Association Between Alexithymia, Sexual Dysfunctions, and Dyadic Adjustment in Obsessive–Compulsive Disorder

Association Between Alexithymia, Sexual Dysfunctions, and Dyadic Adjustment in Obsessive–Compulsive Disorder | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Association Between Alexithymia, Sexual Dysfunctions, and Dyadic Adjustment in Obsessive–Compulsive Disorder Tunahan Sun, Gonca Karakuş, Lut Tamam, Mehmet Emin Demirkol, Zeynep Namlı, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6185799/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Chronic mental disorders can adversely affect sexual functioning and dyadic adjustment. This study aimed to examine the relationship between alexithymia, sexual dysfunctions, and dyadic adjustment by comparing patients with obsessive-compulsive disorder (OCD) to healthy controls. Methods : This research involved 72 patients with OCD and 82 healthy controls who had similar sociodemographic characteristics to the patients. The Toronto Alexithymia Scale (TAS-20), Arizona Sexual Experiences Scale (ASEX), Yale–Brown Obsessive Compulsive Scale (YBOCS), and Dyadic Adjustment Scale (DAS) were applied to the participants. Results : Patients with OCD had significantly higher mean total scores on the TAS-20 and ASEX scales compared to healthy controls (p < 0.001 for both). The median total and subscale scores of the DAS were significantly lower in patients with OCD than in healthy controls (p < 0.001). Additionally, a positive correlation was found between the total scores of the TAS-20 and ASEX in patients with OCD. There was a negative correlation between the total score of the TAS-20 and both the total and subscale scores of the DAS (p < 0.05 for each). Conclusion : The results of the study suggest that patients with OCD exhibit higher levels of alexithymic traits, poorer sexual functioning, and lower dyadic adjustment compared to the healthy population. Additionally, the presence of alexithymia in patients with OCD is linked to reduced dyadic adjustment and sexual functioning. Evaluating alexithymic traits in patients with OCD and implementing appropriate treatment approaches may help these patients improve their social and familial functioning. Alexithymia Sexual Dysfunction Dyadic Adjustment Obsessive–Compulsive Disorder Introduction Obsessive–compulsive disorder (OCD) is a mental condition characterized by recurrent, ritualistic behaviors or mental acts accompanied by undesired and compulsive thoughts, urges and fantasies. OCD can severely affect habitual routines, work, social life, and relationships and lead to loss of functioning [ 1 ]. The lifetime prevalence of OCD is estimated to be between 1.1% and 3.5%. [ 2 ], and it is often linked to other mental health conditions and disabilities [ 3 ]. The disorder can relapse in 59% of patients with OCD, even after cognitive behavioral therapy, pharmacological treatment, or a combination of both [ 4 ]. Alexithymia is defined by the inability to identify and articulate one's emotions. It is characterized by a deficiency in the ability to identify the facial expressions of others, empathy, and regulation of emotions [ 5 ]. In other words, alexithymia not only inhibits an individual’s ability to identify and express one’s own emotions and use them in daily life but also prevents others from recognizing them [ 6 ]. About 10% of the general population is affected by alexithymia, with a higher prevalence in men than in women [ 7 ]. Additionally, severe alexithymia was found in 45.7% of patients with psychiatric diagnoses, suggesting a possible role of alexithymia in the development and/or persistence of psychiatric disorders [ 8 ]. It was suggested that OCD and alexithymia shared a common neurobiological mechanism. It was reported that pathology in alexithymia was associated with regions in the ventromedial prefrontal cortex, including the orbitofrontal cortex and anterior cingulate [ 9 ]. Some previous studies support reports that the ventromedial prefrontal cortex also plays an important role in patients with OCD [ 10 ]. Previous studies reported high levels of alexithymia in patients with OCD [ 11 , 12 ] and that sexual/religious obsessions were positively associated with alexithymia [ 13 ]. However, there are only a few studies available in the relevant literature. One of the indicators of quality of life is sexual well-being [ 14 ]. Sexual dysfunctions (SDs) are defined as deterioration in relation to the sexual response cycle in both sexes [ 15 ]. Previous research has revealed a connection between obsessive–compulsive symptoms and OCD diagnosis with lower sexual functionality, a higher incidence of SDs, and reduced sexual satisfaction [ 16 ]. Despite the potential for a substantial link between specific OCD symptoms and sexual functioning, only a limited number of studies have investigated sexuality in patients with OCD. Even though SDs in patients with OCD have been attributed to the disorder itself or the medications in use, they are multifactorial and need to be investigated from different perspectives [ 17 ]. Alexithymia is considered another factor that may affect sexual functioning. Difficulties in recognizing and describing bodily sensations such as arousal negatively impact the quality of sexual interactions [ 18 ]. The limbic system is in control of sexuality, and the neocortex is associated with cognition and emotions. The neuropsychological model defines alexithymia as a disconnection between the neocortex and the limbic system [ 19 , 20 ]. Previous studies reported a negative correlation between sexual function and alexithymia levels in non-clinical sample [ 21 , 22 ] . Patients with OCD often face challenges in interpersonal communication, which can negatively impact their relationships with partners [ 23 ]. These patients often conceal their symptoms to gain acceptance, rather than to be feared or distrusted by others. This behavior is linked to a decrease in intimacy with their partners, which contributes to a decline in dyadic adjustment [ 24 ]. It has been suggested that OCD is strongly associated with family and marital distress [ 25 ]. A previous study found that patients with OCD reported lower satisfaction and intimacy with their partners [ 26 ]. Alexithymia is an important factor that is effective in dyadic adjustment. Individuals who score high on alexithymia scales appear to lack the essential qualities needed to establish and uphold intimate relationships [ 27 ]. Previous studies reported a negative correlation between alexithymia and dyadic adjustment in non-clinical sample [ 27 , 28 ]. The influence of alexithymia on SDs and dyadic adjustment—factors that can lead to decreased effectiveness in partner relationships and family life— in patients with OCD has not been thoroughly investigated. The goal of this study was to examine alexithymic traits in patients with OCD and their relationship with SDs and dyadic adjustment. We hypothesized that OCD may be associated with higher levels of alexithymia and that the presence of alexithymia in patients with OCD could be linked to SDs and have a negative impact on dyadic adjustment. This study also aimed to compare patients with OCD and healthy controls in terms of alexithymia levels, sexual dysfunction and dyadic adjustment. Methods Participants The present study was performed at the outpatient clinics of the Department of Mental Health and Diseases at Balcali Hospital, Cukurova University Faculty of Medicine. The study included eighty-two patients who were either married or had a regular sexual partner for at least three months, as assessed via the Structured Clinical Interview for DSM-5 Clinician Version (SCID-5-CV). Pursuant to the inclusion criteria, patients who received only selective serotonin reuptake inhibitor (SSRI) treatment (to minimize the possible effect of psychotropic drugs on sexual life); were aged between 18–65 years; were not diagnosed with comorbid mental disorders; were not diagnosed with dementia, delirium, or mental retardation, which is associated with impaired cognitive function; and were literate in completing the scales were included in this study. Based on the information obtained from the patient and their relatives, upon physical examination findings and a review of clinical records, 10 patients with a history of pelvic or abdominal surgery; a diagnosis of chronic medical diseases, including diabetes mellitus, cardiovascular diseases, and hormone replacement therapy; or the use of medications other than SSRIs were excluded because these conditions might adversely affect sexual function. Eighty-two volunteers who had sociodemographic characteristics similar to those of patients who did not have any mental disorders or complaints, who did not receive any medication or medical conditions, who had a regular sexual partner for at least three months or who were married were included as healthy controls. The study was conducted with 72 patients with OCD who had a sexual partner or were married and 82 healthy controls. Power Analysis In the present study, the G Power 3.1 program was used for power analysis. The minimum sample size required for a single group was 51, and the minimum sample size required for two groups was 102. With a medium effect size (Cohen's d = 0.50), a power of 0.80, and a margin of error of 0.05 (p = 0.059), it was decided that the study, which included 154 participants, was adequately powered. Procedure In the first stage of the study, the first author conducted interviews lasting approximately 60 minutes with all participants. During these interviews, we collected sociodemographic data from the participants using a prepared form. The diagnosis of OCD was confirmed using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), while the Structured Clinical Interview for DSM-5 Disorders (SCID-5-CV) was utilized to identify any comorbid psychiatric disorders accompanying OCD. The Yale-Brown Obsessive Compulsive Scale (YBOCS) was employed to assess OCD symptoms and the severity of the disorder. After the interview, participants received information about the scales used. In the next stage, they were asked to complete the Toronto Alexithymia Scale (TAS-20) to evaluate their level of alexithymia, the Arizona Sexual Experiences Scale (ASEX) to assess sexual functioning, and the Dyadic Adjustment Scale (DAS) to evaluate dyadic adjustment. For patients who experienced difficulty in completing the self-report scales, a clinician provided assistance and clarification on any points that were not understood. Ethics committee approval for the study was obtained on September 4, 2020, from the Cukurova University Faculty of Medicine, Non-Interventional Clinical Research Ethics Committee, upon meeting No. 103. After being fully briefed on the study, all participants provided written informed consent. The research followed the guidelines set forth by the Declaration of Helsinki. Measures Sociodemographic and Clinical Data Form The researchers developed this data form based on previous studies to gather specific information. It includes questions about marital status, age, gender, family history of mental disorders, educational background, employment status, smoking habits, alcohol and substance use, the number of hospitalizations, the duration of OCD, and the types of drug treatments received. Structured Clinical Interview for DSM-5-Clinician Version It is a semistructured clinical interview guide aimed at assessing the diagnoses defined by the DSM-5. It was developed by First [ 29 ]. The SCID-5 has been modified for the Turkish language, and a reliability study was conducted. The kappa coefficient in the Turkish version of the SCID-5 was very high and statistically significant, similar to previous SCID versions [ 30 ]. The scale was created as a clinical diagnostic instrument and is completed by clinicians. The SCID-5-CV was used in our study to investigate comorbid psychiatric diagnoses and confirm the diagnosis of patients with OCD. Yale–Brown Obsessive Compulsive Scale It is a clinician-administered scale aimed at assessing the severity and type of obsessions and compulsions. The reliability and validity of the Turkish version of the scale were assessed by Karamustafalıoğlu et al. [ 31 ]. Although it contains a total of 19 items, to determine the total score, only the first 10 items are used. Accordingly, items 1 through 5 indicate the degree of obsession, and items 6 through 10 indicate the degree of compulsion. Toronto Alexithymia Scale TAS-20 is a scale with 20-item and 5-point Likert-type self-reports. Higher scores obtained from the scale are indicative of difficulty in expressing emotions. The study of Turkish reliability and validity was performed by Güleç et al. [ 32 ].. In the present study, the participants who scored ≥ 61 points were classified as alexithymic, while those who scored below 61 were classified as non-alexithymic. Arizona Sexual Experiences Scale This scale was developed by McGahuey et al. to quickly and easily detect sexual complications [ 33 ]. There are two distinct forms, including for men and women. It is a 6-point Likert-type self-report scale consisting of 5 items. Satisfaction with orgasm, sexual desire, the ability to reach orgasm, vaginal lubrication/penile erection, and arousal are assessed. Higher scores indicate higher SDs. The overall score ranges from 5 to 30. A score of ≥ 5 for any item or a total scale score of ≥ 17 indicates that the person has SDs [ 16 , 34 ]. Soykan conducted a study of the Turkish reliability and validity of the ASEX [ 35 ]. In the present study, participants with a score of ≥ 5 on any item or a total scale score of ≥ 17 were considered individuals with SDs and others without SDs. Dyadic Adjustment Scale Spanier developed this scale to evaluate the quality of relationships among married or cohabiting partners [ 36 ]. The DAS is a self-reported scale that contains 32 items and is divided into four subdomains: Affectional Expression, Dyadic Cohesion, Dyadic Satisfaction, and Dyadic Consensus. Higher scores on the DAS indicate better relationship quality and greater dyadic adjustment. Fisıloğlu and Demir conducted a study to assess the reliability and validity of the Turkish version of the DAS [ 37 ]. Statistical Analysis The data were analyzed using version 25 of the Statistical Package for the Social Sciences (IBM SPSS) software. The normality assumption was considered satisfied when the kurtosis and skewness values of the variables fell between − 1.5 and + 1.5. Additionally, histogram plots were examined. To determine whether the normally distributed variables differed in their averages, an independent groups t-test was conducted, and the results were reported as "Mean ± SD" (mean values and standard deviations). For variables that did not meet the normal distribution criteria, the Mann-Whitney U test was utilized to compare the differences between groups based on their medians. Median and quartile notations were utilized in this analysis. Pearson correlation analysis was conducted to evaluate the relationships between numerical variables that followed a normal distribution. To analyze differences in categorical variables during intergroup comparisons, Fisher's exact test was employed when the expected number of observations was less than 5, and the Yates correction was applied when the expected number was between 5 and 25. The chi-square test was used for all other cases. Results There was no significant difference observed between patients with OCD and healthy controls in several variables, including age, sex distribution, average duration of education, length of marriage, marital status, type of marriage, smoking habits, alcohol and substance use, and place of residence (p > 0.05 for each variable). In the study, it was found that 56.9% of patients with OCD (n = 41) were employed, compared to 87.8% of healthy controls (n = 72). This difference in employment status between the two groups was statistically significant (p < 0.001). Additionally, 45.8% of patients with OCD (n = 33) reported having a family history of mental disorders, while only 22% of the healthy controls had a similar family history (n = 18). This difference regarding family history was also statistically significant (p = 0.03). The distributions of sociodemographic variables in the control and OCD groups are given in Table 1 . Table 1 Sociodemographic variables of the participants Control Group OCD Mean ± SD Mean ± SD Age 36.96 ± 8.08 36.67 ± 8.82 t = 0.22 p = 0.83 Mean years in education 13.39 ± 4.04 13.01 ± 4.79 t = 0.53 p = 0.60 Duration of marriage, years 10.83 ± 10.10 12.38 ± 9.93 t = − 0.96 p = 0.34 n (%) n (%) Sex Female 43(52.4) 39(54.2) \(\:{x}^{2}\) =0.05 p = 0.83a Male 39(47.6) 33(45.8) Marital status Single 16(19.5) 9(12.5) \(\:{x}^{2}\) =0.92 p = 0.34b Married 66(80.5) 63(87.5) Type of marriage Companionate marriage 45(68.2) 37(58.7) \(\:{x}^{2}\) =0.87 p = 0.35b Arranged marriage 21(31.8) 26(41.3) Type of family Nucleus family 65(79.3) 61(84.7) \(\:{x}^{2}\) =2.13 p = 0.34b Extended family 7(8.5) 7(9.7) Living alone 10(12.2) 4(5.6) Profession Not employed 10(12.2) 31(43.1) \(\:{x}^{2}\) =17.14 p < 0.001 b Employed 72(87.8) 41(56.9) Place of residence Smaller than the provincial center 8(9.8) 12(16.7) \(\:{x}^{2}\) =1.07 p = 0.30b Provincial center 74(90.2) 60(83.3) Family history of mental disorders No 64(78) 39(54.2) \(\:{x}^{2}\) =8.82 p = 0.003 b Yes 18(22) 33(45.8) Smoking No 50(61) 40(55.6) \(\:{x}^{2}\) =0.46 P = 0.50a Yes 32(39) 32(44.4) Alcohol No 59(72) 54(75) \(\:{x}^{2}\) =0.06 p = 0.81b Yes 23(28) 18(25) Substance No 80(97.6) 71(98.6) p = 1c Yes 2(2.4) 1(1.4) a: Chi-squared analysis b: Yates statistic c: Fisher’s exact test The p values in bold are statistically significant (p < 