Potential mediators of the association between childhood maltreatment and obsessive-compulsive disorder in adulthood

Background: Childhood maltreatment (CM) is associated with enhanced symptom severity of obsessive -compulsive disorder (OCD). However, little is known about the mechanisms underlying this relationship. In order to improve treatment for CM survivors suffering from OCD, it is important to understand the psychological processes mediating the putative association between CM and OCD. Method: The aim of the study was to investigate the role of emotion regulation difficulties, rumination, attachment, dissociation, and posttraumatic stress symptoms as potential mediators between CM and OCD symptom severity in a clinical sample of OCD patients (N = 68). Participants completed self-report questionnaires and standardized clinical diagnostic interviews while attending specialized inpatient treatment for OCD. To test hypothesis-based mediation models, mediation analyses were calculated using a regression-based approach. Results: As predicted, all hypothesized factors were found to mediate the association between CM and OCD symptom severity. Additionally, more severe CM leads to increased difficulties in emotion regulation, anxiety in close relationships, rumination, dissociative symptoms, and posttraumatic symptoms, which subsequently leads to more severe OCD symptoms. Conclusions: The findings point towards psychological processes that might be responsible for the well-studied relationship between CM and OCD. Implications for future research and clinical management of OCD in CM survivors are discussed.