Journal of Shanghai Jiao Tong University (Medical Science) >

2022 , Vol. 42 >Issue 9: 1315 - 1322

DOI: https://doi.org/10.3969/j.issn.1674-8115.2022.09.019

Clinical research

Mediating effects of neuroticism and immature defense on relationship between childhood trauma and obsessive-compulsive symptoms in patients with obsessive-compulsive disorder

  • Qing ZHAO ,
  • Wenjie GU ,
  • Zhen WANG
Expand
  • Department of Clinical Psychology, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
WANG Zhen, E-mail: wangzhen@smhc.org.cn.

Received date: 2022-05-27

  Accepted date: 2022-07-17

  Online published: 2022-09-28

Supported by

Grants for Important Weak Discipline—Psychosomatic Medicine from Shanghai Municipal Health Commission(2019ZB0201)

Fold

Abstract

Objective ·To explore the characteristics of childhood trauma, personality traits and defense mechanism in the patients with obsessive-compulsive disorder (OCD), and investigate the mediating effects of personality traits and defense style on the relationship between childhood trauma and obsessive-compulsive symptoms in the OCD patients. Methods ·Totally 113 patients with OCD who met the criteria of Diagnostic and Statistical Manual of Mental Disorders-5 (DMS-5), and 66 age- and gender-matched health controls with similar education level distribution were selected. Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was used to evaluate the severity of obsessive-compulsive symptoms. Childhood Trauma Questionnaire (CTQ) was used to evaluate the childhood trauma experience. NEO Five-Factor Inventory (NEO-FFI) was used to measure the personality traits. Defense Style Questionnaire (DSQ) was used to evaluate the defense style. The correlations among childhood experience, obsessive-compulsive symptoms, personality traits and defense style as well as mediating role of personality traits and defense style between childhood trauma and obsessive-compulsive symptoms were analyzed. Results ·Compared with the health controls, the OCD patients showed higher scores of emotional abuse [8 (5, 25) points vs 6 (5, 22) points, P<0.05] and immature defense [(4.65±1.01) points vs (3.60±0.99) points, P<0.05]. In the OCD patients, the scores of emotional abuse (r=0.211, P<0.05) and immature defense (r=0.274, P<0.05) were positively correlated with the total scores of Y-BOCS, and the neuroticism scores of NEO-FFI were positively correlated with the total scores of Y-BOCS (r=0.468, P<0.05). The pathway analysis showed the indirect effect from emotional abuse to Y-BOCS via immature defense was 0.088 (95%CI 0.003?0.173, P<0.05). The immature defense played a completely mediated role, and indirect effect from emotional abuse to immature defense via neuroticism was 0.117 (95%CI 0.014?0.219, P<0.05). Conclusion ·Compared with healthy people, OCD patients have experienced more emotional and physical childhood trauma, and have abnormal personality traits of neuroticism, extraversion and conscientiousness. They tend to use immature defense mechanisms. The emotional abuse has an impact on immature defense via neuroticism, and finally affect the obsessive-compulsive symptoms.

Key words： obsessive-compulsive disorder (OCD); childhood trauma; defense style; personality strait; mediating effect

Cite this article

Qing ZHAO , Wenjie GU , Zhen WANG . Mediating effects of neuroticism and immature defense on relationship between childhood trauma and obsessive-compulsive symptoms in patients with obsessive-compulsive disorder[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022 , 42(9) : 1315 -1322 . DOI: 10.3969/j.issn.1674-8115.2022.09.019