0.05) Abbreviations: Mean ± SD: Mean Value and Standard Deviations The average score of the patients with OCD was 10.611 (SD = 3.222) for the YBOCS obsession subscale, 10.847 (SD = 2.996) for the YBOCS compulsion subscale, and 21.458 (SD = 6.016) for the YBOCS total. The average total scores on the TAS-20 for patients with OCD and healthy controls were 60.97 ± 11.15 and 43.18 ± 8.86, respectively. A statistically significant difference in the total TAS-20 score between the groups was detected (p < 0.001). Patients with OCD exhibited higher scores on both subscales and total scores of the ASEX compared to healthy controls. There were statistically significant differences in the mean scores for lubrication/erection, arousal, desire, orgasm, and satisfaction, as well as the total ASEX score (p < 0.001 for lubrication/erection, p < 0.001 for arousal, p < 0.001 for desire, p = 0.01 for orgasm, p < 0.001 for satisfaction, and p < 0.001 for the total score). In the healthy control group, both the subscale and total median scores of the DAS were higher than those of the OCD group. A statistically significant difference between the two groups was observed in the total and subscale median scores (p < 0.001 for all). The scores for both groups are presented in Table 2 . Table 2 A comparison of participants' scale scores Healthy Controls OCD Mean ± SD Mean ± SD p TAS-20 43.18 ± 8.86 60.97 ± 11.15 t = − 11.02 p < 0.001 Sexual desire 2.73 ± 1.10 3.92 ± 1.31 t = − 6.10 p < 0.001 Arousal 2.77 ± 1.06 3.88 ± 1.40 t = − 5.57 p < 0.001 Lubrication/Erection 2.67 ± 0.93 3.64 ± 1.27 t = − 5.33 p < 0.001 Orgasm 3.30 ± 0.88 3.74 ± 1.21 t = − 2.50 p = 0.01 Satisfaction from orgasm 2.28 ± 0.91 3.17 ± 1.15 t = − 5.34 p < 0.001 ASEX Total 13.76 ± 3.55 18.33 ± 4.93 t = − 6.67 p < 0.001 M(1Q-3Q) M(1Q-3Q) Dyadic Consensus 52(47.75-59) 41(33.25–49.75) U = 1333 Z = − 5.87 p < 0.001 Dyadic Satisfaction 39(33.5–44) 30(26–37) U = 1431.5 Z = − 5.51 p < 0.001 Affectional Expression 10(8–11) 7(4–9) U = 1169.5 Z = − 6.50 p < 0.001 Dyadic Cohesion 16.80 ± 4.24 12.22 ± 4.95 t = 6.19 p < 0.001 DAS Total 119.5(106.75–127) 91.5(74.25-108.75) U = 1108 Z = − 6.68 p < 0.001 Notes: t: Independent groups t-test, Z: Mann–Whitney U analysis, The p values in bold are statistically significant (p < 0.05) Abbreviations: TAS-20: Toronto Alexithymia Scale, ASEX: Arizona Sexual Experiences Scale, DAS: Dyadic Adjustment Scale, M (1Q–3Q): Median and Quartile Values, Mean ± SD: Mean Value and Standard Deviation The median and quartile values of the YBOCS compulsion and obsession subscale scores, as well as the YBOCS total score, were significantly higher in patients with OCD who were alexithymic compared to patients with OCD who were non-alexithymic (p < 0.001 for each). The average scores for both the subscale and total scores of the DAS were higher in patients with OCD who were non-alexithymic compared to those who were alexithymic. A statistically significant difference was observed between the two groups (p < 0.05 for both). Table 3 presents the scale scores for both patients with OCD who were alexithymic and non-alexithymic. Table 3 A comparison of patients with OCD with and without alexithymia Alexithymia+ Alexithymia− Statistics p M(1Q–3Q) M(1Q–3Q) YBOCS obsession 11(10–13) 0(0-5.75) U = 711 Z = − 7.52 p < 0.001 YBOCS compulsion 11.5(10–14) 0(0–5) U = 632.5 Z = − 7.86 p < 0.001 YBOCS Total 22.5(20-26.25) 0(0–10) U = 663.5 Z = − 7.70 p < 0.001 ASEX Total 19.5(16.75–21.75) 14(12-16.75) U = 1028 Z = − 5.76 p < 0.001 Mean ± SD Mean ± SD Dyadic Consensus 38.23 ± 10.88 45.62 ± 11.59 t = − 2.75 p = 0.01 Dyadic Satisfaction 27.53 ± 7.56 34.14 ± 9.25 t = − 3.32 p = 0.001 Affectional Expression 5.72 ± 2.51 7.76 ± 2.69 t = − 3.28 p = 0.002 Dyadic Cohesion 11 ± 4.47 14.03 ± 5.14 t = − 2.66 p = 0.01 DAS Total 81.98 ± 21.73 101.44 ± 25.79 t = − 3.46 p = 0.001 Notes: t: Independent groups t-test, Z: Mann–Whitney U analysis, The p values in bold are statistically significant (p < 0.05) Abbreviations: YBOCS: Yale–Brown Obsessive Compulsive Scale, DAS: Dyadic Adjustment Scale, ASEX: Arizona Sexual Experiences Scale, Mean ± SD: Mean Value and Standard Deviation, M (1Q–3Q): Median and Quartile Values The total YBOCS scores and the YBOCS compulsion subscale scores were significantly higher in patients with OCD who had SDs compared to those without SDs (p = 0.01 and p = 0.003, respectively). While not statistically significant, those with OCD and SDs showed higher YBOCS obsession subscale scores (p = 0.051). There were no significant differences in age, sex, education, marital status, duration of marriage, type of marriage, family living situation, occupation, place of residence, or duration of OCD between patients with and without SDs. However, a significant difference was found in the subscale and total scores of the DAS between patients with OCD who had SDs and those who did not. Patients without SDs had higher mean scores on the DAS subscales and total scores (p < 0.05 for all comparisons). Additionally, there was a significant difference in the mean scores of the TAS-20 between the two groups (p = 0.02), with patients who had SDs obtaining higher average scores. A comparison of the scale scores of patients with OCD, both those with and without SDs, in terms of OCD and sociodemographic characteristics is presented in Table 4 . Table 4 A comparison of patients with OCD with and without SDs SDs+ SDs– p Age (Mean ± SD) 35.83 ± 7.99 38.24 ± 10.20 t = − 1.11 p = 0.27 Sex n (%) n (%) Female 28(59.6) 11(44) \(\:{x}^{2}\) =1.03 p = 0.31b Male 19(40.4) 14(56) Years in education (Mean ± SD) 13.23 ± 5.23 12.60 ± 3.87 t = 0.53 p = 0.60 Marital status n (%) n (%) Single 5(10.6) 4(16) p = 0.71c Married 42(89.4) 21(84) Duration of marriage (Mean ± SD) 11.77 ± 9.26 13.52 ± 11.19 t = − 0.71 p = 0.48 Type of marriage n (%) n (%) Companionate marriage 26(61.9) 11(52.4) \(\:{x}^{2}\) =0.21 P = 0.65b Arranged marriage 16(38.1) 10(47.6) Type of family n (%) n (%) Nucleus family 39(83) 22(88) P = 1c Extended family 5(10.6) 2(8) Lives alone 3(6.4) 1(4) Profession n (%) n (%) Not employed 21(44.7) 10(40) \(\:{x}^{2}\) =0.02 P = 0.90b Employed 26(55.3) 15(60) Place of residence n (%) n (%) Smaller than the provincial center 10(21.3) 2(8) P = 0.20c Provincial center 37(78.7) 23(92) Duration of OCD (months) (Mean ± SD) 145.68 ± 110.44 111.16 ± 100.75 t = 1.30 p = 0.20 YBOCS obsession (Mean ± SD) 11.15 ± 3.25 9.60 ± 2.97 t = 1.98 p = 0.051 YBOCS compulsion (Mean ± SD) 11.60 ± 2.78 9.44 ± 2.93 t = 3.08 p = 0.003 YBOCS Total (Mean ± SD) 22.74 ± 5.74 19.04 ± 5.88 t = 2.59 p = 0.01 Mean ± SD Mean ± SD Dyadic Consensus 37.87 ± 11.25 47.48 ± 9.92 t = − 3.59 p = 0.001 Dyadic Satisfaction 26.85 ± 8.13 36.48 ± 6.46 t = − 5.12 p < 0.001 Affectional Expression 5.66 ± 2.61 8.20 ± 2.24 t = − 4.12 p < 0.001 Dyadic Cohesion 10.89 ± 4.63 14.72 ± 4.62 t = − 3.34 p = 0.001 DAS Total 80.81 ± 23.11 106.76 ± 19.87 t = − 4.75 p < 0.001 TAS-20 63.17 ± 10.26 56.84 ± 11.76 t = 2.37 p = 0.02 Notes: b: Yates statistic, c: Fisher’s exact test, t: Independent groups t-test, Z: Mann–Whitney U analysis, The p values in bold are statistically significant (p < 0.05) Abbreviations: YBOCS: Yale–Brown Obsessive Compulsive Scale, DAS: Dyadic Adjustment Scale, TAS-20: Toronto Alexithymia Scale, Mean ± SD: Mean Value and Standard Deviation, M (1Q–3Q): Median and Quarterly Values, SDs: Sexual Dysfunctions A weak positive relationship was observed between the YBOCS obsession subscale score and the TAS-20 score in patients diagnosed with OCD (r = 0.304, p = 0.009). Similarly, a weak positive relationship was found between the YBOCS compulsion subscale score and the ASEX total score (r = 0.266, p = 0.024), as well as between the YBOCS compulsion subscale score and the TAS-20 score (r = 0.336, p = 0.004). Additionally, a weak negative relationship was identified between the YBOCS compulsion subscale score and the DAS total score (r = -0.307, p = 0.009). A weak positive relationship was also found between the YBOCS total score and both the ASEX total score (r = 0.256, p = 0.030) and the TAS-20 score (r = 0.330, p = 0.005). Conversely, a weak negative relationship existed between the YBOCS total score and the DAS total score (r = -0.275, p = 0.019). Furthermore, a weak positive relationship was detected between the ASEX total score and the TAS-20 score (r = 0.366, p = 0.002), while a moderate negative relationship was found between the ASEX total score and the DAS total score (r = -0.442, p < 0.001). Lastly, there was a weak negative relationship between the TAS-20 score and the DAS total score (r = -0.339, p = 0.004). No significant correlations were found between the other scale scores. Table 5 presents the correlations of the YBOCS, ASEX, TAS-20, and DAS scores among patients with OCD. Table 5 Correlations of scale scores of patients with OCD YBOCS obsession YBOCS compulsion YBOCS Total ASEX Total TAS-20 DAS Total YBOCS obsession 1 r = 0.872 p < 0.001 r = 0.970 p < 0.001 r = 0.231 p = 0.051 r = 0.304 p = 0.009 r = − 0.228 p = 0.054 YBOCS compulsion r = 0.872 p < 0.001 1 r = 0.965 p < 0.001 r = 0.266 p = 0.024 r = 0.336 p = 0.004 r = − 0.307 p = 0.009 YBOCS Total r = 0.970 p < 0.001 r = 0.965 p < 0.001 1 r = 0.256 p = 0.030 r = 0.330 p = 0.005 r = − 0.275 p = 0.019 ASEX Total r = 0.231 p = 0.051 r = 0.266 p = 0.024 r = 0.256 p = 0.030 1 r = 0.366 p = 0.002 r = − 0.442 p < 0.001 TAS-20 r = 0.304 p = 0.009 r = 0.336 p = 0.004 r = 0.330 p = 0.005 r = 0.366 p = 0.002 1 r = − 0.339 p = 0.004 DAS-Total r = − 0.228 p = 0.054 r = − 0.307 p = 0.009 r = − 0.275 p = 0.019 r = − 0.442 p < 0.001 r = − 0.339 p = 0.004 1 Pearson correlation, The p values in bold are statistically significant (p < 0.05) Abbreviations: YBOCS: Yale–Brown Obsessive Compulsive Scale, ASEX: Arizona Sexual Experiences Scale, TAS-20: Toronto Alexithymia Scale, DAS: Dyadic Adjustment Scale, Discussion This study aimed to investigate the relationships between alexithymia, SDs and dyadic adjustment in patients with OCD compared to healthy controls. To our knowledge, no prior research has examined the correlation between alexithymia, sexual dysfunction, and dyadic adjustment, specifically in patients with OCD. The most significant finding of our study was that OCD patients with alexithymia exhibited greater impairment in sexual functioning and lower dyadic adjustment than those without alexithymia. Additionally, we found that patients with OCD had higher alexithymia scores, poorer sexual functioning, and lower levels of dyadic adjustment compared to the healthy population. In the present study, the levels of alexithymia in patients with OCD were significantly higher than those in healthy controls. This finding is consistent with previous studies that also found that OCD patients exhibited greater levels of alexithymia compared to healthy individuals [ 11 , 12 , 38 ]. These findings indicate that patients with OCD struggle to recognize and identify their emotions, suggesting that chronic OCD processes may contribute to alexithymic traits. In the present study, patients with OCD who were alexithymic experienced more severe obsessions and compulsions compared to those without alexithymic. Additionally, a positive relationship was found between levels of obsession, compulsion, and alexithymia. These findings can be interpreted in two ways: either alexithymia increases as the severity of OCD rises, or individuals with alexithymic traits experience more severe clinical manifestations of OCD. Khosravani et al. reported that OCD symptoms were more severe in alexithymic patients than in those without alexithymia [ 38 ]. De Berardis et al. found that symptoms were more severe in patients with OCD who had higher levels of alexithymia [ 39 ]. Roh et al. found a positive correlation between alexithymia, obsession levels, and the severity of OCD symptoms [ 13 ]. Carpenter and Chung found that alexithymia in patients with OCD correlates with the severity and number of OCD symptoms [ 40 ]. Uslu et al. found no significant correlation between the severity of obsessive symptoms and alexithymia, which was attributed to the small sample size of the study [ 12 ]. The results from the literature review and the current study align with each other. These findings indicate that cognitive behavioral therapy (CBT) aimed at addressing alexithymia may have a positive impact on the progression of the disease by decreasing the severity of OCD symptoms. In the present study, patients with OCD exhibited significantly greater impairments in arousal, sexual desire, orgasm, penile erection, and satisfaction with orgasm compared to healthy controls. The higher rate of SDs in patients with OCD than in the control group supports the findings of previous studies in the relevant literature, which compared patients with OCD with the control group [ 16 , 34 ]. Many patients with OCD are often dissatisfied with their sexual relationships and tend to avoid sexual intercourse [ 41 ]. Some cognitive biases associated with OCD may also affect sexual satisfaction and functioning. Additionally, certain symptoms, such as contamination, can impair sexual performance [ 42 ]. Sexual obsessions can cause feelings of guilt in some patients. Additionally, drug treatments may lead to SDs [ 43 ]. The results of the study may be influenced by the nature of OCD or the medication used. However, the impact of alexithymia and dyadic adjustment on sexuality should not be overlooked. In the current study, patients with OCD who experienced SDs exhibited significantly more severe compulsions and OCD symptoms compared to those without SDs. While the severity of obsessions was also greater in patients with OCD who had SDs, this difference was not statistically significant. Furthermore, the study found that the incidence of SDs increased alongside the severity of OCD symptoms and compulsions in these patients. This aligns with the findings from Thakurta et al., which reported a positive correlation between the severity of OCD symptoms and the presence of SDs [ 44 ]. Raisi et al. found a negative correlation between OCD symptom severity and sexual satisfaction [ 45 ]. OCD is a chronic disorder caused by impairments in several areas of function [ 46 ] and the results of the present study indicate that as the severity of the disease increases, the degree of impairment in dyadic relationships and sexuality, which are important areas of function, increases. Compulsions, such as repeated cleaning after sex and extensive cleaning efforts, can take a long time and are often visibly noticeable. These behaviors can lead to sexual avoidance and SDs. In the present study, patients with OCD who had SDs exhibited significantly higher levels of alexithymia compared to those without SDs. Additionally, patients with OCD who were alexithymic demonstrate a greater extent of sexual dysfunction than those who were not alexithymic. A positive correlation is observed between the level of alexithymia and the severity of SDs in patients with OCD. This finding suggests that as the level of alexithymia increases in patients with OCD, there is a corresponding decline in sexual function. However, to the best of our knowledge, no previous studies have specifically examined the relationship between alexithymia and SDs in patients with OCD. Giuliani et al. conducted a study on individuals without mental disorders, revealing that levels of alexithymia were significantly higher in those with SDs compared to a control group without SDs [ 21 ]. Berenguer et al. found that higher levels of alexithymia in women were linked to poorer functioning across all dimensions of sexual function, except for the sexual desire stage [ 22 ]. Wise et al. reported no relationship between types of SDs and alexithymia levels [ 47 ]. The association between alexithymic individuals and sexual difficulties seems intuitively logical. In human sexuality, the ability to express and experience emotions is one of the most important elements [ 48 ]. While further research is needed to determine whether alexithymia is associated with SDs, especially in clinical populations such as those with OCD, it is important that clinicians are more aware of alexithymic traits in patients with OCD. The present study also investigated how the participants interpreted their dyadic adjustment, in addition to sexual functions reflecting partner relationships. The dyadic adjustment levels of patients with OCD were considerably lower than those of healthy controls. Furthermore, there was a negative relationship between obsession levels, compulsion levels, and the severity of OCD symptoms and dyadic adjustment in patients with OCD. Given these results, it can be suggested that an increase in the severity of OCD symptoms decreases dyadic adjustment. A previous study reported a negative correlation between the severity of obsessions and relationship satisfaction [ 49 ]. Another study suggested that couples experienced less marital distress as OCD symptoms decreased after exposure treatment and that there was a negative relationship between OCD severity and relationship satisfaction [ 50 ]. Riggs et al. reported a significant increase in marital adjustment after CBT in patients with OCD who were dissatisfied with their marriages before treatment and reported that the treatment of OCD symptoms contributed to improvements in marital satisfaction [ 25 ]. OCD plays a drastic role in the emergence of issues related to marriage and sexuality, as it exposes a person to excessive anxiety and leads to strained relationships. As the severity of obsessions increases, patients with OCD, who are more preoccupied with intrusive thoughts, devote less time and energy to intimate relationships with their partners [ 25 , 50 ]. This can reduce dyadic adjustment, as expected. Family- and couple-based