Document Type : Original Article

Author of Clinical Psychology, Department of Psychology, University of Mohaghegh Ardabili, Ardabil, Iran


The purpose of this study was to examine the compare of cognitive insight and separation anxiety in patients with generalized anxiety disorder and obsessive-compulsive disorder. The population consist of all patients with generalized anxiety disorder and obsessive-compulsive disorder referred to clinical centers of Ardabil. In this study 80 patients were selected. In this study were used of questionnaire of separation anxiety and cognitive insight. Data analysis included multivariate regression, pearson’s r correlations, regression analysis, ANOVA analyses with SPSS software (package of Spss / pc + + ver 21). The results showed that, the mean of your thinking and cognitive vision in patients with obsessive-compulsive disorder more than patients with generalized anxiety disorder. According to the findings, the mean of discomfort due to separation, relax in the separation and cognitive insight in patients with obsessive-compulsive disorder more than patients with generalized anxiety disorder.


Abramowitz, J.S., Whiteside, S., Kalsy, SA. & Tolin, DF. (2003). Thought control strategies in obsessive- compulsive disorder:  A replication and extension. Behavior Research and Therapy, 41(2), 529-540.
Amador, X.F., & David, A.S. (2004). Insight and Psychosis. New York: Oxford Univercity Press.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th Ed.). Washington, DC:  Author.
Bandura, A. (1988). Self-efficacy conception of anxiety. Anxiety Res. 1, 77–98.
Bar-Haim, Y., Lamy, D., Pergamin, L., Bakermans-Kranenburg, M. J., and Van IJzendoorn, M. H. (2007). Threat-related attentional bias in anxious and nonanxious individuals: a meta-analytic study. Psychol. Bull. 133, 1–24.
Bech, A.T., Baruch, E., Balter, J.M., Stress, R.A., & warman, D.M. (2004). Anew instrument for measuring in sight: the Beck cognsitive in sight scale, schizo phrenia Research, 68(5), 319-329.
Boldrini, M., Del Pace, L., Placidi, G. P., Keilp, J., Ellis, S. P., Signori, S., et al. (2005). Selective cognitive deficits in obsessive-compulsive disorder compared to panic disorder with agoraphobia. Acta Psychiatr. Scand. 111, 150–158.
Bonanno, G. A., Keltner, D., Holen, A., and Horowitz, M. J. (1995). When avoiding unpleasant emotions might not be such a bad thing: verbal-autonomic response dissociation and midlife conjugal bereavement. J. Pers. Soc. Psychol. 69, 975.
Borkovec, T. D., and Inz, J. (1990). The nature of worry in generalized anxiety disorder: a predominance of thought activity. Behav. Res. Ther. 28, 153–158.
Brown, T. A., Antony, M. M., and Barlow, D. H. (1992). Psychometric properties of the Penn state worry questionnaire in a clinical anxiety disorders sample. Behav. Res. Ther. 30, 33–37.
Catapano, F., Perris, F., Fabrazzo, M., Cioffi, V., Giacco, D., Santis, V D., & Maj, M. (2010). Obsessive–compulsive disorder with poor insight: A three-year prospective study. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 34(2), 323–330.
Chapman, L. J., and Chapman, J. P. (2001). Commentary on two articles concerning generalized and specific cognitive deficits. J. Abnorm. Psychol. 110, 31–39.
Charney, D. S., Woods, S. W., Goodman, W. K., Rifkin, B., Kinch, M., Aiken, B., et al. (1986). Drug treatment of panic disorder: the comparative efficacy of imipramine, alprazolam, and trazodone. J. Clin. Psychiatry 47, 580–586.
Cherian, AV.,  Narayanaswamy, JC.,  Srinivasaraju, R., Viswanath, B.,  & Math, SB. (2012). Kandavel, TH. Reddy, YCJ    Does insight have specific correlation with symptom dimensions in OCD?Journal of Affective Disorders. 138(3), 352–359.
Clark, L., Manes, F., Antoun, N., Sahakian, B. J., and Robbins, T. W. (2003). The contributions of lesion laterality and lesion volume to decision-making impairment following frontal lobe damage. Neuropsychologia 41, 1474–1483.