References

1 HUANG Y, WANG Y, WANG H, et al. Prevalence of mental disorders in China: a cross-sectional epidemiological study[J]. Lancet Psychiatry, 2019, 6(3): 211-224.
2 KERTESZ A, KISS-LEIZER M, SZALMA I, et al. Developmental psychopathological characteristics of obsessive-compulsive disorder[J]. Neuropsychopharmacol Hung, 2020, 22(3): 129-140.
3 DVIR Y. Childhood trauma and psychosis: a brief updated review and case study[J]. Child Adolesc Psychiatr Clin N Am, 2022, 31(1): 91-98.
4 DESTRéE L, BRIERLEY M E, ALBERTELLA L, et al. The effect of childhood trauma on the severity of obsessive-compulsive symptoms: a systematic review[J]. J Psychiatr Res, 2021, 142: 345-360.
5 BROWN M, WORRELL C, PARIANTE C M. Inflammation and early life stress: an updated review of childhood trauma and inflammatory markers in adulthood[J]. Pharmacol Biochem Behav, 2021, 211: 173291.
6 MURPHY F, NASA A, CULLINANE D, et al. Childhood trauma, the HPA axis and psychiatric illnesses: a targeted literature synthesis[J]. Front Psychiatry, 2022, 13: 748372.
7 MCGREGOR N W, HEMMINGS S M J, ERDMAN L, et al. Modification of the association between early adversity and obsessive-compulsive disorder by polymorphisms in the MAOA, MAOB and COMT genes[J]. Psychiatry Res, 2016, 246: 527-532.
8 FERRER A, COSTAS J, LABAD J, et al. FKBP5 polymorphisms and hypothalamic-pituitary-adrenal axis negative feedback in major depression and obsessive-compulsive disorder[J]. J Psychiatr Res, 2018, 104: 227-234.
9 MILLER M L, BROCK R L. The effect of trauma on the severity of obsessive-compulsive spectrum symptoms: a meta-analysis[J]. J Anxiety Disord, 2017, 47: 29-44.
10 ?OBAN A, TAN O. Attention deficit hyperactivity disorder, impulsivity, anxiety, and depression symptoms mediating the relationship between childhood trauma and symptoms severity of obsessive-compulsive disorder[J]. Noro Psikiyatr Ars, 2020, 57(1): 37-43.
11 AY R, ERBAY L G. Relationship between childhood trauma and suicide probability in obsessive-compulsive disorder[J]. Psychiatry Res, 2018, 261: 132-136.
12 TIBI L, VAN OPPEN P, VAN BALKOM A J L M, et al. Childhood trauma and attachment style predict the four-year course of obsessive compulsive disorder: findings from the Netherlands obsessive compulsive disorder study[J]. J Affect Disord, 2020, 264: 206-214.
13 BOGER S, EHRING T, BERBERICH G, et al. Impact of childhood maltreatment on obsessive-compulsive disorder symptom severity and treatment outcome[J]. Eur J Psychotraumatology, 2020, 11(1): 1753942.
14 BARYSHNIKOV I, JOFFE G, KOIVISTO M, et al. Relationships between self-reported childhood traumatic experiences, attachment style, neuroticism and features of borderline personality disorders in patients with mood disorders[J]. J Affect Disord, 2017, 210: 82-89.
15 TASKENT V, KARADAG F, TOPCUOGLU V, et al. Psychological defense mechanisms, childhood traumas and dissociative experiences in patients with drug and alcohol dependency[J]. Turk Psikiyatr Derg, 2011, 22: 58.
16 DESPLAN J N, BONSACK C, ROTEN Y D. The study of defense mechanisms: History and concepts[J]. Eur Psychiatr, 1997, 12(2): 416-418.
17 田玉梅, 张瑶, 刘敏, 等. 动力性心理治疗联合氟伏沙明治疗强迫症的临床效果及对心理防御机制的影响[J]. 神经疾病与精神卫生, 2018, 18(8): 587-590.
17 TIAN Y M, ZHANG Y, LIU M, et al. Effects of dynamic psychotherapy combined with fluvoxamine in treatment of obsessive-compulsive disorder and influence on the psychological defense mechanism[J]. J Neurosci Ment Health, 2018, 18(8):587-590.
18 徐勇, 张海音. Yale-Brown强迫量表中文版的信度和效度[J]. 上海精神医学, 2006, 18(6): 321-323.
18 XU Y, ZHANG H Y. The reliability and validity of the Chinese version of Yale-Brown obsessive-compulsive scale[J]. Shanghai Arch Psychiatr, 2006, 18(6): 321-323.
19 王雪云, 施星明, 赵玲慧, 等. 中文版儿童期创伤问卷在精神障碍患者中信度、效度分析[J]. 中国健康心理学杂志, 2018, 26(4):618-622.
19 WANG X Y, SHI X M, ZHAO L H, et al. Reliability and validity of Chinese version of Childhood Trauma Questionnaire in patients with mental disorders[J]. Chin J Health Psychol, 2018, 26(4): 618-622.
20 路敦跃, 张丽杰, 赵瑞, 等. 防御方式问卷初步试用结果[J].中国心理卫生杂志, 1993, 7(2):54-56.
20 LU D Y, ZHANG L J, ZHAO R, et al. Report on preliminary application of Defence Style Questionnaire[J]. Chin Ment Health J, 1993, 7(2): 54-56.
21 姚若松, 梁乐瑶. 大五人格量表简化版(NEO-FFI)在大学生人群的应用分析[J]. 中国临床心理学杂志, 2010, 18(4): 457-459.
