Dysregulation and Parental Expressed Emotion in Pediatric OCD: Their Impact on Symptom Severity and Long-term Outcomes

Aims<br/>This study aimed to investigate parental Expressed Emotion (EE) and the persistence of dysregulation in pediatric OCD, and their association with symptom severity, functional impairment, and comorbidities, while also examining their impact of on treatment outcomes across three years.<br/>Methods<br/>This study is a part of the Nordic Long-term OCD Treatment Study (NordLOTS), including 269 youth aged 7–17 years diagnosed with OCD according to DSM - IV. Dysregulation was assessed using the Child Behavior Checklist Dysregulation Profile (CBCL-DP), while symptom severity and functional impairment were measured with the Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) and the Child Obsessive Impact Scale (COIS-RC/P). Parental EE was analyzed in a sub-sample (n = 49) through Five-Minute Speech Sample (FMSS) interviews at baseline. Comorbidities were evaluated using structured diagnostic tools.<br/>Results<br/>At baseline, 15.9% of participants were classified as dysregulated, showing significantly higher functional impairment (p &lt; .001) and greater comorbid depressive, autistic, and anxiety symptoms, as well as increased rates of ADHD, ODD, and tics (p &lt; .001). Dysregulation levels decreased to 1.4% at 3-year follow-up. Preliminary results indicate that high parental EE will be associated with poorer treatment outcomes, greater symptom severity, and an increased likelihood of long-term difficulties.<br/>Conclusions<br/>Dysregulation and high parental EE significantly impact treatment outcomes in pediatric OCD. Addressing these factors during cognitive behavioral therapy (CBT) may enhance long-term treatment efficacy, improve functional outcomes, and reduce relapse risk. These findings underscore the need to incorporate family dynamics and self-regulation interventions into pediatric OCD treatment.