treatment methods should also be considered in the follow-up and treatment processes of patients diagnosed with OCD to regulate the vicious cycle, in which a severe clinical course inflicts an adverse effect on dyadic adjustment, and low dyadic adjustment increases the severity of the disease. In the present study, a negative relationship was found between dyadic adjustment and alexithymia levels in the patient group, and dyadic adjustment was significantly lower in patients with OCD who were alexithymic than in patients with OCD who were non-alexithymic. These results confirm that the occurrence of alexithymic traits in patients with OCD decreases dyadic adjustment. The authors of the present study found no previous studies that assessed alexithymia and dyadic adjustment in patients with OCD. Previous studies with individuals without mental disorders reported lower dyadic adjustment in individuals with high levels of alexithymia. Aghighi et al. reported a negative relationship between alexithymia and dyadic adjustment and a significant positive relationship between alexithymia and marital stress [ 51 ]. Yelsma and Marrow reported that difficulties in couples' emotional expression in marriage impaired their own and their spouses' marital satisfaction [ 52 ]. Other studies also reported significant negative correlations between alexithymia and dyadic adjustment [ 27 , 28 , 53 ]. OCD patients with higher levels of alexithymia might have difficulty establishing and maintaining intimate relationships. Taylor et al. suggested that alexithymia was not a predictor of dyadic adjustment [ 54 ]. Accordingly, the present study investigated sexual functioning as well, in addition to disease severity and alexithymia, to identify the variables that might be related to dyadic adjustment in patients with OCD. One of the more significant parameters affecting dyadic adjustment is sexual functioning. Dyadic adjustment is adversely affected by impaired sexual functioning; conversely, sexual functioning is impaired when dyadic adjustment is affected [ 55 ]. In the present study, dyadic adjustment was found to be higher in patients with OCD who did not have SDs compared to those with OCD who had SDs, and a negative relationship was observed between SDs and dyadic adjustment in patients with OCD. Raeisi et al. reported a significant negative relationship between SDs and marital satisfaction in patients with OCD [ 56 ]. Similar to our study, in a study with patients diagnosed with bipolar disorder, dyadic adjustment was lower in those who had SDs than in those without SDs [ 57 ]. These data support the bidirectional relationship between SDs and impaired dyadic adjustment in patients with OCD and similar chronic mental disorders. In the present study, the employment rate of patients with OCD was considerably lower than that of the control group. OCD is a persistent mental disorder that adversely affects an individual's familial, social, and occupational functioning [ 46 ]. This may be due to the loss of functionality associated with OCD. To the best of our knowledge, the present study is the first to compare patients with OCD with healthy controls in terms of alexithymia, SDs and dyadic adjustment. A limited number of previous studies have investigated the correlations between OCD and alexithymia, OCD and SDs, and OCD and dyadic adjustment in patients and control groups. Limitations The present study has several limitations. The cross-sectional design prevents us from establishing cause-and-effect relationships between the variables. Although we met the required sample size based on the power analysis, the relatively small sample size is still a significant limitation. Future studies with larger sample sizes may yield more statistically significant results. Additionally, the medications taken by the patient group make it challenging to distinguish between medication-induced SDs and SDs related to OCD. Moreover, the effects of pharmacological treatments on sexual function were assessed through self-reports, which may not provide the most accurate results. More objective findings could be obtained by including evaluations such as hormone measurements and blood prolactin levels. Another limitation of the present study is that we relied solely on self-report scales to assess dyadic adjustment, which may affect the reliability of the data. Furthermore, dyadic adjustment was only evaluated from the participants’ perspective. Including the partners of the patient group in future studies would provide a more comprehensive understanding of dyadic adjustment. Conclusion Based on the study results, patients with OCD exhibit higher levels of alexithymia compared to healthy controls. Additionally, the presence of alexithymia appears to be linked to poorer sexual functioning and lower dyadic adjustment in relationships. Therefore, it is important to explore the presence of alexithymic traits in patients with OCD. Assessing alexithymic characteristics in these patients and understanding their relationships with SDs and dyadic adjustment may facilitate the initiation of appropriate treatment methods and enhance their social and familial functioning. There is a need for longitudinal studies with larger sample sizes, particularly involving newly diagnosed patients with OCD, as well as studies that categorize patients based on their medication use. Additionally, further research into the correlations between dyadic adjustment, sexual dysfunctions, and alexithymia in other psychiatric disorders will help to clarify these issues. Abbreviations OCD Obsessive–Compulsive Disorder SDs Sexual dysfunctions SCID-5-CV Structured Clinical Interview for DSM-5 Clinician Version DSM-5 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition SSRI Selective Serotonin Reuptake Inhibitor YBOCS Yale Brown Obsessive Compulsive Scale TAS Toronto Alexithymia Scale ASEX Arizona Sexual Experiences Scale DAS Dyadic Adjustment Scale CBT Cognitive Behavioral Therapy Declarations Acknowledgements The authors would like to thank the participants who contributed to this study. Author contributions T.S. and G.K. conceived and designed the study. T.S., G.K., M.E.D. and Z.N. conducted the literature review. G.K., L.T., M.E.D., Z.N., T.S. and C.Y. conducted the research. T.S. applied the scales. T.S., G.K., L.T. and M.E.D. performed the statistical analysis. T.S., G.K., Z.N. and C.Y. drafted the manuscript. G.K., L.T. and M.E.D. reviewed the manuscript. All authors read and approved the final version of the manuscript. Funding No specific funding for this research was provided by the government, business, or nonprofit sectors. Data availability No datasets were generated or analysed during the current study. Ethical approval and consent to participate Ethics committee approval for the study was obtained on September 4, 2020, from the Cukurova University Faculty of Medicine, Non-Interventional Clinical Research Ethics Committee, upon meeting No. 103. After being fully briefed on the study, all participants provided written informed consent. The research followed the guidelines set forth by the Declaration of Helsinki. Consent for publication All participants gave informed consent for publication. Competing interests The authors declare no competing interests. Clinical trail number Not applicable Author details 1- Tunahan Sun, MD Düziçi State Hospital Department of Psychiatry, Osmaniye, Turkey [email protected] https://orcid.org/0000-0002-1383-3154 2- Gonca Karakuş, MD Çukurova University Medical School Department of Psychiatry, Adana, Turkey [email protected] https://orcid.org/0000-0001-5211-4032 3- Lut Tamam, MD Çukurova University Medical School Department of Psychiatry, Adana, Turkey [email protected] https://orcid.org/0000-0002-9750-7531 4- Mehmet Emin Demirkol, MD Çukurova University Medical School Department of Psychiatry, Adana, Turkey [email protected] https://orcid.org/0000-0003-3965-7360 5- Zeynep Namlı, MD Çukurova University Medical School Department of Psychiatry, Adana, Turkey [email protected] https://orcid.org/0000-0001-8954-5901 6- Caner Yeşiloğlu, MD Çukurova University Medical School Department of Psychiatry, Adana, Turkey [email protected] https://orcid.org/0000-0002-9997-351X Corresponding Author: Tunahan Sun, MD Düziçi State Hospital Department of Psychiatry, Osmaniye, Turkey [email protected] https://orcid.org/0000-0002-1383-3154 GSM: +905068626693 References Rasmussen SA, Tsuang MT. Clinical characteristics and family history in DSM-III obsessive-compulsive disorder. American Journal of Psychiatry. 1986;143:317–22. Fawcett EJ, Power H, Fawcett JM. Women Are at Greater Risk of OCD Than Men: A Meta-Analytic Review of OCD Prevalence Worldwide. J Clin Psychiatry. 2020;81. Lochner C, Fineberg NA, Zohar J, van Ameringen M, Juven-Wetzler A, Altamura AC, et al. Comorbidity in obsessive-compulsive disorder (OCD): a report from the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS). Compr Psychiatry. 2014;55:1513–9. Eisen JL, Sibrava NJ, Boisseau CL, Mancebo MC, Stout RL, Pinto A, et al. Five-year course of obsessive-compulsive disorder: predictors of remission and relapse. J Clin Psychiatry. 2013;74:233–9. Di Tella M, Adenzato M, Catmur C, Miti F, Castelli L, Ardito RB. The role of alexithymia in social cognition: Evidence from a non-clinical population. J Affect Disord. 2020;273:482–92. Radetzki PA, Wrath AJ, Le T, Adams GC. Alexithymia is a mediating factor in the relationship between adult attachment and severity of depression and social anxiety. J Affect Disord. 2021;295 October 2020:846–55. Mattila AK, Salminen JK, Nummi T, Joukamaa M. Age is strongly associated with alexithymia in the general population. J Psychosom Res. 2006;61:629–35. Mcgillivray L, Becerra R, Harms C. Prevalence and Demographic Correlates of Alexithymia : A Comparison Between Australian Psychiatric and Community Samples. 2016;00:1–12. Berthoz S, Artiges E, Van de Moortele P-F, Poline J-B, Rouquette S, Consoli SM, et al. Effect of impaired recognition and expression of emotions on frontocingulate cortices: an fMRI study of men with alexithymia. american Journal of Psychiatry. 2002;159:961–7. Shapira NA, Liu Y, He AG, Bradley MM, Lessig MC, James GA, et al. Brain activation by disgust-inducing pictures in obsessive-compulsive disorder. Biol Psychiatry. 2003;54:751–6. Bozorg M, Rahimi C, Mohammadi N. Evaluating the Components of Alexithymia in Patients With Obsessive-Compulsive Disorder. 2021;8:175–9. Uslu U, Erensoy H, Meterelliyoz KS, Aytaç HM, Berkol TD. Obsesif kompulsif bozukluǧa sahip hastalar ile saǧlıklı bireyler arasındaki aleksitimi düzey farklılıklarının karşılaştırılması; Comparison of alexithymia level differences associated with obsessive compulsive disorder patients and healthy people. The Journal of Neurobehavioral Sciences. 2020;7:52. Roh D, Kim WJ, Kim CH. Alexithymia in obsessive-compulsive disorder: Clinical correlates and symptom dimensions. Journal of Nervous and Mental Disease. 2011;199:690–5. Davison SL, Bell RJ, LaChina M, Holden SL, Davis SR. The relationship between self-reported sexual satisfaction and general well-being in women. J Sex Med. 2009;6:2690–7. Burri A, Spector T. Recent and lifelong sexual dysfunction in a female UK population sample: prevalence and risk factors. J Sex Med. 2011;8:2420–30. Kendurkar A, Kaur B. Major depressive disorder, obsessive-compulsive disorder, and generalized anxiety disorder: Do the sexual dysfunctions differ? Primary Care Companion to the Journal of Clinical Psychiatry. 2008;10:299–305. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: Prevalence and predictors. Journal of the American Medical Association. 1999;281:537–44. Humphreys TP, Wood LM, Parker JDA. Alexithymia and satisfaction in intimate relationships. Pers Individ Dif. 2009;46:43–7. Van de Poll NE, Van Goozen SH. Hypothalamic involvement in sexuality and hostility: comparative psychological aspects. Prog Brain Res. 1992;93:343–61. Sifneos PE. Affect, emotional conflict, and deficit: an overview. Psychother Psychosom. 1991;56:116–22. Giuliani M, Fabrizi A, Rossi R, Tripodi F, Eleuteri S, Di Pomponio I, et al. Alexithymia and sexual functioning: A clinical study on female patients with sexual disorders. F1000Res. 2011;2. Berenguer C, Rebôlo C, Costa RM. Interoceptive awareness, alexithymia, and sexual function. J Sex Marital Ther. 2019;45:729–38. Stengler-Wenzke K, Kroll M, Matschinger H, Angermeyer MC. Quality of life of relatives of patients with obsessive-compulsive disorder. Compr Psychiatry. 2006;47:523–7. Newth S, Rachman S. The concealment of obsessions. Behaviour research and therapy. 2001;39:457–64. Riggs DS, Hiss H, Foa EB. Marital distress and the treatment of Obsessive Compulsive Disorder. Behav Ther. 1992;23:585–97. Kasalova P, Prasko J, Ociskova M, Holubova M, Vanek J, Kantor K, et al. Marriage under control : Obsessive compulsive disorder and partnership. 2020;41:134–45. Eid P, Boucher S. Alexithymia and dyadic adjustment in intimate relationships: Analyses using the actor partner interdependence model. J Soc Clin Psychol. 2012;31:1095–111. Karakis EN, Levant RF. Is normative male alexithymia associated with relationship satisfaction, fear of intimacy and communication quality among men in relationships? J Mens Stud. 2012;20:179–86. First MB. Structured Clinical Interview for the DSM (SCID). In: Cautin RL, Lilienfeld SO, editors. The Encyclopedia of Clinical Psychology. First Edit. Wiley-Blackwell; 2015. Elbir M, Topbaş ÖA, Bayad S, Kocabaş T, Topak OZ, Çetin Ş. DSM-5 Bozuklukları için Yapılandırılmış Klinik Görüşmenin Klinisyen Versiyonunun Türkçeye Uyarlanması ve Güvenilirlik Çalışması. Türk Psikiyatri Dergisi. 2019;30:51–6. Karamustafalıoğlu O, Üçışık A, Ulusoy M, Erkmen H. Yale-Brown obsesyon kompulsiyon derecelendirme ölçeği’nin geçerlilik ve güvenilirlik çalışması. In: Ulusal Psikiyatri Kongresi Özet Kitabi. Bursa Savaş Ofset; 1993. p. 29. Güleç H, Köse S, Güleç MY, Çitak S, Evren C, Borckardt J, et al. Reliability and factorial validity of the Turkish version of the 20-item Toronto alexithymia scale (TAS-20). Klinik Psikofarmakoloji Bulteni. 2009;19:214. McGahuey CA, Gelenberg AJ, Laukes CA, Moreno FA, Delgado PL, McKnight KM, et al. The Arizona Sexual Experience Scale (ASEX): reliability and validity. J Sex Marital Ther. 2000;26:25–40. Turan Ş, Poyraz CA, Sağlam NGU, Batun GÇ, Yassa A, Duran A. Obsesif kompulsif bozukluk hastalarında cinsel İşlev bozuklukları. Yeni Symposium. 2015;53:37–44. Soykan A. The reliability and validity of Arizona sexual experiences scale in Turkish ESRD patients undergoing hemodialysis. Int J Impot Res. 2004;16:531–4. Spanier GB. Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads. J Marriage Fam. 1976;:15–28. Fişiloğlu H, Demir A. Applicability of the Dyadic Adjustment Scale for measurement of marital quality with Turkish couples. European Journal of Psychological Assessment. 2000;16:214. Khosravani V, Samimi Ardestani M, Sharifi Bastan F, Kamali Z. The relationship between alexithymia and symptom dimensions in patients with obsessive-compulsive disorder. J Obsessive Compuls Relat Disord. 2017;14 November 2016:127–33. De Berardis D, Serroni N, Campanella D, Rapini G, Olivieri L, Feliziani B, et al. Alexithymia, responsibility attitudes and suicide ideation among outpatients with obsessive-compulsive disorder: an exploratory study. Compr Psychiatry. 2015;58:82–7. Carpenter L, Chung MC. Childhood trauma in obsessive compulsive disorder: the roles of alexithymia and attachment. Psychology and Psychotherapy: Theory, Research and Practice. 2011;84:367–88. Angst J, Gamma A, Endrass J, Goodwin R, Ajdacic V, Eich D, et al. Obsessive-compulsive severity spectrum in the community: Prevalence, comorbidity, and course. Eur Arch Psychiatry Clin Neurosci. 2004;254:156–64. Real E, Montejo Á, Alonso P, Manuel Menchón J. Sexuality and obsessive-compulsive disorder: The hidden affair. Neuropsychiatry. 2013;3:23–31. Balon R. SSRI-associated sexual dysfunction. Am J Psychiatry. 2006;163:1504–9; quiz 1664. Thakurta RG, Singh OP, Dhar P, Sarkar S, Ray P. Prevalence and nature of sexual dysfunctions in OCD in a tertiary medical college. 2014;17:20–30. Raisi F, Ghassemzadeh H, Khojastefar RF, Karamghadiri N, Meysamie A, Sorayani M, et al. Prevalence of sexual dysfunction in a group of Obsessive-Compulsive Disorder (OCD) patients in Iran. Imaging Journal of Clinical and Medical Sciences. 2019;6:89–93. Hollander E, Benzaquen SD. Is there a distinct OCD spectrum? CNS Spectr. 1996;1:17–26. Wise TN, Osborne C, Strand J, Fagan PJ, Schmidt CWJ. Alexithymia in patients attending a sexual disorders clinic. J Sex Marital Ther. 2002;28:445–50. Purifoy FE, Grodsky A, Giambra LM. The relationship of sexual daydreaming to sexual activity, sexual drive, and sexual attitudes for women across the life-span. Arch Sex Behav. 1992;21:369–85. Abbey RD, Clopton JR, Humphreys JD. Obsessive-Compulsive Disorder and Romantic Functioning. J Clin Psychol. 2007;63:1181–92. Emmelkamp PMG, De Haan E, Hoogduin CAL. Marital Adjustment and Obsessive–Compulsive Disorder. British Journal of Psychiatry. 1990;156:55–60. Aghighi A, Foroughi M, Daneshmandi S, Abbasi M. The Role of Alexithymia and Sexual Self-esteem in the Prediction of Marital Stress and Adjustment in Infertile Women. Practice in Clinical Psychology. 2021;9:19–26. Yelsma P, Marrow S. An examination of couples’ difficulties with emotional expressiveness and their marital satisfaction. The Journal of Family Communication. 2003;3:41–62. Hesse C, Pauley PM, Frye-Cox NE. Alexithymia and marital quality: The mediating role of relationship maintenance behaviors. West J Commun. 2015;79:45–72. Taylor GJ, Bagby RM, Kushner SC, Benoit D, Atkinson L. Alexithymia and adult attachment representations: Associations with the five-factor model of personality and perceived relationship adjustment. Compr Psychiatry. 