Demoralization in patients with obsessive-compulsive disorder: results from an exploratory cross-sectional report

Obsessive-compulsive disorder (OCD) is a chronic, early-onset condition often associated with high rates of treatment resistance, and affective disturbances are frequent comorbidities and linked to poorer therapeutic outcomes. Recently, the concept of "demoralization syndrome" has been proposed as not fully overlapping with major depressive episodes. Given the disabling nature of OCD, it is relevant to specifically evaluate the states of demoralization, considering that this condition may have treatment implications partially different from those related to other forms of affective disturbances. The aim of the present exploratory study was to evaluate demoralization in subjects with OCD and its relationship with the severity of OCD-related symptoms.

Adults with a primary diagnosis of OCD were consecutively recruited from the OCD outpatient clinic of Azienda Ospedaliero-Universitaria Policlinico Umberto I (Rome, Italy). Participants were assessed with clinical interviews as well as with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) for OCD severity, the Demoralization Scale (DS) for demoralization, and the Patient Health Questionnaire (PHQ) and Hamilton Depression Rating Scale (HAM-D) for depressive symptoms. Descriptive and correlational analyses have been performed.

A total of 43 adults with OCD were included. Both depressive and demoralization symptoms were highly prevalent, with clinically-significant demoralization observed in 88% of patients. A subset of individuals exhibited clinically-significant demoralization without clinically-relevant depression. Demoralization severity showed significant associations with the severity of obsessions.

Demoralization was highly prevalent in our sample, and it was significantly associated with the severity of obsessions. Recognizing demoralization states in OCD may improve diagnostic precision and guide tailored therapeutic interventions, complementing standard treatments for the diseases. Further research, including longitudinal studies, is needed to clarify its impact on the course of the disorder.