Demoralization in patients with Obsessive-compulsive disorder: a preliminary report

Background Obsessive–compulsive disorder (OCD) is a chronic, early-onset condition often associated with high rates of treatment resistance. Depression is one of the most frequent comorbidities and is linked to poorer therapeutic outcomes. Recently, the concept of Demoralization Syndrome, has been proposed as distinct from Major Depressive Disorder. Given the disabling nature of OCD, it is relevant to evaluate distinctly Demoralization and Depression states considering that the two conditions may have different treatment implications. Methods The aim of the present preliminary study was to evaluate the presence of 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 Policlinico Umberto I. Eligible participants were assessed with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) for OCD severity, the Demoralization Scale (DS) for demoralization symptoms, and the Patient Health Questionnaire (PHQ) and Hamilton Depression Rating Scale (HAM-D) for clinical relevant depressive symptoms using established cutoffs. Results A total of 43 adults with OCD, consecutively screened and enrolled, were included. Both depressive symptoms and demoralization symtoms were highly prevalent, with clinically significant demoralization observed in 88% of patients. A subset of individuals exhibited demoralization without clinical relevant depression, suggesting a partial distinction between the two constructs. Demoralization severity showed a strong association with overall OCD severity, particularly with obsessions rather than with compulsions, and this relationship remained significant even after controlling for depressive symptoms. Conclusion Demoralization is highly prevalent in our sample and can occur independently of clinically significant depression. Recognizing demoralization as a distinct construct may improve diagnostic precision and guide tailored therapeutic interventions, complementing standard treatments for OCD and depression. Further research, including longitudinal studies, is needed to clarify its impact on the course of the disorder.