2014;55:1258–68. Hawton K, Catalan J. Prognostic factors in sex therapy. Behaviour Research and Therapy. 1986;24:377–85. Raeisi F, Ghassemzadeh H, Karamghadiri N, Firoozikhojastefar R, Meysami A, Nasehi AA, et al. Sexual function and marital satisfaction in female with obsessive-compulsive disorder. Journal of Arak University of Medical Sciences. 2016;19:11–9. Namli Z, Karakuş G, Tamam L. Assessment of Dyadic Adjustment and Sexual Functions in Patients with Bipolar Disorder. Archives of Neuropsychiatry. 2018;55:171. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6185799","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":440195034,"identity":"b491f8b5-d5cd-4943-be9b-5b108d180141","order_by":0,"name":"Tunahan Sun","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzElEQVRIiWNgGAWjYBADHjb2BiBlYEGEUigtx8dzAKRFgngtxnISCSCaCC32ErkHP/5su5PYJvn86oYfBRIM/O3dCfhtkchLluZte5bYJp1TdrMH6DCJM2c3ENCSYyDN2HYYpCXtBg9Qi4FELkEtxj9/grRInkm7+YdILWYSvG2Hjdkk2I/dJs6WM2/MrHnOHZZj48lhuy1jIMFD0C/s7TnGN3+UHeaRbz/+7OabPzZy/O29+LUgW2gAJolVDrbwASmqR8EoGAWjYAQBABJQQem1JHg/AAAAAElFTkSuQmCC","orcid":"","institution":"Düziçi State Hospital","correspondingAuthor":true,"prefix":"","firstName":"Tunahan","middleName":"","lastName":"Sun","suffix":""},{"id":440195035,"identity":"eb097b25-eeca-4e0a-9ab9-acb7c56d6f9f","order_by":1,"name":"Gonca Karakuş","email":"","orcid":"","institution":"Cukurova University","correspondingAuthor":false,"prefix":"","firstName":"Gonca","middleName":"","lastName":"Karakuş","suffix":""},{"id":440195036,"identity":"439a0dd1-40b7-46b9-a5da-add60d80997f","order_by":2,"name":"Lut Tamam","email":"","orcid":"","institution":"Cukurova University","correspondingAuthor":false,"prefix":"","firstName":"Lut","middleName":"","lastName":"Tamam","suffix":""},{"id":440195037,"identity":"445c7ca5-c479-41fa-86a1-ca382604c966","order_by":3,"name":"Mehmet Emin Demirkol","email":"","orcid":"","institution":"Cukurova University","correspondingAuthor":false,"prefix":"","firstName":"Mehmet","middleName":"Emin","lastName":"Demirkol","suffix":""},{"id":440195038,"identity":"2c83f205-6c04-4637-ac5d-3a912a58ae93","order_by":4,"name":"Zeynep Namlı","email":"","orcid":"","institution":"Cukurova University","correspondingAuthor":false,"prefix":"","firstName":"Zeynep","middleName":"","lastName":"Namlı","suffix":""},{"id":440195041,"identity":"e582f2e2-e877-4261-902b-3b37f9d8abf3","order_by":5,"name":"Caner Yeşiloğlu","email":"","orcid":"","institution":"Cukurova University","correspondingAuthor":false,"prefix":"","firstName":"Caner","middleName":"","lastName":"Yeşiloğlu","suffix":""}],"badges":[],"createdAt":"2025-03-08 20:23:11","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6185799/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6185799/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90507736,"identity":"43dc8f2b-c07e-42f9-a7fb-6b67f642316e","added_by":"auto","created_at":"2025-09-03 13:02:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1242732,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6185799/v1/cc1ffa4b-d2ed-4ea6-913a-db04999b569b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association Between Alexithymia, Sexual Dysfunctions, and Dyadic Adjustment in Obsessive–Compulsive Disorder","fulltext":[{"header":"Introduction","content":"\u003cp\u003eObsessive\u0026ndash;compulsive disorder (OCD) is a mental condition characterized by recurrent, ritualistic behaviors or mental acts accompanied by undesired and compulsive thoughts, urges and fantasies. OCD can severely affect habitual routines, work, social life, and relationships and lead to loss of functioning [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The lifetime prevalence of OCD is estimated to be between 1.1% and 3.5%. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], and it is often linked to other mental health conditions and disabilities [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The disorder can relapse in 59% of patients with OCD, even after cognitive behavioral therapy, pharmacological treatment, or a combination of both [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlexithymia is defined by the inability to identify and articulate one's emotions. It is characterized by a deficiency in the ability to identify the facial expressions of others, empathy, and regulation of emotions [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In other words, alexithymia not only inhibits an individual\u0026rsquo;s ability to identify and express one\u0026rsquo;s own emotions and use them in daily life but also prevents others from recognizing them [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. About 10% of the general population is affected by alexithymia, with a higher prevalence in men than in women [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Additionally, severe alexithymia was found in 45.7% of patients with psychiatric diagnoses, suggesting a possible role of alexithymia in the development and/or persistence of psychiatric disorders [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. It was suggested that OCD and alexithymia shared a common neurobiological mechanism. It was reported that pathology in alexithymia was associated with regions in the ventromedial prefrontal cortex, including the orbitofrontal cortex and anterior cingulate [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Some previous studies support reports that the ventromedial prefrontal cortex also plays an important role in patients with OCD [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Previous studies reported high levels of alexithymia in patients with OCD [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] and that sexual/religious obsessions were positively associated with alexithymia [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. However, there are only a few studies available in the relevant literature.\u003c/p\u003e \u003cp\u003eOne of the indicators of quality of life is sexual well-being [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Sexual dysfunctions (SDs) are defined as deterioration in relation to the sexual response cycle in both sexes [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Previous research has revealed a connection between obsessive\u0026ndash;compulsive symptoms and OCD diagnosis with lower sexual functionality, a higher incidence of SDs, and reduced sexual satisfaction [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Despite the potential for a substantial link between specific OCD symptoms and sexual functioning, only a limited number of studies have investigated sexuality in patients with OCD. Even though SDs in patients with OCD have been attributed to the disorder itself or the medications in use, they are multifactorial and need to be investigated from different perspectives [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlexithymia is considered another factor that may affect sexual functioning. Difficulties in recognizing and describing bodily sensations such as arousal negatively impact the quality of sexual interactions [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The limbic system is in control of sexuality, and the neocortex is associated with cognition and emotions. The neuropsychological model defines alexithymia as a disconnection between the neocortex and the limbic system [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Previous studies reported a negative correlation between sexual function and alexithymia levels in non-clinical sample [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] .\u003c/p\u003e \u003cp\u003ePatients with OCD often face challenges in interpersonal communication, which can negatively impact their relationships with partners [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. These patients often conceal their symptoms to gain acceptance, rather than to be feared or distrusted by others. This behavior is linked to a decrease in intimacy with their partners, which contributes to a decline in dyadic adjustment [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. It has been suggested that OCD is strongly associated with family and marital distress [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. A previous study found that patients with OCD reported lower satisfaction and intimacy with their partners [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlexithymia is an important factor that is effective in dyadic adjustment. Individuals who score high on alexithymia scales appear to lack the essential qualities needed to establish and uphold intimate relationships [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Previous studies reported a negative correlation between alexithymia and dyadic adjustment in non-clinical sample [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe influence of alexithymia on SDs and dyadic adjustment\u0026mdash;factors that can lead to decreased effectiveness in partner relationships and family life\u0026mdash; in patients with OCD has not been thoroughly investigated. The goal of this study was to examine alexithymic traits in patients with OCD and their relationship with SDs and dyadic adjustment. We hypothesized that OCD may be associated with higher levels of alexithymia and that the presence of alexithymia in patients with OCD could be linked to SDs and have a negative impact on dyadic adjustment. This study also aimed to compare patients with OCD and healthy controls in terms of alexithymia levels, sexual dysfunction and dyadic adjustment.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eThe present study was performed at the outpatient clinics of the Department of Mental Health and Diseases at Balcali Hospital, Cukurova University Faculty of Medicine. The study included eighty-two patients who were either married or had a regular sexual partner for at least three months, as assessed via the Structured Clinical Interview for DSM-5 Clinician Version (SCID-5-CV). Pursuant to the inclusion criteria, patients who received only selective serotonin reuptake inhibitor (SSRI) treatment (to minimize the possible effect of psychotropic drugs on sexual life); were aged between 18\u0026ndash;65 years; were not diagnosed with comorbid mental disorders; were not diagnosed with dementia, delirium, or mental retardation, which is associated with impaired cognitive function; and were literate in completing the scales were included in this study.\u003c/p\u003e \u003cp\u003eBased on the information obtained from the patient and their relatives, upon physical examination findings and a review of clinical records, 10 patients with a history of pelvic or abdominal surgery; a diagnosis of chronic medical diseases, including diabetes mellitus, cardiovascular diseases, and hormone replacement therapy; or the use of medications other than SSRIs were excluded because these conditions might adversely affect sexual function.\u003c/p\u003e \u003cp\u003eEighty-two volunteers who had sociodemographic characteristics similar to those of patients who did not have any mental disorders or complaints, who did not receive any medication or medical conditions, who had a regular sexual partner for at least three months or who were married were included as healthy controls. The study was conducted with 72 patients with OCD who had a sexual partner or were married and 82 healthy controls.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePower Analysis\u003c/h3\u003e\n\u003cp\u003eIn the present study, the G Power 3.1 program was used for power analysis. The minimum sample size required for a single group was 51, and the minimum sample size required for two groups was 102. With a medium effect size (Cohen's d\u0026thinsp;=\u0026thinsp;0.50), a power of 0.80, and a margin of error of 0.05 (p\u0026thinsp;=\u0026thinsp;0.059), it was decided that the study, which included 154 participants, was adequately powered.\u003c/p\u003e\n\u003ch3\u003eProcedure\u003c/h3\u003e\n\u003cp\u003eIn the first stage of the study, the first author conducted interviews lasting approximately 60 minutes with all participants. During these interviews, we collected sociodemographic data from the participants using a prepared form. The diagnosis of OCD was confirmed using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), while the Structured Clinical Interview for DSM-5 Disorders (SCID-5-CV) was utilized to identify any comorbid psychiatric disorders accompanying OCD.\u003c/p\u003e \u003cp\u003eThe Yale-Brown Obsessive Compulsive Scale (YBOCS) was employed to assess OCD symptoms and the severity of the disorder. After the interview, participants received information about the scales used. In the next stage, they were asked to complete the Toronto Alexithymia Scale (TAS-20) to evaluate their level of alexithymia, the Arizona Sexual Experiences Scale (ASEX) to assess sexual functioning, and the Dyadic Adjustment Scale (DAS) to evaluate dyadic adjustment. For patients who experienced difficulty in completing the self-report scales, a clinician provided assistance and clarification on any points that were not understood.\u003c/p\u003e \u003cp\u003e Ethics committee approval for the study was obtained on September 4, 2020, from the Cukurova University Faculty of Medicine, Non-Interventional Clinical Research Ethics Committee, upon meeting No. 103. After being fully briefed on the study, all participants provided written informed consent. The research followed the guidelines set forth by the Declaration of Helsinki.\u003c/p\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eSociodemographic and Clinical Data Form\u003c/h2\u003e \u003cp\u003eThe researchers developed this data form based on previous studies to gather specific information. It includes questions about marital status, age, gender, family history of mental disorders, educational background, employment status, smoking habits, alcohol and substance use, the number of hospitalizations, the duration of OCD, and the types of drug treatments received.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStructured Clinical Interview for DSM-5-Clinician Version\u003c/h2\u003e \u003cp\u003eIt is a semistructured clinical interview guide aimed at assessing the diagnoses defined by the DSM-5. It was developed by First [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. The SCID-5 has been modified for the Turkish language, and a reliability study was conducted. The kappa coefficient in the Turkish version of the SCID-5 was very high and statistically significant, similar to previous SCID versions [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. The scale was created as a clinical diagnostic instrument and is completed by clinicians. The SCID-5-CV was used in our study to investigate comorbid psychiatric diagnoses and confirm the diagnosis of patients with OCD.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eYale–Brown Obsessive Compulsive Scale\u003c/h3\u003e\n\u003cp\u003eIt is a clinician-administered scale aimed at assessing the severity and type of obsessions and compulsions. The reliability and validity of the Turkish version of the scale were assessed by Karamustafalıoğlu et al. [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Although it contains a total of 19 items, to determine the total score, only the first 10 items are used. Accordingly, items 1 through 5 indicate the degree of obsession, and items 6 through 10 indicate the degree of compulsion.\u003c/p\u003e\n\u003ch3\u003eToronto Alexithymia Scale\u003c/h3\u003e\n\u003cp\u003eTAS-20 is a scale with 20-item and 5-point Likert-type self-reports. Higher scores obtained from the scale are indicative of difficulty in expressing emotions. The study of Turkish reliability and validity was performed by G\u0026uuml;le\u0026ccedil; et al. [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].. In the present study, the participants who scored\u0026thinsp;\u0026ge;\u0026thinsp;61 points were classified as alexithymic, while those who scored below 61 were classified as non-alexithymic.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eArizona Sexual Experiences Scale\u003c/h2\u003e \u003cp\u003eThis scale was developed by McGahuey et al. to quickly and easily detect sexual complications [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. There are two distinct forms, including for men and women. It is a 6-point Likert-type self-report scale consisting of 5 items. Satisfaction with orgasm, sexual desire, the ability to reach orgasm, vaginal lubrication/penile erection, and arousal are assessed. Higher scores indicate higher SDs. The overall score ranges from 5 to 30. A score of \u0026ge;\u0026thinsp;5 for any item or a total scale score of \u0026ge;\u0026thinsp;17 indicates that the person has SDs [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Soykan conducted a study of the Turkish reliability and validity of the ASEX [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. In the present study, participants with a score of \u0026ge;\u0026thinsp;5 on any item or a total scale score of \u0026ge;\u0026thinsp;17 were considered individuals with SDs and others without SDs.