The Relationship Between Adverse Childhood Experiences, Symptom Severity, Negative Thinking, Comorbidity, and Treatment Response in Youth with Obsessive-Compulsive Disorder

The Relationship between Childhood Trauma Experiences and Psychotic Vulnerability in Obsessive Compulsive Disorder: An Italian Cross-Sectional Study

People with obsessive compulsive disorder (OCD) are at increased risk of developing psychotic disorders; yet little is known about specific clinical features which might hint at this vulnerability. The present study was aimed at elucidating the pathophysiological mechanism linking OCD to psychosis through the investigation of childhood trauma experiences in adolescents and adults with OCD. One hundred outpatients, aged between 12 and 65 years old, were administered the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and its Child version (CY-BOCS), as well as the Childhood Trauma Questionnaire (CTQ); Cognitive-Perceptual basic symptoms (COPER) and high-risk criterion Cognitive Disturbances (COGDIS) were assessed in the study sample. Greater childhood trauma experiences were found to predict psychotic vulnerability (p = 0.018), as well as more severe OCD symptoms (p = 0.010) and an earlier age of OCD onset (p = 0.050). Participants with psychotic vulnerability reported higher scores on childhood trauma experiences (p = 0.02), specifically in the emotional neglect domain (p = 0.01). In turn, emotional neglect and psychotic vulnerability were found higher in the pediatric group than in the adult group (p = 0.01). Our findings suggest that childhood trauma in people with OCD may represent an indicator of psychotic vulnerability, especially in those with an earlier OCD onset. Research on the pathogenic pathways linking trauma, OCD, and psychosis is needed.

Effect of Adverse Childhood Experiences, Parenting Styles, and Family Accommodation on Patients Diagnosed with Obsessive-Compulsive Disorder

Background

Obsessive-compulsive disorder (OCD) is a mental illness that has multiple biological, psychological, and sociological factors. The aim of this study was to investigate childhood traumatic experiences, parenting style, and family adaptive behaviors in patients with OCD, to explore the psychosocial factors that affect its occurrence, and to analyze the correlation between these psychosocial factors and OCD symptoms to better understand its etiology.

Methods

We recruited 109 patients diagnosed with OCD (patient group) and 144 healthy controls (control group) into this study. The Obsessive-Compulsive Inventory-Revised (OCI-R), Childhood Trauma Questionnaire-Short Form (CTQ-SF), Egna Minnen Betraffande Uppfostran (EMBU), and Family Accommodation Scale-Patient Version (FAS-PV) questionnaires were administered to all participants.

Results

Patient OCI-R scores for checking, hoarding, obsessing, ordering, washing, neutralizing, and total OCI-R scores were significantly higher when compared with the control group (all P < .05). Patient CTQ scores for emotional abuse, physical abuse, sexual abuse, emotional neglect, physical neglect, and total CTQ scores were significantly higher when compared with the control group (all P < .05). Patients' EMBU scores for F1, F2, F3, F5, F6, M1, M2, M3, M4, M5, and total EMBU scores were significantly higher when compared with the control group (all P < .05). There was no significant difference in the F4 scores between the 2 groups (P = .622). Patient FAS-PV scores for the direct participation and facilitation of OCD symptoms, avoidance of OCD triggers, taking on patient responsibilities, modification of personal responsibilities, and total FAS-PV scores were significantly higher when compared with the control group (all P < .05). The total OCI-R score showed a significant positive correlation with emotional abuse, physical abuse, sexual abuse, physical neglect, and total CTQ score (r = 0.564; r = 0.518; r = 0.542; r = 0.586; r = 0.603, all P < .05). The total OCI-R score showed a significant positive correlation with the scores for F1, F2, F3, F5, F6, M1, M2, M3, M4, M5, and the total EMBU score (r = 0.504; r = 0.531; r = 0.611; r = 0.466; r = 0.519; r = 0.665; r = 0.351; r = 0.597; r = 0.667; r = 0.484; r = 0.586; r = 0.662, all P < .05). The total OCI-R score showed a significant positive correlation with scores for direct participation and facilitation, avoidance of OCD triggers, taking on patient responsibilities, modification of personal responsibilities, and total FAS-PV score (r = 0.571; r = 0.624; r = 0.670; r = 0.592; r = 0.684, all P < .05).

Conclusion

Our findings highlight the importance of adverse childhood experiences, parenting styles, and family accommodation on OCD patients. Importantly, these adverse experiences are closely related to the severity of symptoms in these patients. We suggest that psychological, and not only physiological, changes play a crucial role in the occurrence and development of OCD. This study confirmed that family and childhood experiences play an important role in the occurrence of OCD, and family education in childhood greatly affects the occurrence of OCD. Therefore, it can be inferred that good family psychological education in childhood has a positive effect on reducing the risk of OCD. If family psychological education can be included in community medical services, this will help to mitigate the development of mental health situations.