Cognitive and emotional traits as mediators in the relationship between family factors and obsessive-compulsive disorder in adolescents

BACKGROUND: Obsessive-compulsive disorder (OCD) is a multifaceted psychiatric disease requiring more in-depth mechanism research to improve treatment outcomes, with family-related variables playing a crucial role, particularly in adolescent populations. METHODS: A total of 113 adolescents with OCD were included in this study. All patients were assessed by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Family Environment Scale (FES), Parenting Style Assessment Scale (EMBU), Obsessive Beliefs Questionnaire (OBQ-44) and State-Trait Anxiety Inventory (STAI). The correlation between family factors (dysfunctional family environment and negative parent rearing), cognitive traits (obsessive beliefs), emotional traits (anxiety traits), and obsessive-compulsive symptoms (OCS) were analyzed. Moreover, the mediating effect of cognitive and emotional traits between family factors and OCS was explored. Finally, 31 parents of patients and 20 non-clinical adolescents and their parents completed the FES, EMBU, OBQ-44, and STAI. RESULTS: The results showed that dysfunctional family environment, negative parent rearing, obsessive beliefs and anxiety traits were positively correlated with OCS in adolescents with OCD. Parallel mediation analyses revealed that obsessive beliefs fully mediated the relationship between family factors and OCS, whereas anxiety traits did not show a significant unique mediating effect after controlling for obsessive beliefs. Compared with parents of non-clinical adolescents, parents of OCD patients showed significant obsessive beliefs and anxiety traits. CONCLUSION: Cognitive traits (obsessive beliefs), but not emotional traits (anxiety traits), served as a unique mediating mechanism between family factors and OCS. Both cognitive and emotional traits demonstrated familial aggregation. These findings provide an empirical basis for family-based interventions targeting obsessive beliefs in adolescents with OCD.