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eDyadic Adjustment Scale\u003c/h2\u003e \u003cp\u003eSpanier developed this scale to evaluate the quality of relationships among married or cohabiting partners [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. The DAS is a self-reported scale that contains 32 items and is divided into four subdomains: Affectional Expression, Dyadic Cohesion, Dyadic Satisfaction, and Dyadic Consensus. Higher scores on the DAS indicate better relationship quality and greater dyadic adjustment. Fisıloğlu and Demir conducted a study to assess the reliability and validity of the Turkish version of the DAS [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eThe data were analyzed using version 25 of the Statistical Package for the Social Sciences (IBM SPSS) software. The normality assumption was considered satisfied when the kurtosis and skewness values of the variables fell between \u0026minus;\u0026thinsp;1.5 and +\u0026thinsp;1.5. Additionally, histogram plots were examined. To determine whether the normally distributed variables differed in their averages, an independent groups t-test was conducted, and the results were reported as \"Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\" (mean values and standard deviations). For variables that did not meet the normal distribution criteria, the Mann-Whitney U test was utilized to compare the differences between groups based on their medians. Median and quartile notations were utilized in this analysis. Pearson correlation analysis was conducted to evaluate the relationships between numerical variables that followed a normal distribution. To analyze differences in categorical variables during intergroup comparisons, Fisher's exact test was employed when the expected number of observations was less than 5, and the Yates correction was applied when the expected number was between 5 and 25. The chi-square test was used for all other cases.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThere was no significant difference observed between patients with OCD and healthy controls in several variables, including age, sex distribution, average duration of education, length of marriage, marital status, type of marriage, smoking habits, alcohol and substance use, and place of residence (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05 for each variable). In the study, it was found that 56.9% of patients with OCD (n\u0026thinsp;=\u0026thinsp;41) were employed, compared to 87.8% of healthy controls (n\u0026thinsp;=\u0026thinsp;72). This difference in employment status between the two groups was statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Additionally, 45.8% of patients with OCD (n\u0026thinsp;=\u0026thinsp;33) reported having a family history of mental disorders, while only 22% of the healthy controls had a similar family history (n\u0026thinsp;=\u0026thinsp;18). This difference regarding family history was also statistically significant (p\u0026thinsp;=\u0026thinsp;0.03). The distributions of sociodemographic variables in the control and OCD groups are given in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic variables of the participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOCD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.96\u0026thinsp;\u0026plusmn;\u0026thinsp;8.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.67\u0026thinsp;\u0026plusmn;\u0026thinsp;8.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;0.22\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMean years in education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.39\u0026thinsp;\u0026plusmn;\u0026thinsp;4.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.01\u0026thinsp;\u0026plusmn;\u0026thinsp;4.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;0.53\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDuration of marriage, years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.83\u0026thinsp;\u0026plusmn;\u0026thinsp;10.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.38\u0026thinsp;\u0026plusmn;\u0026thinsp;9.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.96\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003en (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003en (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43(52.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39(54.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{x}^{2}\\)\u003c/span\u003e\u003c/span\u003e=0.05\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.83a\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39(47.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33(45.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(19.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9(12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{x}^{2}\\)\u003c/span\u003e\u003c/span\u003e=0.92\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.34b\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66(80.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63(87.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eType of marriage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCompanionate marriage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45(68.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37(58.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{x}^{2}\\)\u003c/span\u003e\u003c/span\u003e=0.87\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.35b\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eArranged marriage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21(31.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26(41.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eType of family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNucleus family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65(79.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61(84.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{x}^{2}\\)\u003c/span\u003e\u003c/span\u003e=2.13\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.34b\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExtended family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(8.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7(9.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLiving alone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(12.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(5.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eProfession\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(12.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31(43.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{x}^{2}\\)\u003c/span\u003e\u003c/span\u003e=17.14\u003c/p\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003eb\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72(87.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41(56.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePlace of residence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmaller than the provincial center\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(9.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12(16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{x}^{2}\\)\u003c/span\u003e\u003c/span\u003e=1.07\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.30b\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProvincial center\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74(90.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60(83.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eFamily history of mental disorders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64(78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39(54.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{x}^{2}\\)\u003c/span\u003e\u003c/span\u003e=8.82\u003c/p\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.003\u003c/b\u003eb\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18(22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33(45.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50(61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40(55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{x}^{2}\\)\u003c/span\u003e\u003c/span\u003e=0.46\u003c/p\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.50a\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32(39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32(44.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAlcohol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59(72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54(75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{x}^{2}\\)\u003c/span\u003e\u003c/span\u003e=0.06\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.81b\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23(28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18(25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSubstance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80(97.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71(98.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;1c\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(1.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003ea: Chi-squared analysis\u003c/p\u003e \u003cp\u003eb: Yates statistic\u003c/p\u003e \u003cp\u003ec: Fisher\u0026rsquo;s exact test\u003c/p\u003e \u003cp\u003eThe p values in bold are statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eAbbreviations: Mean \u0026plusmn; SD: Mean Value and Standard Deviations\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe average score of the patients with OCD was 10.611 (SD\u0026thinsp;=\u0026thinsp;3.222) for the YBOCS obsession subscale, 10.847 (SD\u0026thinsp;=\u0026thinsp;2.996) for the YBOCS compulsion subscale, and 21.458 (SD\u0026thinsp;=\u0026thinsp;6.016) for the YBOCS total. The average total scores on the TAS-20 for patients with OCD and healthy controls were 60.97\u0026thinsp;\u0026plusmn;\u0026thinsp;11.15 and 43.18\u0026thinsp;\u0026plusmn;\u0026thinsp;8.86, respectively. A statistically significant difference in the total TAS-20 score between the groups was detected (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Patients with OCD exhibited higher scores on both subscales and total scores of the ASEX compared to healthy controls. There were statistically significant differences in the mean scores for lubrication/erection, arousal, desire, orgasm, and satisfaction, as well as the total ASEX score (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for lubrication/erection, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for arousal, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for desire, p\u0026thinsp;=\u0026thinsp;0.01 for orgasm, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for satisfaction, and p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for the total score). In the healthy control group, both the subscale and total median scores of the DAS were higher than those of the OCD group. A statistically significant difference between the two groups was observed in the total and subscale median scores (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for all). The scores for both groups are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eA comparison of participants' scale scores\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealthy Controls\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOCD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMean \u0026plusmn; SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eMean \u0026plusmn; SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTAS-20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43.18\u0026thinsp;\u0026plusmn;\u0026thinsp;8.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.97\u0026thinsp;\u0026plusmn;\u0026thinsp;11.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;11.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSexual desire\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.73\u0026thinsp;\u0026plusmn;\u0026thinsp;1.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.92\u0026thinsp;\u0026plusmn;\u0026thinsp;1.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;6.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArousal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.77\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.88\u0026thinsp;\u0026plusmn;\u0026thinsp;1.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;5.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLubrication/Erection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.64\u0026thinsp;\u0026plusmn;\u0026thinsp;1.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;5.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrgasm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.74\u0026thinsp;\u0026plusmn;\u0026thinsp;1.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;2.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSatisfaction from orgasm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.17\u0026thinsp;\u0026plusmn;\u0026thinsp;1.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;5.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASEX Total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.76\u0026thinsp;\u0026plusmn;\u0026thinsp;3.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.33\u0026thinsp;\u0026plusmn;\u0026thinsp;4.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;6.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eM(1Q-3Q)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eM(1Q-3Q)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyadic Consensus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52(47.75-59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41(33.25\u0026ndash;49.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eU\u0026thinsp;=\u0026thinsp;1333\u003c/p\u003e \u003cp\u003eZ\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;5.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyadic Satisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39(33.5\u0026ndash;44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30(26\u0026ndash;37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eU\u0026thinsp;=\u0026thinsp;1431.5\u003c/p\u003e \u003cp\u003eZ\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;5.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAffectional Expression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10(8\u0026ndash;11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(4\u0026ndash;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eU\u0026thinsp;=\u0026thinsp;1169.5\u003c/p\u003e \u003cp\u003eZ\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;6.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyadic Cohesion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.80\u0026thinsp;\u0026plusmn;\u0026thinsp;4.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.22\u0026thinsp;\u0026plusmn;\u0026thinsp;4.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;6.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDAS Total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e119.5(106.75\u0026ndash;127)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91.5(74.25-108.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eU\u0026thinsp;=\u0026thinsp;1108\u003c/p\u003e \u003cp\u003eZ\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;6.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eNotes: t: Independent groups t-test, Z: Mann\u0026ndash;Whitney U analysis, The p values in bold are statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eAbbreviations: TAS-20: Toronto Alexithymia Scale, ASEX: Arizona Sexual Experiences Scale, DAS: Dyadic Adjustment Scale, M (1Q\u0026ndash;3Q): Median and Quartile Values, Mean \u0026plusmn; SD: Mean Value and Standard Deviation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe median and quartile values of the YBOCS compulsion and obsession subscale scores, as well as the YBOCS total score, were significantly higher in patients with OCD who were alexithymic compared to patients with OCD who were non-alexithymic (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for each). The average scores for both the subscale and total scores of the DAS were higher in patients with OCD who were non-alexithymic compared to those who were alexithymic. A statistically significant difference was observed between the two groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 for both). Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the scale scores for both patients with OCD who were alexithymic and non-alexithymic.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eA comparison of patients with OCD with and without alexithymia\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlexithymia+\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAlexithymia\u0026minus;\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStatistics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eM(1Q\u0026ndash;3Q)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eM(1Q\u0026ndash;3Q)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYBOCS obsession\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(10\u0026ndash;13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0-5.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eU\u0026thinsp;=\u0026thinsp;711\u003c/p\u003e \u003cp\u003eZ\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;7.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYBOCS compulsion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.5(10\u0026ndash;14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eU\u0026thinsp;=\u0026thinsp;632.5\u003c/p\u003e \u003cp\u003eZ\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;7.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYBOCS Total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.5(20-26.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0\u0026ndash;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eU\u0026thinsp;=\u0026thinsp;663.5\u003c/p\u003e \u003cp\u003eZ\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;7.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASEX Total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19.5(16.75\u0026ndash;21.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14(12-16.