The Impact of Expressed Emotions on Comorbidity and Severity of Symptoms in Patients with Obsessive Compulsive Disorder

Background: obsessive-compulsive disorder (OCD) is a chronic neuropsychiatric disorder characterized by obsessions and compulsive behaviors, often associated with comorbid psychiatric conditions. Expressed emotion (EE) reflecting family members’ criticism, hostility, or emotional over-involvement has been identified as a psychosocial factor influencing the course and prognosis of several psychiatric disorders, including OCD. Aim: To investigate the impact of expressed emotions on the comorbidity and severity of symptoms among patients with OCD. Methods: An analytical cross-sectional study was conducted among 280 adult OCD patients attending psychiatry outpatient clinics at Damietta Faculty of Medicine, Al-Azhar University Hospital, and affiliated mental health hospitals. Diagnosis and comorbidities were confirmed using the Structured Clinical Interview for DSM-IV (modified to DSM-V criteria). OCD severity was assessed using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), and Family Emotional Involvement and Criticism Scale (FEICS) were used to measure levels of expressed emotion Results: Y-BOCS mean score score was 24.6 ± 5.3, indicating moderate to severe OCD. Females demonstrated significantly higher Y-BOCS and FEICS scores (p < 0.01). The mean FEICS total score was 45.7 ± 4.5, with high perceived criticism and emotional involvement levels. Anxiety (60%) and depression (47.8%) were the most frequent comorbidities. A significant positive correlation was found between FEICS & Y-BOCS scores (r = 0.477, p < 0.001). Conclusion: High expressed emotion, significantly correlates with increased OCD symptom severity and certain psychiatric comorbidities, particularly anxiety and hostility.