiagnóstico en la Etiología y Mantenimiento del Trastorno Obsesivo Compulsivo Según el Modelo Estructural Funcional de las Tres Fases del TOC
DOI:
https://doi.org/10.5944/rdp.v35i129.38732Palabras clave:
Trauma, Trastorno Obsesivo Compulsivo, TOC, Disociación estructural de la personalidad, Ritual, Esquema defensivo, Apego, EMDRResumen
El Trastorno Obsesivo-Compulsivo (TOC) se enfoca desde una perspectiva novedosa: la traumatización compleja como factor clave en su etiología y desarrollo. El modelo estructural funcional de tres fases del TOC (3FTOC), reconoce el trauma como un constructo transdiagnóstico que permite asimismo integrar modelos previos. Se trata de un modelo ecléctico de tipo biopsicosocial, integrador, que enfatiza la relevancia del trauma en el trastorno obsesivo compulsivo
En la Fase I, se argumenta que la epigenética, las experiencias adversas tempranas y los estilos de apego contribuyen a alteraciones neuroquímicas y neuroanatómicas, aumentando la vulnerabilidad emocional y dando lugar a fobias afectivas y patrones defensivos.
La Fase II introduce la idea de “traumatización al fracaso defensivo” (TFD), una experiencia singular que resulta en el TOC, generando memorias disfuncionales y la disociación estructural del esquema defensivo.
La Fase III aborda la “traumatización obsesiva” (TOB), con la aparición de la primera obsesión y creando una red de memoria acumulativa de exposición al trauma cada vez que aparecen obsesiones que abarca hasta el presente, creando un efecto traumático continuado.
Este modelo 3FTOC propone una comprensión integral del TOC, respaldada por la investigación en neurociencia. Desde una perspectiva clínica, ofrece la posibilidad de un tratamiento más eficaz, facilitando opciones de tratamiento para pacientes que no han respondido a enfoques convencionales. Al abordar el trastorno desde la perspectiva de la traumatización, se presenta como una alternativa prometedora para abordar los desafíos del TOC y las recaídas.
Descargas
Citas
Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical psychology review, 30(2), 217-237. http://dx.doi.org/10.1016/j.cpr.2009.11.004
Al-Solaim, L., & Loewenthal, K. M. (2011). Religion and obsessive-compulsive disorder (OCD) among young Muslim women in Saudi Arabia. Mental Health, Religion & Culture, 14(2), 169-182. http://dx.doi.org/10.1080/13674676.2010.544868
American Psychological Association. APA. (2014). DSM-5: Manual Diagnóstico y Estadístico de los Trastornos Mentales. Madrid: Editorial Médica Panamericana.
Bados, A. (2005). Trastorno obsesivo compulsivo. Publicado por el Departament de personalitat, avaluació i tractament psicològics. Universitat de Barcelona.
Belloch, A. (2012). Propuestas para un enfoque transdiagnóstico de los trastornos mentales y del comportamiento: evidencia, utilidad y limitaciones. Revista de Psicopatología y Psicología Clínica Vol. 17, N.º 3, pp. 295-311, 2012
Berry, L. M., & Laskey, B. (2012). A review of obsessive intrusive thoughts in the general population. Journal of Obsessive-Compulsive and Related Disorders, 1(2), 125-132. http://dx.doi.org/10.1016/j.jocrd.2012.02.002
Bey, K., Lennertz, L., Riesel, A., Klawohn, J., Kaufmann, C., Heinzel, S. … & Wagner, M. (2017). Harm avoidance and childhood adversities in patients with obsessive-compulsive disorder and their unaffected first-degree relatives. Acta Psychiatr Scand, 135(4), 328-338. http://dx.doi.org/10.1111/acps.12707
Bobes, J., González, M. P., Bascaran, M. T., Arango, C., Saiz, P. A., & Bousono, M. (2001). Quality of life and disability in patients with obsessive-compulsive disorder. European Psychiatry, 16(4), 239-245. http://dx.doi.org/10.1016/S0924-9338(01)00571-5
