Visser Henny A, van Minnen Agnes, van Megen Harold, Eikelenboom Merijn, Hoogendoorn Adriaan W, Kaarsemaker Maarten, van Balkom Anton J, van Oppen Patricia
GGZ Centraal, lokatie Veldwijk, Afdeling Marina de Wolf Centrum, Postbus 1000, 3853 BA, Ermelo, the Netherlands
J Clin Psychiatry. 2014 Oct;75(10):1034-9. doi: 10.4088/JCP.13m08825.
Studies on the relationship between adverse childhood experiences (ACEs) and obsessive-compulsive disorder (OCD) symptom severity are scarce. Available studies leave a considerable degree of uncertainty. The present study examines the relationship between ACEs and symptom severity, chronicity, and comorbidity in a sample of patients with OCD.
Baseline data of the Netherlands Obsessive Compulsive Disorder Association (NOCDA) study, in which 382 referred patients with DSM-IV-diagnosed OCD participated, were analyzed. ACEs (physical abuse, sexual abuse, witnessing interparental violence, maternal dysfunction, paternal dysfunction, and early separation from a parent) were measured using a structured interview. Data were collected between September 2005 and November 2009.
None of the ACEs were related to OCD symptom severity or chronicity, nor was there a dose-response relationship between ACEs and OCD severity or chronicity, but results of linear regression analysis revealed that ACEs were related to comorbidity in patients with OCD (P < .001), in particular to comorbid affective disorders (P < .01), substance use disorders (P < .01), and eating disorders (P < .01), but not to comorbid anxiety disorders.
Results of the study suggest that unlike in other psychiatric disorders, ACEs play no significant role in symptom severity and chronicity of OCD. This study was the first to reveal evidence for a relationship between ACEs and comorbidity in patients with OCD. Conclusions about trauma-relatedness of OCD based on studies finding higher trauma rates or severity among patients with OCD than among healthy controls, should be critically reconsidered, since presence of comorbidity might account for these differences.
关于童年不良经历（ACEs）与强迫症（OCD）症状严重程度之间关系的研究较少。现有研究存在相当程度的不确定性。本研究在一组强迫症患者样本中考察了ACEs与症状严重程度、慢性病程及共病之间的关系。
对荷兰强迫症协会（NOCDA）研究的基线数据进行分析，该研究有382名转诊的符合DSM-IV诊断标准的强迫症患者参与。使用结构化访谈来测量ACEs（身体虐待、性虐待、目睹父母间暴力、母亲功能障碍、父亲功能障碍以及早年与父母分离）。数据收集时间为2005年9月至2009年11月。
没有一种ACEs与强迫症症状严重程度或慢性病程相关，ACEs与强迫症严重程度或慢性病程之间也不存在剂量反应关系，但线性回归分析结果显示，ACEs与强迫症患者的共病有关（P <.001），尤其与共病的情感障碍（P <.01）、物质使用障碍（P <.01）和进食障碍（P <.01）有关，但与共病的焦虑障碍无关。
研究结果表明，与其他精神障碍不同，ACEs在强迫症的症状严重程度和慢性病程中不起重要作用。本研究首次揭示了ACEs与强迫症患者共病之间存在关联的证据。基于发现强迫症患者中创伤发生率或严重程度高于健康对照的研究而得出的关于强迫症与创伤相关性的结论，应予以批判性地重新审视，因为共病的存在可能解释了这些差异。
