Xu Ziming, Zhu Cheng
Department of Psychiatry, Hangzhou Seventh People's Hospital, Hangzhou Zhejiang, China.
Alpha Psychiatry. 2023 Nov 1;24(6):261-269. doi: 10.5152/alphapsychiatry.2023.231247. eCollection 2023 Nov.
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.
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.
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 < .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 < .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 < .05). There was no significant difference in the F4 scores between the 2 groups ( = .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 < .05). The total OCI-R score showed a significant positive correlation with emotional abuse, physical abuse, sexual abuse, physical neglect, and total CTQ score ( = 0.564; = 0.518; = 0.542; = 0.586; = 0.603, all < .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 ( = 0.504; = 0.531; = 0.611; = 0.466; = 0.519; = 0.665; = 0.351; = 0.597; = 0.667; = 0.484; = 0.586; = 0.662, all < .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 ( = 0.571; = 0.624; = 0.670; = 0.592; = 0.684, all < .05).
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.
强迫症（OCD）是一种具有多种生物学、心理学和社会学因素的精神疾病。本研究的目的是调查强迫症患者的童年创伤经历、养育方式和家庭适应行为，探索影响其发病的社会心理因素，并分析这些社会心理因素与强迫症症状之间的相关性，以更好地理解其病因。
我们招募了109名被诊断为强迫症的患者（患者组）和144名健康对照者（对照组）参与本研究。对所有参与者进行了强迫症量表修订版（OCI-R）、儿童创伤问卷简版（CTQ-SF）、父母教养方式问卷（EMBU）和家庭适应量表患者版（FAS-PV）问卷调查。
与对照组相比，患者组在检查、囤积、强迫观念、排序、洗涤、中和方面的OCI-R得分以及OCI-R总分均显著更高（均P <.05）。与对照组相比，患者组在情感虐待、身体虐待、性虐待、情感忽视、身体忽视方面的CTQ得分以及CTQ总分均显著更高（均P <.05）。与对照组相比，患者组在F1、F2、F3、F5、F6、M1、M2、M3、M4、M5方面的EMBU得分以及EMBU总分均显著更高（均P <.05）。两组在F4得分上无显著差异（P = 0.622）。与对照组相比，患者组在直接参与和促进强迫症症状、避免强迫症触发因素、承担患者责任、调整个人责任方面的FAS-PV得分以及FAS-PV总分均显著更高（均P <.05）。OCI-R总分与情感虐待、身体虐待、性虐待、身体忽视以及CTQ总分呈显著正相关（r = 0.564；r = 0.518；r = 0.542；r = 0.586；r = 0.603，均P <.05）。OCI-R总分与F1、F2、F3、F5、F6、M1、M2、M3、M4、M5方面的得分以及EMBU总分呈显著正相关（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，均P <.05）。OCI-R总分与直接参与和促进、避免强迫症触发因素、承担患者责任、调整个人责任方面的得分以及FAS-PV总分呈显著正相关（r = 0.571；r = 0.624；r = 0.670；r = 0.592；r = 0.684，均P <.05）。
我们的研究结果凸显了童年不良经历、养育方式和家庭适应对强迫症患者的重要性。重要的是，这些不良经历与这些患者症状的严重程度密切相关。我们认为心理变化而非仅仅生理变化在强迫症的发生和发展中起关键作用。本研究证实家庭和童年经历在强迫症的发生中起重要作用，童年期的家庭教育极大地影响强迫症的发生。因此，可以推断童年期良好的家庭心理教育对降低强迫症风险有积极作用。如果能将家庭心理教育纳入社区医疗服务，这将有助于缓解心理健康状况的发展。