Briggs, ES. & Price, IR. (2009). The relationship between adverse childhood experience and obsessive-compulsive symptoms and beliefs: the role of anxiety, depression, and experiential avoidance. Journal of Anxiety Disord, 23(8), 1037–1046. http://dx.doi.org/10.1016/j.janxdis.2009.07.004
Brussoni, M. J., Jang, K. L., Livesley, W. J., & Macbeth, T. M. (2000). Genetic and environmental influences on adult attachment styles. Personal Relationships, 7(3), 283-289. http://dx.doi.org/10.1111/j.1475-6811.2000.tb00017.x
Carpenter, L. & Chung, MC. (2011). Childhood trauma in obsessive compulsive disorder: the roles of alexithymia and attachment. Psychol Psychother, 84(4), 367–88. http://dx.doi.org/10.1111/j.2044-8341.2010.02003.x
Chen, S. X., & Mak, W. W. (2008). Seeking professional help: Etiology beliefs about mental illness across cultures. Journal of Counseling Psychology, 55(4), 442. http://dx.doi.org/10.1037/a0012898
Cirulli, F., Laviola, G., & Ricceri, L. (2009). Risk factors for mental health: translational models from behavioural neuroscience. Neuroscience and biobehavioral reviews, 33(4), 493-497. http://dx.doi.org/10.1016/j.neubiorev.2009.01.006
Coluccia, A., Fagiolini, A., Ferretti, F., Pozza, A., Costoloni, G., Bolognesi, S., & Goracci, A. (2016). Adult obsessive–compulsive disorder and quality of life outcomes: a systematic review and meta-analysis. Asian Journal of Psychiatry, 22, 41-52. doi: 10.1016/j.ajp.2016.02.001
Crawford, T. N., Livesley, W. J., Jang, K. L., Shaver, P. R., Cohen, P. & Ganiban, J. (2007). Insecure attachment and personality disorder: A twin study of adults. European Journal of Personality, 21. https://doi.org/10.1002/per.602.
Cromer, KR; Schmidt, NB. & Murphy, DL. (2007). An investigation of traumatic life events and obsessive-compulsive disorder. Behavioral Research and Therapy, 45(7), 1683–1691. http://dx.doi.org/10.1016/j.brat.2006.08.018
Cusimano, A. (2018). EMDR in the treatment of adolescent obsessive-compulsive disorder: A case study. Journal of EMDR Practice and Research, 12(4), 242-254. http://dx.doi.org/10.1891/1933-3196.12.4.242
De Silva, P. y Marks, M. (1999). The role of traumatic experiences in the genesis of obsessive-compulsive disorder. Behavior Research and Therapy, 37, 941–951. http://dx.doi.org/10.1016/S0005-7967(98)00185-5
Dowling, A. L. S., Martz, G. U., Leonard, J. L. y Zoeller, R.T. (2000). Acute Changes in Maternal Thyroid Hormone Induce Rapid and Transient Changes in Gene Expression in Fetal Rat Brain. Journal of Neuroscience, 20(6), 2255-2265. http://dx.doi.org/10.1523/JNEUROSCI.20-06-02255.2000
American Psychiatric Association. (2014). DSM-5: Manual diagnóstico y estadístico de los trastornos mentales.
Ellman, L. M., Schetter, C. D., Hobel, C. J., Chicz‐DeMet, A., Glynn, L. M., & Sandman, C. A. (2008). Timing of fetal exposure to stress hormones: effects on newborn physical and neuromuscular maturation. Developmental Psychobiology: The Journal of the International Society for Developmental Psychobiology, 50(3), 232-241. http://dx.doi.org/10.1002/dev.20293
Finnegan, R. A., Hodges, E. V., & Perry, D. G. (1996). Preoccupied and avoidant coping during middle childhood. Child Development, 67(4), 1318-1328. http://dx.doi.org/10.2307/1131702
Fitz, A. (1990). Religious and familial factors in the etiology of obsessive-compulsive disorder: A review. Journal of Psychology and Theology, 18(2), 141-147. http://dx.doi.org/10.1177/009164719001800204
Foa, E. B., & Kozak, M. J. (2004). Mastery of obsessive-compulsive disorder: A cognitive-behavioral approach therapist guide. Oxford University Press.
