The effect of childhood maltreatment on suicidal ideation through cognitive emotion regulation strategies and specific obsessive–compulsive symptoms in obsessive–compulsive disorder

Abstract

Childhood maltreatment is thought to be associated with suicidality in patients with obsessive-compulsive disorder (OCD). Although the underlying mechanism of this relationship is not clear, cognitive emotion regulation strategies (CERSs) and the specific OC symptoms including unacceptable obsessional thoughts (UOTs) and responsibility for harm (RFH) may underlie this link. Accordingly, the study aimed to assess the effect of childhood maltreatment on suicidal ideation through UOTs, RFH and adaptive and maladaptive CERSs in OCD patients. Three hundred patients meeting a DSM-5 diagnosis of OCD were selected and completed the scales measuring childhood maltreatment, OCD, suicidality and depressive symptoms. After controlling for depressive symptoms and OCD severity, childhood maltreatment was shown to affect suicidal ideation directly. Also, the indirect effect of childhood maltreatment on suicidal ideation was mediated by adaptive CERSs, UOTs and RFH.The findings show that OCD patients with a history of childhood maltreatment, less use of adaptive CERSs and the experiences of UOTs and RFH should be carefully considered regarding suicidal risk.

The associations of obsessive–compulsive symptom dimensions and general severity with suicidal ideation in patients with obsessive–compulsive disorder: The role of specific stress responses to COVID‐19

“…The present study aimed to evaluate the effects of OC symptom dimensions and OCD symptom severity on suicidal ideation through the role of specific stress responses to COVID‐19 in a clinical group of patients with OCD. The prevalence of suicide attempts in patients was 22.7%, consistent with rates reported in the previous studies (i.e., 1 to 52%; Albert et al, 2019; De La Vega et al, 2018; Dell'Osso et al, 2018; Kim et al, 2016; Rajabi Khamesi et al, in press; Pellegrini et al, 2020). Discrepancies in reporting the prevalence of suicide attempts in these studies may be due to the study samples differing in the prevalence of comorbid psychiatric disorders, especially BD, MDD, and SUDs (Albert et al, 2018) as well as heterogeneity regarding age ranges, sample size, study design, gender distribution, and various tools assessing suicide attempts (see Angelakis et al, 2015; Pellegrini et al, 2020).…”

“…The results of the current study showed that, among the OC symptom dimensions, responsibility for harm and unacceptable obsessional thoughts as well as OCD severity indirectly affected suicidal ideation through stress responses in reaction to the pandemic, specifically traumatic stress symptoms and compulsive checking, after controlling for covariates of general depression and anxiety, comorbidity, and lifetime suicide attempts. These results are consistent with prior findings showing the significant role of these same OC symptom dimensions and OCD severity in suicidality, including suicidal ideation (e.g., Albert et al, 2019; Balci & Sevincok, 2010; De Berardis et al, 2015; DeVylder et al, 2012; Khosravani, Bastan, et al, 2017; Khosravani, Kamali, et al, 2017; Kim et al, 2016; Krebs et al, 2020; Rajabi Khamesi et al, in press; Torres et al, 2011; Velloso et al, 2016). Further, the present findings are consistent with the results of previous studies reporting the relationships between COVID‐19 and suicidal ideation in patients with OCD (Benatti, Albert, et al, 2020).…”

“…Among these dimensions, responsibility for harm and unacceptable thoughts play an important role in the maintenance of OCD (Abramowitz et al, 2006; Arntz et al, 2007; Neal et al, 2017) and are associated with poor treatment outcomes (Jacoby, Abramowitz, et al, 2019; Mataix‐Cols et al, 2002; Shetti et al, 2005; Steketee et al, 2019; Williams et al, 2014). In addition, the responsibility for harm and unacceptable thoughts dimensions are more strongly related to suicidality than other OC symptom dimensions above and beyond depression and OCD severity (Albert et al, 2019; Balci & Sevincok, 2010; De Berardis et al, 2015; DeVylder et al, 2012; Khosravani, Bastan, et al, 2017; Khosravani, Kamali, et al, 2017; Kim et al, 2016; Krebs et al, 2020; Rajabi Khamesi et al, in press; Torres et al, 2011; Velloso et al, 2016).…”

Suicidal Ideation and Obsessive-Compulsive Disorder: Links and Knowledge

“…Experiencing traumatic events during childhood when the individual is psychologically and neurodevelopmentally vulnerable is associated with an increased risk of developing psychopathology and SI later in life. 60 , 61 Especially childhood sexual abuse and the development of early maladaptive schemas. 6 , 62 As previously mentioned, childhood abuse been suggested to be the most notable variable distinguishing SI from SA in OCD.…”

“… 65 However, in individuals with OCD and a history of childhood maltreatment, unacceptable obsessional thoughts and responsibility for harm may be critical to this connection. 61 Emotion regulation has also been proposed as a potential underlying mechanism of OCD-related suicidality, due to a critical disruption of these abilities following an adverse event. 61 , 66 …”