中学生强迫症状及其心理、环境危险因素和整合模型研究

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	中学生强迫症状及其心理、环境危险因素和整合模型研究
	李占江
导师	王极盛
	1998
摘要	强迫症状是影响中学生心理健康的主要问题之一。在国内外，对其进行的系统研究较少见。本文在复习了有关文献的基础上，针对目前这一领域研究中存在的问题，采用量表式问卷调查结合临床诊断会谈的方法，对中学生强迫症状的评定工具、内容和结构、发展特点、心理和环境危险因素及其整合规模进行了研究。整个研究共分三个阶段：第一阶段使用Leyton强迫问卷儿童版（LOI－CV）对北京市四所中学初一到高三的3185名学生（平均年龄14.68 ± 1.75岁）进行了调查。主要用于LOI－CV的修订、强迫症状内容和结构、发展特点以及强迫症状学生筛查的研究。然后采用强迫、焦虑、抑郁、人格、应对、归因、负性生活事件、家庭环境、父母养育方式、学校生活适应的自评问卷和自编一般情况调查表对在上次调查筛出有强迫症状的和无强迫症状的学生进行了调查。按学校、年级和性别配对，共216对。主要用于强迫症状的心理、环境危险因素及其整合模型的研究。最后，用强迫症状问卷和负性生活事件量表对264名有强迫症状的学生再次进行了调查。主要用于强迫症状心理、环境危险因素整合模型的研究。本研究的主要发现有：（1）LOI－VI在我国城市中学生中应用具有良好的信度指标。在内容结构上，可将其分为一般强迫思维、整齐和清洁、检查和重复、幸运数字四个因子。对其进行的效标关联效度的检验结果也是较为理想的。以是／否分≥15或总干扰分≥20作为强迫症状的划界点是可以接受的。（2）中学生强迫症状的总检出率为13.6％。强迫症状的常见表为：怕脏和污染、按精确方式做事、为书桌被弄乱而生气、过分谨慎、担心清洁和一些想法或词句在脑内盘旋等；不常见的表现为：脑内数数或数次数、用额外多余的时间检查作业、讲些特别的数字或词句、以特殊的方式讲话或行走、为手的干净而烦恼。从内容结构看，一般强迫思维、整齐和清洁、检查和重复最为常见，而幸运数字相对少见。（3）中学生强迫症状在严重程度上无性别差异，而强迫症状总检出率男生高于女生。（4）中学生强迫症状检出率表现出新入学和即将毕业年级学生较高的特点。强迫症状在严重程度上除整齐清洁因子的严重程度和个别表现的出现频率呈现出年级发展的特点外，随着年级的增高，强迫症状并无明显变化。（5）中学生强迫症状产生的主要心理、环境危险因素包括人格因素中的低灵活性、低自我实现水平和责任心差、负性情绪中的焦虑、应对方式中的好幻想和少求助、母亲养育方式中的过度保护和干涉、同伴关系不良、负性生活事件总刺激量和母亲职业地位低下。（6）中学生强迫症状心理、环境危险因素整合模型提示强迫症状产生和维持的可能心理机制为：人格因素主要通过中介因素的中介作用导致负性情绪的发生。个体体检到的负性生活事件水平要受到环境因素的影响；负性生活事件直接作用使个体出现负性情绪。最后，负性情绪导致强迫症状的产生。其中，人格因素与环境因素是处于动态的、相互作用的关系。人格因素和环境因素分别通过对方影响着强迫症状的个性心理素质基础和个体体验到的心理应激水平。强迫症状的维持主要受个体以往的强迫症状水平和其所体验到的负性生活事件的影响程度所决定。由上述发现可见，本研究不仅加深了对中学生强迫症状的认识，较全面地了解到强迫症状产生的心理、环境危险因素，而且首次通过实证研究将素质－应激理论应用到强迫症状发生的心理机制解释中，并对其进行了细化和扩展。所以，本研究的结果具有一定的理论价值，同时对在中学生中进行强迫症状高危人群的预测、强迫症状的干预和治疗及其预防和健康教育也具有重要的实践意义。
其他摘要	Obsessive-Compulsive Symptoms, which are one of common factors effected on mental health of secondary school students, have been rarely studied at home and abroad. In accordance with the problems existed in these literature up till now, the thesis had mainly studied the measured tool, contents and structure, developmental features, psychosocial risk factors and integrated model of obsessive-compulsive symptoms from them by means of investigation with quetionnaires. The entire research was divided into three phases. 3185 students(age 14.68±1.75 years) were firstly measured with the 20-item Leyton Obsessional Inventory-Child Version(LOI-CV) at four secondary schools including six grades in Beijing city, which was applied to revise LOI-CV, and to study the structure and contents, developmental features and screen of obsessive-compulsive symptoms. Then, 216 subjects with obsessive-compulsive symptoms, paired with controls in the light of school, grade and gender, were investigated with 10 self-rating scales on obsessive-compulsive symptoms, anxiety, depression, personality, coping and attributional style, negative life events, parent's rearing style, family environment and life adaptation in school, and with an inventory on social demography. The results were used to explore psychosocial risk factors and integrated model of obsessive-compulsive symptoms. The third survey was only carried out, about two months after the second, among 264 subjects with