Gershuny, B. S., Baer, L., Parker, H., Gentes, E. L., Infield, A. L., & Jenike, M. A. (2008). Trauma and posttraumatic stress disorder in treatment‐resistant obsessive‐compulsive disorder. Depression and anxiety, 25(1), 69-71. http://dx.doi.org/10.1002/da.20284
Goldsmith, H. H., & Harman, C. (1994). Temperament and attachment: Individuals and relationships. Current Directions in Psychological Science, 3(2), 53-57. http://dx.doi.org/10.1111/1467-8721.ep10769948
Goleman, D. (2011). The brain and emotional intelligence: New insights. Regional Business, 94-95.
González, A. y Mosquera, D. (2012). EMDR y disociación: el abordaje progresivo. Madrid: Ediciones Pléyades.
Gothelf, D., Aharonovsky, O., Horesh, N., Carty, T. y Apter, A. (2004). Life events and personality factors in children and adolescents with obsessive-compulsive disorder and other anxiety disorders. Comprehensive Psychiatry, 45(3), 192–198. http://dx.doi.org/10.1016/j.comppsych.2004.02.010
Harper, S. (2011). An examination of structural dissociation of the personality and the implications for cognitive behavioural therapy. The Cognitive Behaviour Therapist, 4(2), 53-67. http://dx.doi.org/10.1017/S1754470X11000031
Hogg, B., Gardoki-Souto, I., Valiente-Gómez, A., Rosa, A. R., Fortea, L., Radua, J., ... & Moreno-Alcázar, A. (2022). Psychological trauma as a transdiagnostic risk factor for mental disorder: an umbrella meta-analysis. European Archives of Psychiatry and Clinical Neuroscience, 1-14. http://dx.doi.org/10.1007/s00406-022-01495-5
Hollander, E., De Caria, C., & Liebowitz, M. R. (1989). Biological aspects of obsessive compulsive disorder. Psychiatric Annals, 19(2), 80-87. http://dx.doi.org/10.3928/0048-5713-19890201-08
Holtkamp, K., Müller, B., Heussen, N., Remschmidt, H., & Herpertz-Dahlmann, B. (2005). Depression, anxiety, and obsessionality in long-term recovered patients with adolescent-onset anorexia nervosa. European child & adolescent psychiatry, 14(2), 106-110. http://dx.doi.org/10.1007/s00787-005-0431-5
Huppert, F. A., Baylis, N., & Keverne, B. (Eds.). (2005). The science of well-being. Oxford University Press, USA. http://dx.doi.org/10.1093/acprof:oso/9780198567523.001.0001
Huppert, J. D., Siev, J., & Kushner, E. S. (2007). When religion and obsessive–compulsive disorder collide: Treating scrupulosity in ultra‐orthodox Jews. Journal of Clinical Psychology, 63(10), 925-941. http://dx.doi.org/10.1002/jclp.20404
Jansen, M., Overgaauw, S., & De Bruijn, E. R. (2020). Social cognition and obsessive-compulsive disorder: a review of subdomains of social functioning. Frontiers in psychiatry, 118. http://dx.doi.org/10.3389/fpsyt.2020.00118
Julien, D., O’Connor, K., & Aardema, F. (2016). The inference-based approach to obsessive-compulsive disorder: A comprehensive review of its etiological model, treatment efficacy, and model of change. Journal of Affective Disorders, 202, 187-196. http://dx.doi.org/10.1016/j.jad.2016.05.060
Jarero, I., Amaya, C., Givaudan, M. y Miranda, A. (2013). EMDR individual protocol for paraprofessional use: A randomized controlleg trial with first respoders. Journal of EMDR Practice and Research, 7(2), 55-64. http://dx.doi.org/10.1891/1933-3196.7.2.55
Keenan, P., Keenan, L., Ingham, C., & Farrell, D. (2014). Treating obsessive compulsive disorder (OCD) using eye movement desensitisation and reprocessing (EMDR): A case series design. Ponencia presentada en la 15 EMDR Europe Association Conference.
