Research coordinated by IDOR sheds light on a less widespread symptom, which can be confused with psychosis

Unreal concerns about one’s own identity are a warning sign for various psychiatric conditions, such as dissociative identity disorder – formerly known as multiple personality disorder – and schizophrenia. What is less known even in clinics and medical offices is that this characteristic can also be a symptom of Obsessive-Compulsive Disorder (OCD). A recent study sought to characterize this symptom in an article published in the Australian & New Zealand Journal of Psychiatry. The research was coordinated by the D’Or Institute for Research and Education (IDOR) and the Federal University of Rio de Janeiro (UFRJ), with the participation of the Federal University of São Paulo (Unifesp), University of São Paulo (USP), Federal University of Health Sciences of Porto Alegre (UFCSPA), and Monash University, Australia.

Transformation OCD involves an obsession related to changes, transformations, or alterations of physical and mental identity. These obsessions can lead, for example, to a constant fear of turning into an undesirable person through touch or breathing, as well as aesthetic compulsions such as frequent plastic surgeries, excessive exercise, or extreme diets. An important difference between OCD transformation obsessions and delusional beliefs of people with schizophrenia lies in the self-criticism that individuals with OCD exhibit. Unlike individuals with schizophrenia, those with OCD actively struggle against their symptoms.

Distinguishing transformation obsession in OCD

As research in this area is still in its early stages due to low awareness of the problem and consequent diagnostic errors, one of the main goals of scientists was to characterize this population to better distinguish and understand the origin of their obsessions.

They used data obtained by the Brazilian Consortium for Research on Obsessive-Compulsive Spectrum Disorders, which from 2003 to 2009 brought together seven Brazilian university centers to meticulously collect and catalog information from over 1,000 OCD patients. In the article, after excluding clinical cases where there was also a clear indication of psychosis and schizophrenia in the assessments, 44 patients with transformation obsessions were identified. Another 876 OCD patients without this symptom were used as a comparative group for the research.

The scientists sought to identify demographic and clinical relations in transformation obsession, considering the gender of patients, suicidal behaviors, different OCD symptoms, and issues related to personal image, such as spending more than 3 hours a day thinking about their appearances and a history of body dysphoria, anorexia, or bulimia.

Characterizing patients with transformation obsession

Analyses indicated that it was common for patients with transformation obsession to also have OCD related to aggression, religious or sexual thoughts, symmetry, and hoarding, but these symptoms were not more severe compared to the control group. In the evaluation of suicidal thoughts, people with transformation obsessions scored an average of 4 points on a scale of 6, which is considered high.

The study’s sample found a higher incidence of transformation fear in the female population, but not enough to identify gender as a predictive or aggravating factor for the development of the problem. The research also found no relationship between transformation obsession and disorders such as body dysphoria, anorexia, and bulimia, despite the majority of individuals stating that they spent more than 3 hours daily concerned about their appearance.

A noteworthy finding was that people with transformation obsession were significantly younger than the average of the control group. Those with the fear of transformation had also been diagnosed with OCD earlier than other patients but took about a year longer to seek treatment compared to the group without the symptom. The factor related to the age of patients was particularly alarming for the authors, given the emotional vulnerability of the younger population to emotional disorders. An additional aspect that deserves further investigation in this young population is how transformation obsessions will evolve over time.

A little-known but significant problem

Imagine a problem that can commonly afflict a 16-year-old girl. Difficulties in school, conflicts with parents, insecurity about appearance, or constant fear of turning into Adolf Hitler and developing a mustache and male genitalia? All options could underscore disorders such as depression or anxiety, but a disparate concern (and a real clinical situation) like the latter tends to be more alarming for the guardians of these young individuals. The authors believe that this contributes to the early seeking of professional opinions.

However, the delay in initiating treatment for these patients may indicate that healthcare professionals struggle to diagnose transformation obsession cases correctly, a concern that could be even more serious considering that, despite being little known, the problem affected a significant portion of almost 5% of the sample patients.

The lack of awareness about transformation obsessions in OCD reinforces the importance of studies like this, which is the first in the world to centralize demographic information and clinical correlations regarding the problem. Knowing that it is a symptom that primarily affects adolescents and young adults who may also be prone to suicidal thoughts makes the situation even more alarming, not only for healthcare professionals but also for parents and family members. Specialized emotional support and proper diagnosis for this population are crucial supports that can change, and even save, the lives of many young individuals with this or other mental health difficulties.

Psychological support can save young lives

Conducted last year, a Unicef survey with 7,700 Brazilian adolescents and young people revealed that half of this population felt the need to seek help for their mental health at some point, but many do not seek help or are unaware of services dedicated to this support. This group also has suicide as one of the main causes of death, and it is common that in extreme cases like this, the victims were also struggling with mental disorders.

The role of a psychologist in the life of a young person can make all the difference in dealing with mental health problems, offering the possibility of improvement for difficulties that the patient often does not understand and does not share with family and friends. The space for specialized listening and self-awareness development is often a turning point in the quality of life for many people.

In the Psychology Undergraduate program at IDOR, excellent education combined with scientific development are key elements for training psychologists who are skilled and updated regarding various clinical conditions that may arise in their counseling sessions. On our website, you can find more information about the course and sign up to receive updates about new classes.

Written by Maria Eduarda Ledo de Abreu.