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eU\u0026thinsp;=\u0026thinsp;1028\u003c/p\u003e \u003cp\u003eZ\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;5.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMean \u0026plusmn; SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eMean \u0026plusmn; SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyadic Consensus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38.23\u0026thinsp;\u0026plusmn;\u0026thinsp;10.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45.62\u0026thinsp;\u0026plusmn;\u0026thinsp;11.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;2.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyadic Satisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27.53\u0026thinsp;\u0026plusmn;\u0026thinsp;7.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.14\u0026thinsp;\u0026plusmn;\u0026thinsp;9.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;3.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAffectional Expression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.72\u0026thinsp;\u0026plusmn;\u0026thinsp;2.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.76\u0026thinsp;\u0026plusmn;\u0026thinsp;2.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;3.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyadic Cohesion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u0026thinsp;\u0026plusmn;\u0026thinsp;4.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.03\u0026thinsp;\u0026plusmn;\u0026thinsp;5.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;2.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDAS Total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81.98\u0026thinsp;\u0026plusmn;\u0026thinsp;21.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101.44\u0026thinsp;\u0026plusmn;\u0026thinsp;25.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;3.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eNotes: t: Independent groups t-test, Z: Mann\u0026ndash;Whitney U analysis, The p values in bold are statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eAbbreviations: YBOCS: Yale\u0026ndash;Brown Obsessive Compulsive Scale, DAS: Dyadic Adjustment Scale, ASEX: Arizona Sexual Experiences Scale, Mean \u0026plusmn; SD: Mean Value and Standard Deviation, M (1Q\u0026ndash;3Q): Median and Quartile Values\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe total YBOCS scores and the YBOCS compulsion subscale scores were significantly higher in patients with OCD who had SDs compared to those without SDs (p\u0026thinsp;=\u0026thinsp;0.01 and p\u0026thinsp;=\u0026thinsp;0.003, respectively). While not statistically significant, those with OCD and SDs showed higher YBOCS obsession subscale scores (p\u0026thinsp;=\u0026thinsp;0.051). There were no significant differences in age, sex, education, marital status, duration of marriage, type of marriage, family living situation, occupation, place of residence, or duration of OCD between patients with and without SDs. However, a significant difference was found in the subscale and total scores of the DAS between patients with OCD who had SDs and those who did not. Patients without SDs had higher mean scores on the DAS subscales and total scores (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 for all comparisons). Additionally, there was a significant difference in the mean scores of the TAS-20 between the two groups (p\u0026thinsp;=\u0026thinsp;0.02), with patients who had SDs obtaining higher average scores. A comparison of the scale scores of patients with OCD, both those with and without SDs, in terms of OCD and sociodemographic characteristics is presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eA comparison of patients with OCD with and without SDs\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSDs+\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSDs\u0026ndash;\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (Mean \u0026plusmn; SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.83\u0026thinsp;\u0026plusmn;\u0026thinsp;7.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.24\u0026thinsp;\u0026plusmn;\u0026thinsp;10.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;1.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003en (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003en (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28(59.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{x}^{2}\\)\u003c/span\u003e\u003c/span\u003e=1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c6\" namest=\"c5\" rowspan=\"2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.31b\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19(40.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14(56)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears in education (Mean \u0026plusmn; SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.23\u0026thinsp;\u0026plusmn;\u0026thinsp;5.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.60\u0026thinsp;\u0026plusmn;\u0026thinsp;3.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003en (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003en (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(10.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c6\" namest=\"c5\" rowspan=\"2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.71c\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42(89.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21(84)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of marriage (Mean \u0026plusmn; SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.77\u0026thinsp;\u0026plusmn;\u0026thinsp;9.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.52\u0026thinsp;\u0026plusmn;\u0026thinsp;11.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of marriage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003en (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003en (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCompanionate marriage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26(61.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(52.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{x}^{2}\\)\u003c/span\u003e\u003c/span\u003e=0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c6\" namest=\"c5\" rowspan=\"2\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.65b\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArranged marriage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16(38.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(47.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003en (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003en (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNucleus family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39(83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22(88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c6\" namest=\"c5\" rowspan=\"3\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;1c\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtended family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(10.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLives alone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfession\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003en (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003en (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21(44.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{x}^{2}\\)\u003c/span\u003e\u003c/span\u003e=0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c6\" namest=\"c5\" rowspan=\"2\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.90b\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26(55.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(60)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlace of residence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003en (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003en (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmaller than the provincial center\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10(21.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c6\" namest=\"c5\" rowspan=\"2\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.20c\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProvincial center\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37(78.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23(92)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of OCD (months) (Mean \u0026plusmn; SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e145.68\u0026thinsp;\u0026plusmn;\u0026thinsp;110.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e111.16\u0026thinsp;\u0026plusmn;\u0026thinsp;100.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;1.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYBOCS obsession (Mean \u0026plusmn; SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.15\u0026thinsp;\u0026plusmn;\u0026thinsp;3.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.60\u0026thinsp;\u0026plusmn;\u0026thinsp;2.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;1.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.051\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYBOCS compulsion (Mean \u0026plusmn; SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.60\u0026thinsp;\u0026plusmn;\u0026thinsp;2.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.44\u0026thinsp;\u0026plusmn;\u0026thinsp;2.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;3.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYBOCS Total (Mean \u0026plusmn; SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.74\u0026thinsp;\u0026plusmn;\u0026thinsp;5.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.04\u0026thinsp;\u0026plusmn;\u0026thinsp;5.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;2.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMean \u0026plusmn; SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eMean \u0026plusmn; SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyadic Consensus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37.87\u0026thinsp;\u0026plusmn;\u0026thinsp;11.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.48\u0026thinsp;\u0026plusmn;\u0026thinsp;9.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;3.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyadic Satisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.85\u0026thinsp;\u0026plusmn;\u0026thinsp;8.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.48\u0026thinsp;\u0026plusmn;\u0026thinsp;6.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;5.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAffectional Expression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.66\u0026thinsp;\u0026plusmn;\u0026thinsp;2.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.20\u0026thinsp;\u0026plusmn;\u0026thinsp;2.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;4.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyadic Cohesion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.89\u0026thinsp;\u0026plusmn;\u0026thinsp;4.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.72\u0026thinsp;\u0026plusmn;\u0026thinsp;4.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;3.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDAS Total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80.81\u0026thinsp;\u0026plusmn;\u0026thinsp;23.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e106.76\u0026thinsp;\u0026plusmn;\u0026thinsp;19.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;4.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTAS-20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63.17\u0026thinsp;\u0026plusmn;\u0026thinsp;10.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56.84\u0026thinsp;\u0026plusmn;\u0026thinsp;11.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;2.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eNotes: b: Yates statistic, c: Fisher\u0026rsquo;s exact test, t: Independent groups t-test, Z: Mann\u0026ndash;Whitney U analysis, The p values in bold are statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eAbbreviations: YBOCS: Yale\u0026ndash;Brown Obsessive Compulsive Scale, DAS: Dyadic Adjustment Scale, TAS-20: Toronto Alexithymia Scale, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD: Mean Value and Standard Deviation, M (1Q\u0026ndash;3Q): Median and Quarterly Values, SDs: Sexual Dysfunctions\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eA weak positive relationship was observed between the YBOCS obsession subscale score and the TAS-20 score in patients diagnosed with OCD (r\u0026thinsp;=\u0026thinsp;0.304, p\u0026thinsp;=\u0026thinsp;0.009). Similarly, a weak positive relationship was found between the YBOCS compulsion subscale score and the ASEX total score (r\u0026thinsp;=\u0026thinsp;0.266, p\u0026thinsp;=\u0026thinsp;0.024), as well as between the YBOCS compulsion subscale score and the TAS-20 score (r\u0026thinsp;=\u0026thinsp;0.336, p\u0026thinsp;=\u0026thinsp;0.004).\u003c/p\u003e \u003cp\u003eAdditionally, a weak negative relationship was identified between the YBOCS compulsion subscale score and the DAS total score (r = -0.307, p\u0026thinsp;=\u0026thinsp;0.009). A weak positive relationship was also found between the YBOCS total score and both the ASEX total score (r\u0026thinsp;=\u0026thinsp;0.256, p\u0026thinsp;=\u0026thinsp;0.030) and the TAS-20 score (r\u0026thinsp;=\u0026thinsp;0.330, p\u0026thinsp;=\u0026thinsp;0.005). Conversely, a weak negative relationship existed between the YBOCS total score and the DAS total score (r = -0.275, p\u0026thinsp;=\u0026thinsp;0.019).\u003c/p\u003e \u003cp\u003eFurthermore, a weak positive relationship was detected between the ASEX total score and the TAS-20 score (r\u0026thinsp;=\u0026thinsp;0.366, p\u0026thinsp;=\u0026thinsp;0.002), while a moderate negative relationship was found between the ASEX total score and the DAS total score (r = -0.442, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Lastly, there was a weak negative relationship between the TAS-20 score and the DAS total score (r = -0.339, p\u0026thinsp;=\u0026thinsp;0.004). No significant correlations were found between the other scale scores. Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e presents the correlations of the YBOCS, ASEX, TAS-20, and DAS scores among patients with OCD.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelations of scale scores of patients with OCD\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYBOCS obsession\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYBOCS compulsion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYBOCS Total\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eASEX Total\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTAS-20\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDAS Total\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYBOCS obsession\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.872\u003c/p\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.970\u003c/p\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.231\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.051\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003er\u0026thinsp;=\u0026thinsp;0.304\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.009\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.228\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.054\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYBOCS compulsion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.872\u003c/p\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.965\u003c/p\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003er\u0026thinsp;=\u0026thinsp;0.266\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.024\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003er\u0026thinsp;=\u0026thinsp;0.336\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003er\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.307\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.009\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYBOCS Total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.970\u003c/p\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.965\u003c/p\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003er\u0026thinsp;=\u0026thinsp;0.256\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.030\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003er\u0026thinsp;=\u0026thinsp;0.330\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003er\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.275\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.019\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASEX Total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.231\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.051\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.266\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.256\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003er\u0026thinsp;=\u0026thinsp;0.366\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003er\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.442\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTAS-20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.304\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.336\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.330\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.366\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003er\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.339\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDAS-Total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.228\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.307\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.275\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.442\u003c/p\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.339\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003ePearson correlation, The p values in bold are statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eAbbreviations: YBOCS: Yale\u0026ndash;Brown Obsessive Compulsive Scale, ASEX: Arizona Sexual Experiences Scale, TAS-20: Toronto Alexithymia Scale, DAS: Dyadic Adjustment Scale,\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to investigate the relationships between alexithymia, SDs and dyadic adjustment in patients with OCD compared to healthy controls. To our knowledge, no prior research has examined the correlation between alexithymia, sexual dysfunction, and dyadic adjustment, specifically in patients with OCD. The most significant finding of our study was that OCD patients with alexithymia exhibited greater impairment in sexual functioning and lower dyadic adjustment than those without alexithymia. Additionally, we found that patients with OCD had higher alexithymia scores, poorer sexual functioning, and lower levels of dyadic adjustment compared to the healthy population.