Lafleur, DL., Petty, C., Mancuso, E., McCarthyet, E., Biederman, J., Faro, A., Levy, H.C. y Geller, D.A. (2011). Traumatic events and obsessive compulsive disorder in children and adolescents: is there a link? Journal of Anxiety Disorders, 25 (4), 513–519. http://dx.doi.org/10.1016/j.janxdis.2010.12.005
Leeds, A. M. (2011). Guía de protocolos estándar de EMDR para terapeutas, supervisores y consultores. Biblioteca de psicología. Bilbao: Desclée de Brouwer.
Liotti, M., & Mayberg, H. S. (2001). The role of functional neuroimaging in the neuropsychology of depression. Journal of Clinical and Experimental Neuropsychology, 23(1), 121-136. http://dx.doi.org/10.1076/jcen.23.1.121.1223
Lochner, C., du Toit, P. L., Zungu‐Dirwayi, N., Marais, A., van Kradenburg, J., Seedat, S., ... & Stein, D. J. (2002). Childhood trauma in obsessive‐compulsive disorder, trichotillomania, and controls. Depression and anxiety, 15(2), 66-68. http://dx.doi.org/10.1002/da.10028
Lochner, C., Seedat, S., Allgulander, C., Kidd, M., Stein, D. y Gerdner, A. (2010). Childhood trauma in adults with social anxiety disorder and panic disorder: a cross-national study. African Journal of Psychiatry, 13, 376–381. http://dx.doi.org/10.4314/ajpsy.v13i5.63103
Mancini, F., & Gangemi, A. (2004). Fear of guilt from behaving irresponsibly in obsessive–compulsive disorder. Journal of Behavior Therapy and Experimental Psychiatry, 35(2), 109-120. http://dx.doi.org/10.1016/j.jbtep.2004.04.003
Marr, J. (2012). EMDR treatment of obsessive-compulsive disorder: Preliminary research. Journal of EMDR Practice and Research, 6(1), 2-15. doi: 10.1891 / 1933.
Marsden, Z., Lovell, K., Blore, D., Ali, S., & Delgadillo, J. (2018). A randomized controlled trial comparing EMDR and CBT for obsessive–compulsive disorder. Clinical psychology & psychotherapy, 25(1), e10-e18.
Mathews, C. A., Kaur, N., & Stein, M. B. (2008). Childhood trauma and obsessive‐compulsive symptoms. Depression and anxiety, 25(9), 742-751. http://dx.doi.org/10.1002/da.20316
Mazzoni, G. P., Pozza, A., La Mela, C., & Fernandez, I. (2017). CBT combined with emdr for resistant refractory obsessive-compulsive disorder report of three cases. Clinical Neuropsychiatry, (5).
McKeon, J., Roa, B. y Mann, A. (1984). Life events and personality traits in obsessive-compulsive neurosis. British Journal of Psychiatry, 144, 185–189. http://dx.doi.org/10.1192/bjp.144.2.185
Moritz, S., Fink, J., Miegel, F., Nitsche, K., Kraft, V., Tonn, P., & Jelinek, L. (2018). Obsessive–compulsive disorder is characterized by a lack of adaptive coping rather than an excess of maladaptive coping. Cognitive therapy and research, 42(5), 650-660. http://dx.doi.org/10.1007/s10608-018-9902-0
Mosquera, D., González, A., & Leeds, A. M. (2014). Early experience, structural dissociation, and emotional dysregulation in borderline personality disorder: the role of insecure and disorganized attachment. Borderline personality disorder and emotion dysregulation, 1(1), 1-8. http://dx.doi.org/10.1186/2051-6673-1-15
Mowrer, D. (1971). Transfer of training in articulation therapy. Journal of Speech and Hearing Disorders, 36(4), 427-446. http://dx.doi.org/10.1044/jshd.3604.427
Nacasch, N., Fostick, L., y Zohar, J. (2011). High prevalence of obsessive–compulsive disorder among posttraumatic stress disorder patients. European Neuropsychopharmacology, 21(12), 876-879. http://dx.doi.org/10.1016/j.euroneuro.2011.03.007
Nazari, H., Momeni, N., Jariani, M., & Tarrahi, M. J. (2011). Comparison of eye movement desensitization and reprocessing with citalopram in treatment of obsessive–compulsive disorder. International journal of psychiatry in clinical practice, 15(4), 270-274. http://dx.doi.org/10.3109/13651501.2011.590210
Nijenhuis, E., van der Hart, O., & Steele, K. (2010). Trauma-related structural dissociation of the personality. Activitas Nervosa Superior, 52(1), 1-23. http://dx.doi.org/10.1007/BF03379560
O’Connor, K., & Audet, J. S. (2019). OCD is not a phobia: an alternative conceptualization of OCD. Clinical Neuropsychiatry, 16(1), 39.
