自閉スペクトラム症における強迫関連現象の一考察 --“見る”ことによる心的体験に着目して--

Abstract

自閉スペクトラム症(autism spectrum disorder ; 以下 ASD)と強迫性障害(obsessive compulsive disorder ; 以下OCD)の併存率の高さが注目されている。本論ではASDの強迫様症状をOCDの併存ではなくASD独自の強迫関連現象と捉え、その基底にある強迫心性を検討することで強迫発生の機序を論考した。ASDの強迫関連現象については背後に不安障害の併存を指摘するもの、神経心理学的な問題の関与を示唆するものなど、その発生原因の可能性は多岐に渡り未だ解明をみない。本論はその中でもASD特有の視覚認知特性の関与に着目しmarginalな局所を選択的に注視するという彼ら独特の“見る”ことの在り方が、強迫関連現象に繋がる強迫の連鎖をもたらすという仮説に帰着した。また知覚と情動の敏感さから生じる「強い警戒的な構え」と、原初的知覚が優位というASD独自の知覚体験により、彼らが日常的に強い不安、侵入的体験している可能性が示唆され、このことから彼ら独自の在り方に寄り添った援助が肝要であるとの考察に至った。

The high coexistence rate of autism spectrum disorder (ASD) and obsessive compulsive disorder (OCD) has been addressed in the literature. In this study, the mechanisms underlying the compulsive symptoms of ASD were investigated by regarding them as ASD-specific obsessive-compulsive phenomena rather than the coexistence of OCD and examining the underlying compulsiveness. The mechanisms of the obsessive-compulsive phenomena of ASD have not been clarified. While there are various considerations including the coexistence of anxiety disorders and the involvement of neuropsychological problems. This study focused on the visual cognitive traits peculiar to ASD and developed a hypothesis that the unique way of “seeing” by these individuals that involves selectively gazing at marginal local areas brings about a chain of compulsion and then compulsion-related phenomena. In addition, ASD’s unique perceptual experience such as “strong alertness” resulting from perceptual and emotional sensitivity and the predominance of primitive perception suggests that these individuals may experience strong anxiety and intrusion in their daily lives. Therefore, it is essential to provide assistance to these individuals close to their own way of being.