\u003c/p\u003e \u003cp\u003eIn the present study, the levels of alexithymia in patients with OCD were significantly higher than those in healthy controls. This finding is consistent with previous studies that also found that OCD patients exhibited greater levels of alexithymia compared to healthy individuals [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. These findings indicate that patients with OCD struggle to recognize and identify their emotions, suggesting that chronic OCD processes may contribute to alexithymic traits.\u003c/p\u003e \u003cp\u003eIn the present study, patients with OCD who were alexithymic experienced more severe obsessions and compulsions compared to those without alexithymic. Additionally, a positive relationship was found between levels of obsession, compulsion, and alexithymia. These findings can be interpreted in two ways: either alexithymia increases as the severity of OCD rises, or individuals with alexithymic traits experience more severe clinical manifestations of OCD. Khosravani et al. reported that OCD symptoms were more severe in alexithymic patients than in those without alexithymia [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. De Berardis et al. found that symptoms were more severe in patients with OCD who had higher levels of alexithymia [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Roh et al. found a positive correlation between alexithymia, obsession levels, and the severity of OCD symptoms [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Carpenter and Chung found that alexithymia in patients with OCD correlates with the severity and number of OCD symptoms [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Uslu et al. found no significant correlation between the severity of obsessive symptoms and alexithymia, which was attributed to the small sample size of the study [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The results from the literature review and the current study align with each other. These findings indicate that cognitive behavioral therapy (CBT) aimed at addressing alexithymia may have a positive impact on the progression of the disease by decreasing the severity of OCD symptoms.\u003c/p\u003e \u003cp\u003eIn the present study, patients with OCD exhibited significantly greater impairments in arousal, sexual desire, orgasm, penile erection, and satisfaction with orgasm compared to healthy controls. The higher rate of SDs in patients with OCD than in the control group supports the findings of previous studies in the relevant literature, which compared patients with OCD with the control group [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Many patients with OCD are often dissatisfied with their sexual relationships and tend to avoid sexual intercourse [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Some cognitive biases associated with OCD may also affect sexual satisfaction and functioning. Additionally, certain symptoms, such as contamination, can impair sexual performance [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Sexual obsessions can cause feelings of guilt in some patients. Additionally, drug treatments may lead to SDs [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. The results of the study may be influenced by the nature of OCD or the medication used. However, the impact of alexithymia and dyadic adjustment on sexuality should not be overlooked.\u003c/p\u003e \u003cp\u003eIn the current study, patients with OCD who experienced SDs exhibited significantly more severe compulsions and OCD symptoms compared to those without SDs. While the severity of obsessions was also greater in patients with OCD who had SDs, this difference was not statistically significant. Furthermore, the study found that the incidence of SDs increased alongside the severity of OCD symptoms and compulsions in these patients. This aligns with the findings from Thakurta et al., which reported a positive correlation between the severity of OCD symptoms and the presence of SDs [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Raisi et al. found a negative correlation between OCD symptom severity and sexual satisfaction [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. OCD is a chronic disorder caused by impairments in several areas of function [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e] and the results of the present study indicate that as the severity of the disease increases, the degree of impairment in dyadic relationships and sexuality, which are important areas of function, increases. Compulsions, such as repeated cleaning after sex and extensive cleaning efforts, can take a long time and are often visibly noticeable. These behaviors can lead to sexual avoidance and SDs.\u003c/p\u003e \u003cp\u003eIn the present study, patients with OCD who had SDs exhibited significantly higher levels of alexithymia compared to those without SDs. Additionally, patients with OCD who were alexithymic demonstrate a greater extent of sexual dysfunction than those who were not alexithymic. A positive correlation is observed between the level of alexithymia and the severity of SDs in patients with OCD. This finding suggests that as the level of alexithymia increases in patients with OCD, there is a corresponding decline in sexual function. However, to the best of our knowledge, no previous studies have specifically examined the relationship between alexithymia and SDs in patients with OCD. Giuliani et al. conducted a study on individuals without mental disorders, revealing that levels of alexithymia were significantly higher in those with SDs compared to a control group without SDs [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Berenguer et al. found that higher levels of alexithymia in women were linked to poorer functioning across all dimensions of sexual function, except for the sexual desire stage [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Wise et al. reported no relationship between types of SDs and alexithymia levels [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. The association between alexithymic individuals and sexual difficulties seems intuitively logical. In human sexuality, the ability to express and experience emotions is one of the most important elements [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. While further research is needed to determine whether alexithymia is associated with SDs, especially in clinical populations such as those with OCD, it is important that clinicians are more aware of alexithymic traits in patients with OCD.\u003c/p\u003e \u003cp\u003eThe present study also investigated how the participants interpreted their dyadic adjustment, in addition to sexual functions reflecting partner relationships. The dyadic adjustment levels of patients with OCD were considerably lower than those of healthy controls. Furthermore, there was a negative relationship between obsession levels, compulsion levels, and the severity of OCD symptoms and dyadic adjustment in patients with OCD. Given these results, it can be suggested that an increase in the severity of OCD symptoms decreases dyadic adjustment. A previous study reported a negative correlation between the severity of obsessions and relationship satisfaction [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Another study suggested that couples experienced less marital distress as OCD symptoms decreased after exposure treatment and that there was a negative relationship between OCD severity and relationship satisfaction [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. Riggs et al. reported a significant increase in marital adjustment after CBT in patients with OCD who were dissatisfied with their marriages before treatment and reported that the treatment of OCD symptoms contributed to improvements in marital satisfaction [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. OCD plays a drastic role in the emergence of issues related to marriage and sexuality, as it exposes a person to excessive anxiety and leads to strained relationships. As the severity of obsessions increases, patients with OCD, who are more preoccupied with intrusive thoughts, devote less time and energy to intimate relationships with their partners [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. This can reduce dyadic adjustment, as expected. Family- and couple-based treatment methods should also be considered in the follow-up and treatment processes of patients diagnosed with OCD to regulate the vicious cycle, in which a severe clinical course inflicts an adverse effect on dyadic adjustment, and low dyadic adjustment increases the severity of the disease.\u003c/p\u003e \u003cp\u003eIn the present study, a negative relationship was found between dyadic adjustment and alexithymia levels in the patient group, and dyadic adjustment was significantly lower in patients with OCD who were alexithymic than in patients with OCD who were non-alexithymic. These results confirm that the occurrence of alexithymic traits in patients with OCD decreases dyadic adjustment. The authors of the present study found no previous studies that assessed alexithymia and dyadic adjustment in patients with OCD. Previous studies with individuals without mental disorders reported lower dyadic adjustment in individuals with high levels of alexithymia. Aghighi et al. reported a negative relationship between alexithymia and dyadic adjustment and a significant positive relationship between alexithymia and marital stress [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. Yelsma and Marrow reported that difficulties in couples' emotional expression in marriage impaired their own and their spouses' marital satisfaction [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. Other studies also reported significant negative correlations between alexithymia and dyadic adjustment [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. OCD patients with higher levels of alexithymia might have difficulty establishing and maintaining intimate relationships.\u003c/p\u003e \u003cp\u003eTaylor et al. suggested that alexithymia was not a predictor of dyadic adjustment [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. Accordingly, the present study investigated sexual functioning as well, in addition to disease severity and alexithymia, to identify the variables that might be related to dyadic adjustment in patients with OCD. One of the more significant parameters affecting dyadic adjustment is sexual functioning. Dyadic adjustment is adversely affected by impaired sexual functioning; conversely, sexual functioning is impaired when dyadic adjustment is affected [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the present study, dyadic adjustment was found to be higher in patients with OCD who did not have SDs compared to those with OCD who had SDs, and a negative relationship was observed between SDs and dyadic adjustment in patients with OCD. Raeisi et al. reported a significant negative relationship between SDs and marital satisfaction in patients with OCD [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. Similar to our study, in a study with patients diagnosed with bipolar disorder, dyadic adjustment was lower in those who had SDs than in those without SDs [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]. These data support the bidirectional relationship between SDs and impaired dyadic adjustment in patients with OCD and similar chronic mental disorders.\u003c/p\u003e \u003cp\u003eIn the present study, the employment rate of patients with OCD was considerably lower than that of the control group. OCD is a persistent mental disorder that adversely affects an individual's familial, social, and occupational functioning [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. This may be due to the loss of functionality associated with OCD.\u003c/p\u003e \u003cp\u003eTo the best of our knowledge, the present study is the first to compare patients with OCD with healthy controls in terms of alexithymia, SDs and dyadic adjustment. A limited number of previous studies have investigated the correlations between OCD and alexithymia, OCD and SDs, and OCD and dyadic adjustment in patients and control groups.\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThe present study has several limitations. The cross-sectional design prevents us from establishing cause-and-effect relationships between the variables. Although we met the required sample size based on the power analysis, the relatively small sample size is still a significant limitation. Future studies with larger sample sizes may yield more statistically significant results. Additionally, the medications taken by the patient group make it challenging to distinguish between medication-induced SDs and SDs related to OCD. Moreover, the effects of pharmacological treatments on sexual function were assessed through self-reports, which may not provide the most accurate results. More objective findings could be obtained by including evaluations such as hormone measurements and blood prolactin levels. Another limitation of the present study is that we relied solely on self-report scales to assess dyadic adjustment, which may affect the reliability of the data. Furthermore, dyadic adjustment was only evaluated from the participants\u0026rsquo; perspective. Including the partners of the patient group in future studies would provide a more comprehensive understanding of dyadic adjustment.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBased on the study results, patients with OCD exhibit higher levels of alexithymia compared to healthy controls. Additionally, the presence of alexithymia appears to be linked to poorer sexual functioning and lower dyadic adjustment in relationships. Therefore, it is important to explore the presence of alexithymic traits in patients with OCD. Assessing alexithymic characteristics in these patients and understanding their relationships with SDs and dyadic adjustment may facilitate the initiation of appropriate treatment methods and enhance their social and familial functioning. There is a need for longitudinal studies with larger sample sizes, particularly involving newly diagnosed patients with OCD, as well as studies that categorize patients based on their medication use. Additionally, further research into the correlations between dyadic adjustment, sexual dysfunctions, and alexithymia in other psychiatric disorders will help to clarify these issues.