Organización Mundial de la Salud (2020). The Mental Health Atlas. World Health Organization.
Pallanti, S., et al. (2011). Obsessive-compulsive disorder comorbidity: clinical assessment and therapeutic implications. Frontiers in Psychiatry, vol. 2.
Pardo, M., Sandín, B., Valiente, R. M., & Chorot, P. (2022). Factores de riesgo y de protección asociados al trastorno obsesivo-compulsivo en niños y adolescentes: Una revisión sistemática. Revista de Psicopatología y Psicología Clínica, 27(3), 217-232.
Pauls, D. L., Abramovitch, A., Rauch, S. L., & Geller, D. A. (2014). Obsessive–compulsive disorder: an integrative genetic and neurobiological perspective. Nature Reviews Neuroscience, 15(6), 410-424. http://dx.doi.org/10.1038/nrn3746
Pérez-Acosta, A. M. (2005). Fundamentos de las terapias de exposición contra las fobias: Una propuesta teórica integradora de la conducta de evitación. Terapia psicológica, 23(1), 25-35.
Perry, N. B., Calkins, S. D., Nelson, J. A., Leerkes, E. M., & Marcovitch, S. (2012). Mothers' responses to children's negative emotions and child emotion regulation: The moderating role of vagal suppression. Developmental psychobiology, 54(5), 503-513. http://dx.doi.org/10.1002/dev.20608
Perry, N. B., Calkins, S. D., Nelson, J. A., Leerkes, E. M., & Marcovitch, S. (2014). Mothers' responses to children's negative emotions and child emotion regulation: the moderating role of vagal suppression. Developmental Psychobiology, 6(56), 1438-1438. http://dx.doi.org/10.1002/dev.21120
Pinillos, I. (2010). Un modelo estructural funcional de los trastornos obsesivo-compulsivos. Clínica Comtemporánea,1(3), 183-202. https://doi.org/10.5093/cc2010v1n3a3.
Pinillos, I. (2023). El trastorno obsesivo compulsivo. Modelo etiológico. Tratamiento con EMDR. Publicación Independiente. https://www.amazon.com.mx.
Pozza, A., Mazzoni, G. P., Neri, M. T., Bisciglia, R., La Mela, C., Fernandez, I., & Dèttore, D. (2014). “Tackling trauma to overcome OCD resistance” (the TTOOR Florence trial) efficacy of EMDR plus CBT versus CBT alone for inpatients with resistant obsessive compulsive disorder. Protocol for a randomized comparative outcome trial. American Journal of Applied Psychology, 2(5), 114-122.
Rachman, S. (1980). Emotional processing. Behaviour research and therapy, 18(1), 51-60.
Rachman, S. (1993). Obsessions, responsibility and guilt. Behaviour Research an Therapy, 31(2), 149-154. http://dx.doi.org/10.1016/0005-7967(93)90066-4
Radomsky, A. S., & Taylor, S. (2005). Subtyping OCD: Prospects and problems. Behavior Therapy, 36(4), 371-379. http://dx.doi.org/10.1016/S0005-7894(05)80119-4
Salkovskis, P. M. (1989). Cognitive-behavioural factors and the persistence of intrusive thoughts in obsessional problems. Behaviour research and therapy, 27(6), 677-682.
Sandín, B., Chorot, P., & Valiente, R. M. (2012). Transdiagnóstico: nueva frontera en psicología clínica. Revista de Psicopatología y Psicología Clínica, 17(3), 185-203.