21 YAO R S, LIANG L Y. Analysis of the application of simplified NEO-FFI to undergraduates[J]. Chin J Clin Psychol, 2010, 18(4): 457-459.
22 温忠麟, 张雷, 侯杰泰, 等. 中介效应检验程序及其应用[J]. 心理学报, 2004, 36(5): 614-620.
22 WEN Z L, ZHANG L, HOU J T, et al. Testing and application of the mediating effects[J]. Acta Psychol Sin, 2004, 36(5): 614-620.
23 ROSSEEL Y. lavaan: an R package for structural equation modeling[J]. J Stat Softw, 2012, 48(2): 1-36.
24 VAN LISSA CJ. tidySEM: a tidy workflow for running, reporting, and plotting structural equation models in lavaan or Mplus[EB/OL]. (2022-02-12)[2022-05-27]. https://github.com/cjvanlissa/tidySEM/.
25 KROSKA E B, MILLER M L, ROCHE A I, et al. Effects of traumatic experiences on obsessive-compulsive and internalizing symptoms: the role of avoidance and mindfulness[J]. J Affect Disord, 2018, 225: 326-336.
26 WANG P, ZHAO Q, XU T, et al. Interaction between PGRN gene and the early trauma on clinical characteristics in patients with obsessive-compulsive disorder[J]. J Affect Disord, 2020, 263: 134-140.
27 SCHIRMBECK F, BOYETTE L L, VAN DER VALK R, et al. Relevance of Five-Factor Model personality traits for obsessive-compulsive symptoms in patients with psychotic disorders and their un-affected siblings[J]. Psychiatry Res, 2015, 225(3): 464-470.
28 马玉红. 强迫症患者父母教养方式及心理防御机制研究[J]. 临床心身疾病杂志, 2016, 22(4): 92-94.
28 MA Y H. Parental rearing patterns and psychological defense mechanism of OCD patients[J]. J Clin Psychosomat Dis, 2016, 22(4): 92-94.
29 YANG J Z, KANG C Y, YUAN J, et al. Effect of adverse childhood experiences on hypothalamic-pituitary-adrenal (HPA) axis function and antidepressant efficacy in untreated first episode patients with major depressive disorder[J]. Psychoneuroendocrinology, 2021, 134: 105432.
30 NEMEROFF C B, BINDER E. The preeminent role of childhood abuse and neglect in vulnerability to major psychiatric disorders: toward elucidating the underlying neurobiological mechanisms[J]. J Am Acad Child Adolesc Psychiatry, 2014, 53(4): 395-397.
31 AGORASTOS A, PERVANIDOU P, CHROUSOS G P, et al. Developmental trajectories of early life stress and trauma: a narrative review on neurobiological aspects beyond stress system dysregulation[J]. Front Psychiatry, 2019, 10: 118.
32 WARD K, RYAN-IBARRA S, SMITH M, et al. Adverse childhood experiences and cognitive disability in the 2019 United States behavioral risk factor surveillance system[J]. Prev Med Rep, 2022, 27: 101826.
33 ALLEN B, LAUTERBACH D. Personality characteristics of adult survivors of childhood trauma[J]. J Trauma Stress, 2007, 20(4): 587-595.
34 KANDLER C, BLEIDORN W, RIEMANN R, et al. Life events as environmental states and genetic traits and the role of personality: a longitudinal twin study[J]. Behav Genet, 2012, 42(1): 57-72.
35 CRAMER P. Defense mechanisms and physiological reactivity to stress[J]. J Pers, 2003, 71(2): 221-244.
36 BOLDRINI T, LO BUGLIO G, GIOVANARDI G, et al. Defense mechanisms in adolescents at high risk of developing psychosis: an empirical investigation[J]. Res Psychother, 2020, 23(1): 456.
37 FOSSE G K, HOLEN A. Reported maltreatment in childhood in relation to the personality features of Norwegian adult psychiatric outpatients[J]. J Nerv Ment Dis, 2007, 195(1): 79-82.
38 DYE H L. Is emotional abuse as harmful as physical and/or sexual abuse? [J]. J Child Adolesc Trauma, 2020, 13(4): 399-407.
39 GABBARD G O. Psychodynamic psyehiauy in clinical practice[M]. 3rd ed. Washington DC: American Psychiatric Press, 2000: 212-216.
40 BUSSEMAKERS C, KRAAYKAMP G, TOLSMA J. Co-occurrence of adverse childhood experiences and its association with family characteristics. A latent class analysis with Dutch population data[J]. Child Abuse Negl, 2019, 98: 104185.
41 朱相华, 李娇, 王振, 等. 某高校医学生儿童期虐待、人格、家庭关系、自尊和自我效能感及不安全感关系的调查研究[J]. 神经疾病与精神卫生, 2012, 12(2): 132-136
41 ZHU X H, LI J, WANG Z, et al. The effects of childhood abuse, personality, self-esteem, self-efficacy and family relations on insecurity of college students: a path analysis[J]. J Neurosci Ment Health, 2012, 12(2): 132-136.
42 冯伟, 许文英. 父母婚姻质量与儿童行为问题的关系: 儿童气质的调节作用[J]. 中小学心理健康教育, 2017(6): 17-22.
42 FENG W, XU W Y. Parental rearing patterns and psychological defense mechanism of OCD patients[J]. Ment Health Educ Prim Second Sch, 2017(6): 17-22.
Options
Outlines

/

〈 〉