Cohen, L. J., Hollander, E., Decaria, C. M., and Stein, D. J. (1996). Specificity of neuropsychological impairment in obsessive-compulsive disorder: a comparison with social phobic and normal control subjects. J. Neuropsychiatry Clin. Neurosci. 8, 82–85.
 Colis, MJ., Steer, R A., & Beck, A T. (2006). Cognitive Insight in Inpatients with Psychotic, Bipolar, and Major Depressive Disorders.Journal of Psychopathology and Behavioral Assessment. 28(­4), 242-249.
Corballis, P. M., Funnell, M. G., and Gazzaniga, M. S. (2002). Hemispheric asymmetries for simple visual judgments in the split brain. Neuropsychologia 40, 401–410.
Cornwell, B. R., Alvarez, R. P., Lissek, S., Kaplan, R., Ernst, M., and Grillon, C. (2011). Anxiety overrides the blocking effects of high perceptual load on amygdala reactivity to threat-related distractors. Neuropsychologia 49, 1363–1368.
Cornwell, B. R., Baas, J. M., Johnson, L., Holroyd, T., Carver, F. W., Lissek, S., et al. (2007). Neural responses to auditory stimulus deviance under threat of electric shock revealed by spatially-filtered magnetoencephalography. Neuroimage 37, 282–289.
Cornwell, B. R., Echiverri, A. M., Covington, M. F., and Grillon, C. (2008). Modality-specific attention under imminent but not remote threat of shock: evidence from differential prepulse inhibition of startle. Psychol. Sci. 19, 615–622.
Dalton, K. M., Kalin, N. H., Grist, T. M., and Davidson, R. J. (2005). Neural-cardiac coupling in threat-evoked anxiety. J. Cogn. Neurosci. 17, 969–980.
Darke, S. (1988). Effects of anxiety on inferential reasoning task performance. J. Pers. Soc. Psychol. 55, 499–505.
Davidson, R. J. (1978). Specificity and patterning in biobehavioral systems: implications for behavior change. Am. Psychol. 33, 430.
Davis, M. (1998). Are different parts of the extended amygdala involved in fear versus anxiety? Biol. Psychiatry 44, 1239–1247.
D'Esposito, M., Aguirre, G. K., Zarahn, E., Ballard, D., Shin, R. K., and Lease, J. (1998). Functional MRI studies of spatial and nonspatial working memory. Cogn. Brain Res. 7, 1–13.
Diekhof, E. K., Geier, K., Falkai, P., and Gruber, O. (2011). Fear is only as deep as the mind allows: a coordinate-based meta-analysis of neuroimaging studies on the regulation of negative affect. Neuroimage 58, 275–285.
Engels, A. S., Heller, W., Mohanty, A., Herrington, J. D., Banich, M. T., Webb, A. G., et al. (2007). Specificity of regional brain activity in anxiety types during emotion processing. Psychophysiology 44, 352–363.
Eysenck, M. W., and Calvo, M. G. (1992). Anxiety and performance: the processing efficiency theory. Cogn. Emot. 6, 409–434.
Eysenck, M. W., Derakshan, N., Santos, R., and Calvo, M. G. (2007). Anxiety and cognitive performance: attentional control theory. Emotion 7, 336–353.
Eysenck, N. D. M. W. (1998). Working memory capacity in high trait-anxious and repressor groups. Cogn. Emot. 12, 697–713.
Fales, C. L., Barch, D. M., Burgess, G. C., Schaefer, A., Mennin, D. S., Gray, J. R., et al. (2008). Anxiety and cognitive efficiency: differential modulation of transient and sustained neural activity during a working memory task. Cogn. Affect. Behav. Neurosci. 8, 239–253.
First, M. B., Gibbon, M., Spitzer, R. L., and Williams, J. B. W. (1995). Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) Research Version. New York, NY: New York State Psychiatric Institute.
Ge, Y., Wu, J., Sun, X., and Zhang, K. (2011). Enhanced mismatch negativity in adolescents with posttraumatic stress disorder (PTSD). Int. J. Psychophysiol. 79, 231–235.
Goldwin, R., Lipsitz, J.D., Chapman, T.F., Fyer, A.J. & Mannuzza, S. (2001). Obsessive- compulsive disorder and separation anxiety co-morbidity in early onset panic disorder. Psychological Medicine, 31(8), 1307-1310.
Grillon, C. (2002). Startle reactivity and anxiety disorders: aversive conditioning, context, and neurobiology. Biol. Psychiatry 52, 958–975.
