Impulsivity in patients with obsessive-compulsive disorder: exploring the mediating effect of cognitive emotion regulation strategies and depressive symptoms

Abstract

Background: the underlying mechanism of impulsivity in obsessive-compulsive disorder (OCD) patients is complex and still unclear. Previous studies have not thoroughly explored whether impulsivity in OCD patients is a result of the obsessive-compulsive symptoms themselves or other contributing factors. This study aimed to explore whether cognitive emotion regulation strategies and depressive symptoms mediate the relationship between the severity of obsessive-compulsive symptoms and impulsivity in a clinical population with OCD.

Methods: this was a case-control study that recruited 65 OCD patients (male/female=31/34) and 65 healthy controls (male/female =23/42), matched for age, gender, and education level. Demographic and clinical data were collected, and the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Beck Depression Inventory-II (BDI-II), Barratt Impulsiveness Scale-11 (BIS-11) and Cognitive Emotion Regulation Questionnaire (CERQ) were adopted.

Results: OCD patients scored higher on BIS-11 attentional and non-planning impulsiveness and total scores (all p < 0.05). On CERQ, OCD patients showed elevated maladaptive strategies (self-blame, rumination, catastrophizing, blaming others) and reduced adaptive strategies (positive reappraisal) (all p < 0.05). Attentional impulsiveness positively correlated with OCD severity, depression, and maladaptive strategies (all p < 0.05). Non-planning impulsiveness and BIS-11 total scores positively correlated with depression and negatively with adaptive strategies (all p < 0.05). After adjusting for age, gender, depression level, there was only a significant negative correlation between BIS-11 non-planning impulsiveness and CERQ maladaptive strategies (r = -0.28, p < 0.05). Mediation analysis revealed significant indirect effects of OCD severity on impulsivity via adaptive strategies/depression (β = 0.13, 95% CI: 0.03~0.24, p = 0.012) and via maladaptive strategies/depression (β = 0.09, 95% CI: 0.00~0.23, p = 0.042), but no significant direct or total effects.

Conclusions: OCD symptom severity indirectly influences impulsivity through emotion regulation strategies and depressive symptoms, highlighting the need to target these mediators in clinical interventions.

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ORCID for Ruihua Hou: orcid.org/0000-0001-6127-1478

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