Sandman, C. A., Glynn, L., Wadhwa, P. D., Chicz-DeMet, A., Porto, M., & Garite, T. (2003). Maternal hypothalamic-pituitary-adrenal disregulation during the third trimester influences human fetal responses. Developmental neuroscience, 25(1), 41-49. http://dx.doi.org/10.1159/000071467
Sasson, Y., Dekel, S., Nacasch, N., Chopra, M., Zinger, Y., Amital, D., & Zohar, J. (2005). Posttraumatic obsessive–compulsive disorder: A case series. Psychiatry Research, 135(2), 145-152. http://dx.doi.org/10.1016/j.psychres.2004.05.026
Schutz, W. (1966): The interpersonal underworld: A reprint of FIRO: A three dimensional theory of interpersonal behaviour. Palo Alto: Science and Behavior Books.
Shaker, A., & Homeyli, N. (2011). Comparing parental bonding and attachment styles in patients with obsessive-compulsive disorder, generalized anxiety and depression. Journal of Jahrom University of Medical Sciences, 9(3).
Shapiro, F. (2006). New notes on adaptative information processing perspective. En F. Shapiro, F., Kaslow, F; y Maxfield, L. (Eds.), Handbook of EMDR and familly therapy processes (pp.3-36). New York: Willey.
Shapiro, F., & Laliotis, D. (2011). EMDR and the adaptive information processing model: Integrative treatment and case conceptualization. Clinical Social Work Journal, 39(2), 191-200. http://dx.doi.org/10.1007/s10615-010-0300-7
Siegel, D. J. (2007). La mente en desarrollo. Cómo interactúan las relaciones y el cerebro para modelar nuestro ser. Bilbao: Desclée de Brouwer.
Siegel, D. J., & Payne, T. F. (2012). El cerebro del niño. Barcelona: Alba Editorial.
Silberg, J. L., & Bulik, C. M. (2005). The developmental association between eating disorders symptoms and symptoms of depression and anxiety in juvenile twin girls. Journal of Child Psychology and Psychiatry, 46(12), 1317-1326. http://dx.doi.org/10.1111/j.1469-7610.2005.01427.x
Tallis, F. (1994). Obsessions, responsibility and guilt: two case reports suggesting a common and specific aetiology. Behaviour Research and therapy, 32(1), 143-145. http://dx.doi.org/10.1016/0005-7967(94)90096-5
.
Taylor, S. (2012). Endophenotypes of obsessive–compulsive disorder: Current status and future directions. Journal of Obsessive-Compulsive and Related Disorders, 1(4), 258-262. http://dx.doi.org/10.1016/j.jocrd.2012.06.004
Van Den Heuvel, O. A., Remijnse, P. L., Mataix-Cols, D., Vrenken, H., Groenewegen, H. J., Uylings, H. B., ... & Veltman, D. J. (2009). The major symptom dimensions of obsessive-compulsive disorder are mediated by partially distinct neural systems. Brain, 132(4), 853-868. http://dx.doi.org/10.1093/brain/awn267
Van den Leeuwen, W. A., Van Wingen, G. A., Luyten, P., Denys, D., & Van Marle, H. J. F. (2020). Attachment in OCD: A meta-analysis. Journal of Anxiety Disorders, 70, 102187. http://dx.doi.org/10.1016/j.janxdis.2020.102187
Wadhwa, P. D. (2000). The influence of corticotropin-releasing hormone on human fetal development and parturition. Journal of Prenatal & Perinatal Psychology & Health, 14(3/4), 243.
Wegner, D. M., Schneider, D. J., Carter, S. R., & White, T. L. (1987). Paradoxical effects of thought suppression. Journal of personality and social psychology, 53(1), 5. http://dx.doi.org/10.1037/0022-3514.53.1.5
Wegner, D.M., y Zanatos, S. (1994). Chronic thoughtsupression. Journal of Personality, 62, 615-640.
Williams, M.T., Hennessy, M.B. y Davis, H.N. (1995). CRF administered to pregnant rats alters offspring behavior and morphology. Pharmacology Biochemistry and Behavior, 52(1), 161-167. http://dx.doi.org/10.1016/0091-3057(95)00082-8
Publicado
Cómo citar
Número
Sección
Licencia
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial 4.0.