Heller, W., Nitschke, J. B., Etienne, M. A., and Miller, G. A. (1997). Patterns of regional brain activity differentiate types of anxiety. J. Abnorm. Psychol. 106, 376–385.
Ikeda, M., Iwanaga, M., and Seiwa, H. (1996). Test anxiety and working memory system. Percept. Mot. Skills 82, 1223–1231.
Jacob, R. G., Moller, M. B., Turner, S. M., and Wall, C. 3rd. (1985). Otoneurological examination in panic disorder and agoraphobia with panic attacks: a pilot study. Am. J. Psychiatry 142, 715–720.
Kalisch, R., Wiech, K., Critchley, H. D., and Dolan, R. J. (2006). Levels of appraisal: a medial prefrontal role in high-level appraisal of emotional material. Neuroimage 30, 1458–1466.
Kashyap, H., Kumar, J. K., Kandavel, T., & Reddy, Y. C. J. (2012). Neuropsychological correlates of insight in obsessive–compulsive disorder. Acta Psychiatrica Scandinavica. 126(2),  106–114.
Katon, W. (1984). Panic disorder and somatization: review of 55 cases. Am. J. Med. 77, 101–106.
Kessler, R. C., Aguilar-Gaxiola, S., Alonso, J., Chatterji, S., Lee, S., Ormel, J., et al. (2009). The global burden of mental disorders: an update from the WHO World Mental Health (WMH) surveys. Epidemiol. Psichiatr. Soc. 18, 23–33.
Kim, S. H., and Hamann, S. (2007). Neural correlates of positive and negative emotion regulation. J. Cogn. Neurosci. 19, 776–798.
Lang, P. J., Bradley, M. M., and Cuthbert, B. N. (1998). Emotion and motivation: measuring affective perception. J. Clin. Neurophysiol. 15, 397–408.
Lavie, N. (2005). Distracted and confused?: selective attention under load. Trends Cogn. Sci. 9, 75–82.
Lavric, A., Rippon, G., and Gray, J. R. (2003). Threat-evoked anxiety disrupts spatial working memory performance: an attentional account. Cogn. Ther. Res. 27, 489–504.
Lim, S. L., Padmala, S., and Pessoa, L. (2009). Segregating the significant from the mundane on a moment-to-moment basis via direct and indirect amygdala contributions. Proc. Natl. Acad. Sci. U.S.A. 106, 16841–16846.
Lucas, J. A., Telch, M. J., and Bigler, E. D. (1991). Memory functioning in panic disorder: a neuropsychological perspective. J. Anxiety Disord. 5, 1–20.
Manoach, D. S., White, N. S., Lindgren, K. A., Heckers, S., Coleman, M. J., Dubal, S., et al. (2004). Hemispheric specialization of the lateral prefrontal cortex for strategic processing during spatial and shape working memory. Neuroimage 21, 894–903.
Markham, R., and Darke, S. (1991). The effects of anxiety on verbal and spatial task performance. Aust. J. Psychol. 43, 107–111.
Masson, M. E. (2003). Using confidence intervals for graphically based data interpretation. Can. J. Exp. Psychol. 57, 203–220.
Molina, S., and Borkovec, T. D. (1994). “The penn state worry questionnaire: psychometric properties and associated characteristics,” in Worrying: Perspectives on Theory, Assessment and Treatment, eds G. C. L. Davey and F. Tallis (Oxford: John Wiley and Sons), 265–283.
Morgan, C. A. III., and Grillon, C. (1999). Abnormal mismatch negativity in women with sexual assault-related posttraumatic stress disorder. Biol. Psychiatry 45, 827–832.
Mroczkowski, M.M., Goes, F.S., Riddle, M.A., Grados, M.A., Bienvenu, O.J., Greenberg BD. & Fyer, AJ. (2012). Separation anxiety disorder in OCD. Depress Anxiety, 28(3), 62-256.
Mueller, S. C., Temple, V., Cornwell, B., Grillon, C., Pine, D. S., and Ernst, M. (2009). Impaired spatial navigation in pediatric anxiety. J. Child Psychol. Psychiatry 50, 1227–1234.
Nee, D. E., Brown, J. W., Askren, M. K., Berman, M. G., Demiralp, E., Krawitz, A., et al. (2013). A meta-analysis of executive components of working memory. Cereb. Cortex 23, 264–282.