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eOCD Obsessive\u0026ndash;Compulsive Disorder\u003c/p\u003e\n\u003cp\u003eSDs Sexual dysfunctions\u003c/p\u003e\n\u003cp\u003eSCID-5-CV Structured Clinical Interview for DSM-5 Clinician Version\u003c/p\u003e\n\u003cp\u003eDSM-5 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition\u003c/p\u003e\n\u003cp\u003eSSRI Selective Serotonin Reuptake Inhibitor\u003c/p\u003e\n\u003cp\u003eYBOCS Yale Brown Obsessive Compulsive Scale\u003c/p\u003e\n\u003cp\u003eTAS Toronto Alexithymia Scale\u003c/p\u003e\n\u003cp\u003eASEX Arizona Sexual Experiences Scale\u003c/p\u003e\n\u003cp\u003eDAS Dyadic Adjustment Scale\u003c/p\u003e\n\u003cp\u003eCBT Cognitive Behavioral Therapy\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the participants who contributed to this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eT.S. and G.K. conceived and designed the study. T.S., G.K., M.E.D. and Z.N. conducted the literature review. G.K., L.T., M.E.D., Z.N., T.S. and C.Y. conducted the research. T.S. applied the scales. T.S., G.K., L.T. and M.E.D. performed the statistical analysis. T.S., G.K., Z.N. and C.Y. drafted the manuscript. G.K., L.T. and M.E.D. reviewed the manuscript. All authors read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo specific funding for this research was provided by the government, business, or nonprofit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo datasets were generated or analysed during the current study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics committee approval for the study was obtained on September 4, 2020, from the Cukurova University Faculty of Medicine, Non-Interventional Clinical Research Ethics Committee, upon meeting No. 103. After being fully briefed on the study, all participants provided written informed consent. The research followed the guidelines set forth by the Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants gave informed consent for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trail number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1- Tunahan Sun, MD\u003c/p\u003e\n\u003cp\u003eD\u0026uuml;zi\u0026ccedil;i State Hospital Department of Psychiatry, Osmaniye, Turkey\u003c/p\u003e\n\u003cp\[email protected]\u003c/p\u003e\n\u003cp\u003ehttps://orcid.org/0000-0002-1383-3154\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;2- Gonca Karakuş, MD\u003c/p\u003e\n\u003cp\u003e\u0026Ccedil;ukurova University Medical School Department of Psychiatry, Adana, Turkey\u003c/p\u003e\n\u003cp\[email protected]\u003c/p\u003e\n\u003cp\u003ehttps://orcid.org/0000-0001-5211-4032\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;3- Lut Tamam, MD\u003c/p\u003e\n\u003cp\u003e\u0026Ccedil;ukurova University Medical School Department of Psychiatry, Adana, Turkey\u003c/p\u003e\n\u003cp\[email protected]\u003c/p\u003e\n\u003cp\u003ehttps://orcid.org/0000-0002-9750-7531\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;4- Mehmet Emin Demirkol, MD\u003c/p\u003e\n\u003cp\u003e\u0026Ccedil;ukurova University Medical School Department of Psychiatry, Adana, Turkey\u003c/p\u003e\n\u003cp\[email protected]\u003c/p\u003e\n\u003cp\u003ehttps://orcid.org/0000-0003-3965-7360\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;5- Zeynep Namlı, MD\u003c/p\u003e\n\u003cp\u003e\u0026Ccedil;ukurova University Medical School Department of Psychiatry, Adana, Turkey\u003c/p\u003e\n\u003cp\[email protected]\u003c/p\u003e\n\u003cp\u003ehttps://orcid.org/0000-0001-8954-5901\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;6- Caner Yeşiloğlu, MD\u003c/p\u003e\n\u003cp\u003e\u0026Ccedil;ukurova University Medical School Department of Psychiatry, Adana, Turkey\u003c/p\u003e\n\u003cp\[email protected]\u003c/p\u003e\n\u003cp\u003ehttps://orcid.org/0000-0002-9997-351X\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponding Author:\u0026nbsp;\u003c/strong\u003eTunahan Sun, MD\u003c/p\u003e\n\u003cp\u003eD\u0026uuml;zi\u0026ccedil;i State Hospital Department of Psychiatry, Osmaniye, Turkey\u003c/p\u003e\n\u003cp\[email protected]\u003c/p\u003e\n\u003cp\u003ehttps://orcid.org/0000-0002-1383-3154\u003c/p\u003e\n\u003cp\u003eGSM: +905068626693\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eRasmussen SA, Tsuang MT. Clinical characteristics and family history in DSM-III obsessive-compulsive disorder. American Journal of Psychiatry. 1986;143:317\u0026ndash;22.\u003c/li\u003e\n\u003cli\u003eFawcett EJ, Power H, Fawcett JM. Women Are at Greater Risk of OCD Than Men: A Meta-Analytic Review of OCD Prevalence Worldwide. J Clin Psychiatry. 2020;81.\u003c/li\u003e\n\u003cli\u003eLochner C, Fineberg NA, Zohar J, van Ameringen M, Juven-Wetzler A, Altamura AC, et al. Comorbidity in obsessive-compulsive disorder (OCD): a report from the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS). Compr Psychiatry. 2014;55:1513\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eEisen JL, Sibrava NJ, Boisseau CL, Mancebo MC, Stout RL, Pinto A, et al. Five-year course of obsessive-compulsive disorder: predictors of remission and relapse. J Clin Psychiatry. 2013;74:233\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eDi Tella M, Adenzato M, Catmur C, Miti F, Castelli L, Ardito RB. The role of alexithymia in social cognition: Evidence from a non-clinical population. J Affect Disord. 2020;273:482\u0026ndash;92.\u003c/li\u003e\n\u003cli\u003eRadetzki PA, Wrath AJ, Le T, Adams GC. Alexithymia is a mediating factor in the relationship between adult attachment and severity of depression and social anxiety. J Affect Disord. 2021;295 October 2020:846\u0026ndash;55.\u003c/li\u003e\n\u003cli\u003eMattila AK, Salminen JK, Nummi T, Joukamaa M. Age is strongly associated with alexithymia in the general population. J Psychosom Res. 2006;61:629\u0026ndash;35.\u003c/li\u003e\n\u003cli\u003eMcgillivray L, Becerra R, Harms C. Prevalence and Demographic Correlates of Alexithymia : A Comparison Between Australian Psychiatric and Community Samples. 2016;00:1\u0026ndash;12.\u003c/li\u003e\n\u003cli\u003eBerthoz S, Artiges E, Van de Moortele P-F, Poline J-B, Rouquette S, Consoli SM, et al. Effect of impaired recognition and expression of emotions on frontocingulate cortices: an fMRI study of men with alexithymia. american Journal of Psychiatry. 2002;159:961\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eShapira NA, Liu Y, He AG, Bradley MM, Lessig MC, James GA, et al. Brain activation by disgust-inducing pictures in obsessive-compulsive disorder. Biol Psychiatry. 2003;54:751\u0026ndash;6.\u003c/li\u003e\n\u003cli\u003eBozorg M, Rahimi C, Mohammadi N. Evaluating the Components of Alexithymia in Patients With Obsessive-Compulsive Disorder. 2021;8:175\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eUslu U, Erensoy H, Meterelliyoz KS, Ayta\u0026ccedil; HM, Berkol TD. Obsesif kompulsif bozukluǧa sahip hastalar ile saǧlıklı bireyler arasındaki aleksitimi d\u0026uuml;zey farklılıklarının karşılaştırılması; Comparison of alexithymia level differences associated with obsessive compulsive disorder patients and healthy people. The Journal of Neurobehavioral Sciences. 2020;7:52.\u003c/li\u003e\n\u003cli\u003eRoh D, Kim WJ, Kim CH. Alexithymia in obsessive-compulsive disorder: Clinical correlates and symptom dimensions. Journal of Nervous and Mental Disease. 2011;199:690\u0026ndash;5.\u003c/li\u003e\n\u003cli\u003eDavison SL, Bell RJ, LaChina M, Holden SL, Davis SR. The relationship between self-reported sexual satisfaction and general well-being in women. J Sex Med. 2009;6:2690\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eBurri A, Spector T. Recent and lifelong sexual dysfunction in a female UK population sample: prevalence and risk factors. J Sex Med. 2011;8:2420\u0026ndash;30.\u003c/li\u003e\n\u003cli\u003eKendurkar A, Kaur B. Major depressive disorder, obsessive-compulsive disorder, and generalized anxiety disorder: Do the sexual dysfunctions differ? Primary Care Companion to the Journal of Clinical Psychiatry. 2008;10:299\u0026ndash;305.\u003c/li\u003e\n\u003cli\u003eLaumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: Prevalence and predictors. Journal of the American Medical Association. 1999;281:537\u0026ndash;44.\u003c/li\u003e\n\u003cli\u003eHumphreys TP, Wood LM, Parker JDA. Alexithymia and satisfaction in intimate relationships. Pers Individ Dif. 2009;46:43\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eVan de Poll NE, Van Goozen SH. Hypothalamic involvement in sexuality and hostility: comparative psychological aspects. Prog Brain Res. 1992;93:343\u0026ndash;61.\u003c/li\u003e\n\u003cli\u003eSifneos PE. Affect, emotional conflict, and deficit: an overview. Psychother Psychosom. 1991;56:116\u0026ndash;22.\u003c/li\u003e\n\u003cli\u003eGiuliani M, Fabrizi A, Rossi R, Tripodi F, Eleuteri S, Di Pomponio I, et al. Alexithymia and sexual functioning: A clinical study on female patients with sexual disorders. F1000Res. 2011;2.\u003c/li\u003e\n\u003cli\u003eBerenguer C, Reb\u0026ocirc;lo C, Costa RM. Interoceptive awareness, alexithymia, and sexual function. J Sex Marital Ther. 2019;45:729\u0026ndash;38.\u003c/li\u003e\n\u003cli\u003eStengler-Wenzke K, Kroll M, Matschinger H, Angermeyer MC. Quality of life of relatives of patients with obsessive-compulsive disorder. Compr Psychiatry. 2006;47:523\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eNewth S, Rachman S. The concealment of obsessions. Behaviour research and therapy. 2001;39:457\u0026ndash;64.\u003c/li\u003e\n\u003cli\u003eRiggs DS, Hiss H, Foa EB. Marital distress and the treatment of Obsessive Compulsive Disorder. Behav Ther. 1992;23:585\u0026ndash;97.\u003c/li\u003e\n\u003cli\u003eKasalova P, Prasko J, Ociskova M, Holubova M, Vanek J, Kantor K, et al. Marriage under control : Obsessive compulsive disorder and partnership. 2020;41:134\u0026ndash;45.\u003c/li\u003e\n\u003cli\u003eEid P, Boucher S. Alexithymia and dyadic adjustment in intimate relationships: Analyses using the actor partner interdependence model. J Soc Clin Psychol. 2012;31:1095\u0026ndash;111.\u003c/li\u003e\n\u003cli\u003eKarakis EN, Levant RF. Is normative male alexithymia associated with relationship satisfaction, fear of intimacy and communication quality among men in relationships? J Mens Stud. 2012;20:179\u0026ndash;86.\u003c/li\u003e\n\u003cli\u003eFirst MB. Structured Clinical Interview for the DSM (SCID). In: Cautin RL, Lilienfeld SO, editors. The Encyclopedia of Clinical Psychology. First Edit. Wiley-Blackwell; 2015.\u003c/li\u003e\n\u003cli\u003eElbir M, Topbaş \u0026Ouml;A, Bayad S, Kocabaş T, Topak OZ, \u0026Ccedil;etin Ş. DSM-5 Bozuklukları i\u0026ccedil;in Yapılandırılmış Klinik G\u0026ouml;r\u0026uuml;şmenin Klinisyen Versiyonunun T\u0026uuml;rk\u0026ccedil;eye Uyarlanması ve G\u0026uuml;venilirlik \u0026Ccedil;alışması. T\u0026uuml;rk Psikiyatri Dergisi. 2019;30:51\u0026ndash;6.\u003c/li\u003e\n\u003cli\u003eKaramustafalıoğlu O, \u0026Uuml;\u0026ccedil;ışık A, Ulusoy M, Erkmen H. Yale-Brown obsesyon kompulsiyon derecelendirme \u0026ouml;l\u0026ccedil;eği\u0026rsquo;nin ge\u0026ccedil;erlilik ve g\u0026uuml;venilirlik \u0026ccedil;alışması. In: Ulusal Psikiyatri Kongresi \u0026Ouml;zet Kitabi. Bursa Savaş Ofset; 1993. p. 29.\u003c/li\u003e\n\u003cli\u003eG\u0026uuml;le\u0026ccedil; H, K\u0026ouml;se S, G\u0026uuml;le\u0026ccedil; MY, \u0026Ccedil;itak S, Evren C, Borckardt J, et al. Reliability and factorial validity of the Turkish version of the 20-item Toronto alexithymia scale (TAS-20). Klinik Psikofarmakoloji Bulteni. 2009;19:214.\u003c/li\u003e\n\u003cli\u003eMcGahuey CA, Gelenberg AJ, Laukes CA, Moreno FA, Delgado PL, McKnight KM, et al. The Arizona Sexual Experience Scale (ASEX): reliability and validity. J Sex Marital Ther. 2000;26:25\u0026ndash;40.\u003c/li\u003e\n\u003cli\u003eTuran Ş, Poyraz CA, Sağlam NGU, Batun G\u0026Ccedil;, Yassa A, Duran A. Obsesif kompulsif bozukluk hastalarında cinsel İşlev bozuklukları. Yeni Symposium. 2015;53:37\u0026ndash;44.\u003c/li\u003e\n\u003cli\u003eSoykan A. The reliability and validity of Arizona sexual experiences scale in Turkish ESRD patients undergoing hemodialysis. Int J Impot Res. 2004;16:531\u0026ndash;4.\u003c/li\u003e\n\u003cli\u003eSpanier GB. Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads. J Marriage Fam. 1976;:15\u0026ndash;28.\u003c/li\u003e\n\u003cli\u003eFişiloğlu H, Demir A. Applicability of the Dyadic Adjustment Scale for measurement of marital quality with Turkish couples. European Journal of Psychological Assessment. 2000;16:214.\u003c/li\u003e\n\u003cli\u003eKhosravani V, Samimi Ardestani M, Sharifi Bastan F, Kamali Z. The relationship between alexithymia and symptom dimensions in patients with obsessive-compulsive disorder. J Obsessive Compuls Relat Disord. 2017;14 November 2016:127\u0026ndash;33.\u003c/li\u003e\n\u003cli\u003eDe Berardis D, Serroni N, Campanella D, Rapini G, Olivieri L, Feliziani B, et al. Alexithymia, responsibility attitudes and suicide ideation among outpatients with obsessive-compulsive disorder: an exploratory study. Compr Psychiatry. 2015;58:82\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eCarpenter L, Chung MC. Childhood trauma in obsessive compulsive disorder: the roles of alexithymia and attachment. Psychology and Psychotherapy: Theory, Research and Practice. 2011;84:367\u0026ndash;88.\u003c/li\u003e\n\u003cli\u003eAngst J, Gamma A, Endrass J, Goodwin R, Ajdacic V, Eich D, et al. Obsessive-compulsive severity spectrum in the community: Prevalence, comorbidity, and course. Eur Arch Psychiatry Clin Neurosci. 2004;254:156\u0026ndash;64.\u003c/li\u003e\n\u003cli\u003eReal E, Montejo \u0026Aacute;, Alonso P, Manuel Mench\u0026oacute;n J. Sexuality and obsessive-compulsive disorder: The hidden affair. Neuropsychiatry. 2013;3:23\u0026ndash;31.\u003c/li\u003e\n\u003cli\u003eBalon R. SSRI-associated sexual dysfunction. Am J Psychiatry. 2006;163:1504\u0026ndash;9; quiz 1664.\u003c/li\u003e\n\u003cli\u003eThakurta RG, Singh OP, Dhar P, Sarkar S, Ray P. Prevalence and nature of sexual dysfunctions in OCD in a tertiary medical college. 2014;17:20\u0026ndash;30.\u003c/li\u003e\n\u003cli\u003eRaisi F, Ghassemzadeh H, Khojastefar RF, Karamghadiri N, Meysamie A, Sorayani M, et al. Prevalence of sexual dysfunction in a group of Obsessive-Compulsive Disorder (OCD) patients in Iran. Imaging Journal of Clinical and Medical Sciences. 2019;6:89\u0026ndash;93.\u003c/li\u003e\n\u003cli\u003eHollander E, Benzaquen SD. Is there a distinct OCD spectrum? CNS Spectr. 1996;1:17\u0026ndash;26.\u003c/li\u003e\n\u003cli\u003eWise TN, Osborne C, Strand J, Fagan PJ, Schmidt CWJ. Alexithymia in patients attending a sexual disorders clinic. J Sex Marital Ther. 2002;28:445\u0026ndash;50.\u003c/li\u003e\n\u003cli\u003ePurifoy FE, Grodsky A, Giambra LM. The relationship of sexual daydreaming to sexual activity, sexual drive, and sexual attitudes for women across the life-span. Arch Sex Behav. 1992;21:369\u0026ndash;85.\u003c/li\u003e\n\u003cli\u003eAbbey RD, Clopton JR, Humphreys JD. Obsessive-Compulsive Disorder and Romantic Functioning. J Clin Psychol. 2007;63:1181\u0026ndash;92.\u003c/li\u003e\n\u003cli\u003eEmmelkamp PMG, De Haan E, Hoogduin CAL. Marital Adjustment and Obsessive\u0026ndash;Compulsive Disorder. British Journal of Psychiatry. 1990;156:55\u0026ndash;60.\u003c/li\u003e\n\u003cli\u003eAghighi A, Foroughi M, Daneshmandi S, Abbasi M. The Role of Alexithymia and Sexual Self-esteem in the Prediction of Marital Stress and Adjustment in Infertile Women. Practice in Clinical Psychology. 2021;9:19\u0026ndash;26.\u003c/li\u003e\n\u003cli\u003eYelsma P, Marrow S. An examination of couples\u0026rsquo; difficulties with emotional expressiveness and their marital satisfaction. The Journal of Family Communication. 2003;3:41\u0026ndash;62.\u003c/li\u003e\n\u003cli\u003eHesse C, Pauley PM, Frye-Cox NE. Alexithymia and marital quality: The mediating role of relationship maintenance behaviors. West J Commun. 2015;79:45\u0026ndash;72.\u003c/li\u003e\n\u003cli\u003eTaylor GJ, Bagby RM, Kushner SC, Benoit D, Atkinson L. Alexithymia and adult attachment representations: Associations with the five-factor model of personality and perceived relationship adjustment. Compr Psychiatry. 2014;55:1258\u0026ndash;68.\u003c/li\u003e\n\u003cli\u003eHawton K, Catalan J. Prognostic factors in sex therapy. Behaviour Research and Therapy. 1986;24:377\u0026ndash;85.\u003c/li\u003e\n\u003cli\u003eRaeisi F, Ghassemzadeh H, Karamghadiri N, Firoozikhojastefar R, Meysami A, Nasehi AA, et al. Sexual function and marital satisfaction in female with obsessive-compulsive disorder. Journal of Arak University of Medical Sciences. 2016;19:11\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eNamli Z, Karakuş G, Tamam L. Assessment of Dyadic Adjustment and Sexual Functions in Patients with Bipolar Disorder. Archives of Neuropsychiatry. 2018;55:171.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Alexithymia, Sexual Dysfunction, Dyadic Adjustment, Obsessive–Compulsive Disorder","lastPublishedDoi":"10.21203/rs.3.rs-6185799/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6185799/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003cem\u003e:\u003c/em\u003e\u003cstrong\u003e \u003c/strong\u003eChronic mental disorders can adversely affect sexual functioning and dyadic adjustment. This study aimed to examine the relationship between alexithymia, sexual dysfunctions, and dyadic adjustment by comparing patients with obsessive-compulsive disorder (OCD) to healthy controls.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003cem\u003e:\u003c/em\u003e This research involved 72 patients with OCD and 82 healthy controls who had similar sociodemographic characteristics to the patients. The Toronto Alexithymia Scale (TAS-20), Arizona Sexual Experiences Scale (ASEX), Yale–Brown Obsessive Compulsive Scale (YBOCS), and Dyadic Adjustment Scale (DAS) were applied to the participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003cem\u003e:\u003c/em\u003e Patients with OCD had significantly higher mean total scores on the TAS-20 and ASEX scales compared to healthy controls (p \u0026lt; 0.001 for both). The median total and subscale scores of the DAS were significantly lower in patients with OCD than in healthy controls (p \u0026lt; 0.001). Additionally, a positive correlation was found between the total scores of the TAS-20 and ASEX in patients with OCD. There was a negative correlation between the total score of the TAS-20 and both the total and subscale scores of the DAS (p \u0026lt; 0.05 for each).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003cem\u003e:\u003c/em\u003e The results of the study suggest that patients with OCD exhibit higher levels of alexithymic traits, poorer sexual functioning, and lower dyadic adjustment compared to the healthy population. Additionally, the presence of alexithymia in patients with OCD is linked to reduced dyadic adjustment and sexual functioning. Evaluating alexithymic traits in patients with OCD and implementing appropriate treatment approaches may help these patients improve their social and familial functioning.\u003c/p\u003e","manuscriptTitle":"Association Between Alexithymia, Sexual Dysfunctions, and Dyadic Adjustment in Obsessive–Compulsive Disorder","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-10 06:30:20","doi":"10.21203/rs.3.rs-6185799/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f1707511-4f4d-47d0-af67-31eb7dc6aa50","owner":[],"postedDate":"April 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-03T12:54:11+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-10 06:30:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6185799","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6185799","identity":"rs-6185799","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}