obsessive-compulsive symptoms through MMOCI and Negative Life Event Scale for Adolescents, in order to probe into the integrated model. The research had mainly found: (1) LOI-CV can be used as a screen tool for obsessive-compulsive symptoms in urban adolescents in China; (2) Total screening-out ratio of obsessive-compulsive symptoms was 13.6% (male:15.0%, female:12.2%). The most common manifestations of obsessive-compulsive symptoms were hating dirt and contamination, doing things in exact manner, angry if someone messes desk, bad conscience but no one else, worry about cleanliness, repeated thoughts or words; the least were favorite or special number, spending extra time on homework, special number or words to avoid, talking or moving to avoid bad luck, fussy about hands. The checking and repetition, cleanliness and tidiness, general obsessions were more common forms than numbers-luck; (3) No differences were existed in serious degree of obsessive-compulsive symptoms, but the screening-out ratio in male was higher than it in female; (4) No differences were detected in the serious degree of obsessive-compulsive symptoms except the scores of cleanliness and tidiness among grades, but the screening-out ratio of the grades justly entering secondary school or going to graduate were higher than other ones; (5) The main psychosocial risk factors for obsessive-compulsive symptoms included anxiety, mother's over-protecting and over-interfering, fantasy, flexibility, self-actualization, peers relationship, sense of responsibility, negative life events, mother's occupation, help-seeking, and (6) The integrated model on psychosocial risk factors suggested that the possible developed and sustained mechanism of obsessive-compulsive symptoms was that personality, coping and attributional styles constructed the developmental diathesis foundation of obsessive-compulsive symptoms; negative life events were promoting factors of them. There was a dynamic interaction between personality and environmental factors. Negative emotion played a core role in the developmental process of them. The continued existence of obsessive-compulsive symptoms was related to pre-existed obsessive-compulsive symptoms and negative life events experienced by an individual. Therefore, this research not only let us get a deeper understanding of obsessive-compulsive symptoms and more entirely find out psychosocial risk factors, firstly applied diathesis-stress theory to comprehend the psychological mechanism of obsessive-compulsive symptoms and, moreover, elaborate and expand it, but also has more important practice significance of treatment, prevent and education for obsessive-compulsive symptoms in secondary school students.
关键词	Leyton强迫问卷（儿童版）信度效度强迫症状发展危险因素整合模型中学生
学位类型	博士
语种	中文
学位专业	发展与教育心理学
学位授予单位	中国科学院心理研究所
学位授予地点	中国科学院心理研究所
文献类型	学位论文
条目标识符	http://ir.psych.ac.cn/handle/311026/4808
专题	中国科学院心理研究所回溯数据库(1956-2010)
推荐引用方式 GB/T 7714	李占江. 中学生强迫症状及其心理、环境危险因素和整合模型研究[D]. 中国科学院心理研究所. 中国科学院心理研究所,1998.

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