Nitschke, J. B., Heller, W., Palmieri, P. A., and Miller, G. A. (1999). Contrasting patterns of brain activity in anxious apprehension and anxious arousal. Psychophysiology 36, 628–637.
Ochsner, K. N., Ray, R. D., Cooper, J. C., Robertson, E. R., Chopra, S., Gabrieli, J. D., et al. (2004). For better or for worse: neural systems supporting the cognitive down-and up-regulation of negative emotion. Neuroimage 23, 483–499.
Owen, A. M., McMillan, K. M., Laird, A. R., and Bullmore, E. (2005). N-back working memory paradigm: a meta-analysis of normative functional neuroimaging studies. Hum. Brain Mapp. 25, 46–59.
Paulesu, E., Sambugaro, E., Torti, T., Danelli, L., Ferri, F., Scialfa, G., et al. (2010). Neural correlates of worry in generalized anxiety disorder and in normal controls: a functional MRI study. Psychol. Med. 40, 117–124.
Porcelli, A. J., Cruz, D., Wenberg, K., Patterson, M. D., Biswal, B. B., and Rypma, B. (2008). The effects of acute stress on human prefrontal working memory systems. Physiol. Behav. 95, 282–289.
Qin, S., Hermans, E. J., Van Marle, H. J. F., Luo, J., and Fernández, G. (2009). Acute psychological stress reduces working memory-related activity in the dorsolateral prefrontal cortex. Biol. Psychiatry 66, 25–32.
Rapee, R. M. (1993). The utilisation of working memory by worry. Behav. Res. Ther. 31, 617–620.
Robinson, O. J., Charney, D. R., Overstreet, C., Vytal, K., and Grillon, C. (2012). The adaptive threat bias in anxiety: amygdala-dorsomedial prefrontal cortex coupling and aversive amplification. Neuroimage 60, 523–529.
Robinson, O., Letkiewicz, A., Overstreet, C., Ernst, M., and Grillon, C. (2011). The effect of induced anxiety on cognition: threat of shock enhances aversive processing in healthy individuals. Cogn. Affect. Behav. Neurosci. 11, 217–227.
Sanders, M. R. (2004). Every parent: A positive approachto children’s behavior. Melbourne: Penguin Austalia.
Scaini, S., Pezzica, E., Belotti, R., Colonna, S. & Ogliari, A. (2014). The Nature of Covariation between Separation Anxiety Symptoms and Obsessive Compulsive Symptoms in Developmental Age. Ann Depress Anxiety, 1(4), 1017- 1021.
Shackman, A. J., Maxwell, J. S., McMenamin, B. W., Greischar, L. L., and Davidson, R. J. (2011). Stress potentiates early and attenuates late stages of visual processing. J. Neurosci. 31, 1156–1161.
Shackman, A. J., Sarinopoulos, I., Maxwell, J. S., Pizzagalli, D. A., Lavric, A., and Davidson, R. J. (2006). Anxiety selectively disrupts visuospatial working memory. Emotion 6, 40–61.
Silk, T. J., Bellgrove, M. A., Wrafter, P., Mattingley, J. B., and Cunnington, R. (2010). Spatial working memory and spatial attention rely on common neural processes in the intraparietal sulcus. Neuroimage 53, 718–724.
Simon, N. M., Pollack, M. H., Tuby, K. S., and Stern, T. A. (1998). Dizziness and panic disorder: a review of the association between vestibular dysfunction and anxiety. Ann. Clin. Psychiatry 10, 75–80.
Spielberger, C. D., Gorsuch, R. L., Lushene, R., Vagg, P., and Jacobs, G. A. (1983). Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologist Press.
Viviani, D., Charlet, A., van den Burg, E., Robinet, C., Hurni, N., Abatis, M., et al. (2011). Oxytocin selectively gates fear responses through distinct outputs from the central amygdala. Science 333, 104–107.
Vytal, K., Cornwell, B., Arkin, N., and Grillon, C. (2012). Describing the interplay between anxiety and cognition: from impaired performance under low cognitive load to reduced anxiety under high load. Psychophysiology 49, 842–852.
Watson, D. (2009). Differentiating the mood and anxiety disorders: a quadripartite model. Annu. Rev. Clin. Psychol. 5, 221–247.