The Relationship between Child Abuse and Cognitive Distortions with Clinical Symptoms of Obsessive-Compulsive Disorder: The Mediating Role of Emotion Dysregulation

Literature mainly focuses on the role of dysregulation of negative emotions whereas the topic of dysregulation of positive emotions has been widely neglected. This study aims to explore levels of dysregulation of positive emotions across community, clinical and forensic samples. The Difficulties in Emotion Regulation Scale – Positive (DERS-Positive) was administered to a total sample of 1044 participants, divided in 497 community participants (Mage = 39.18 years), 464 forensic individuals (Mage = 39.36 years), and 83 individuals diagnosed with Bipolar disorder (Mage = 47.26 years). The Difficulties in Emotion Regulation Scale (DERS) and the Toronto Alexithymia Scale (TAS-20) were administered to a subsample of community participants (n = 105). Confirmatory Factor Analyses supported the three-factor structure of the DERS- Positive in both clinical and non-clinical samples. Correlations between DERS-Positive, DERS and TAS-20 scores indicated a good construct validity of the DERS- Positive. We found that the three groups significantly differed from each other on DERS-Positive total scores. Individuals with Bipolar disorders showed higher levels of dysregulation of positive emotions compared to both offenders and community participants. Offenders scored higher on the DERS- Positive compared to community participants. Dysregulation of positive emotions is an often overlooked yet relevant construct that may account for maladaptive behavior and psychopathology.

Objective Studies have shown that theory of mind, emotion regulation and pragmatic abilities are negatively affected in people with obsessive-compulsive disorder (OCD). We aimed to investigate theory of mind (ToM) abilities, social responsiveness, pragmatic language, and emotion regulation skills in children with OCD and to compare them to healthy controls. Methods This study was designed as a single-center, cross-sectional, case-control study. ToM abilities were evaluated via “Reading the Mind in the Eyes Test” (RMET), “Faces Test”, “Faux-Pas Test”, “Comprehension Test” and “Unexpected Outcomes Test”. Social responsiveness, pragmatic language and emotion regulation were evaluated by Social Responsiveness Scale (SRS), Children’s Communication Checklist- Second Edition (CCC-2), Difficulties in Emotion Regulation Scale (DERS) and Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). Within the study period, we enrolled 85 adolescents (42 with OCD and 43 controls). Results The OCD group performed significantly lower than healthy controls in the Faux Pass and Comprehension tests (p = 0.003 for both). We found a statistically significant difference between groups in terms of the goal, strategy, non-acceptance subscales of the DERS (p < 0.001, p = 0.006, p = 0.008, respectively) as well as the total DERS score (p < 0.001). CY-BOCS total scores correlated significantly and negatively with Comprehension, Faux Pas and Unexpected Outcomes tests, and positively with CCC total, SRS total and DERS total scores. In regression analysis the DERS, SRS and CCC tests emerged as significant predictors of CY-BOCS total score. Conclusion Addressing ToM, pragmatic, and ER difficulties when planning the treatment of young people with OCD may contribute to positive outcomes.

The present research aimed to investigate the difficulties in emotion regulation (DER) among patients with obsessive-compulsive disorder (OCD) and to predict obsessive-compulsive (OC) symptom dimensions based on DER dimensions. Eighty outpatients with OCD and 80 normal controls completed the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Obsessive Compulsive Inventory-Revised (OCI-R), the Difficulties in Emotion Regulation Scale (DERS) and the Depression Anxiety Stress Scales (DASS-21). OCD patients revealed significantly higher scores on DER dimensions including lack of emotional clarity, limited access to emotion regulation strategies and non-acceptance of emotional responses than healthy controls. Partial correlations indicated significant associations between OC dimensions such as checking/doubting, obsessing, mental neutralizing, and ordering with non-acceptance of emotional responses, checking/doubting with lack of emotional awareness, and ordering with limited access to emotion regulation strategies. Results indicated that non-acceptance of emotional responses was a significant predictor of checking/doubting, obsessing, mental neutralizing and ordering. These findings revealed that DER, especially non-acceptance of emotional responses, may constitute evidence to improve our understanding of OCD.

Over the past decade, several studies have investigated the relationship between cognitive distortions and emotion regulation among adolescent gamblers, demonstrating the exacerbating role of alcohol consumption when co-occurring with gambling problems. An important construct, that to date has been largely neglected, is mentalizing (i.e. the ability to reflect on one's own and others' mental states). The aim of the present study was (for the first time) to investigate the relative contribution of mentalization, emotional dysregulation, cognitive distortions, and alcohol consumption among adolescent gamblers. A total of 396 students (69.2% females) aged 14–19 years were recruited from secondary schools in Southern Italy. Assessment measures included the South Oaks Gambling Screen Revised for Adolescents (SOGS-RA), the Reflective Functioning Questionnaire (RFQ-8), the Difficulties in Emotion Regulation Scale (DERS), the Gambling Related Cognitions Scale (GRCS), and the Alcohol Use Disorders Identification Test (AUDIT). Regression analysis showed that, along with male gender, the best predictors of adolescent gambling were scores on two GRCS subscales (i.e., ‘inability to stop gambling’ and ‘interpretative bias’), the RFQ-8’s ‘uncertainty about mental states’ dimension, and the DERS ‘impulse control difficulties’ factor, with the overall model explaining more than one-third of the total variance. The results clearly indicated that, along with gambling-related cognitive distortions, uncertainty about mental states, and difficulties remaining in control of one’s behavior when experiencing negative emotions contributed significantly to problematic gambling among adolescents.

هدفت الدراسة إلى تحديد الفروق بين مرضى الإکتئاب ومرضى الوسواس القهري ومرضى اضطراب الشخصية الوسواسية والأسوياء في أبعاد المخططات المعرفية اللاتکيفية وجوانب التشويه المعرفي. کما هدفت إلى معرفة طبيعة العلاقة بين المخططات المعرفية اللاتکيفية والتشويه المعرفى لدى مرضى الإکتئاب ومرضى الوسواس القهري ومرضى اضطراب الشخصية الوسواسية. وتکونت عينة الدراسة من 209 فرد منقسمين إلى مجموعتين: المجوعة الأولى تتکون من (165) مريض منهم (60) مريض بالإکتئاب، و(38) مريض بالوسواس القهري، و(67) مريض باضطراب الشخصية الوسواسية، أما المجموعة الثانية تکونت من (44) شخص کعينة ضابطة، وتراوحت الأعمار من سن (17-45) سنة بمتوسط عمر (27,6) سنة وإنحراف معياري (7,43). وتم تطبيق مقياس التشوهات المعرفية ومقياس المخططات المعرفية اللاتکيفية، واستبيان تشخيص اضطرابات الشخصية. وأسفرت النتائج عن وجود فروق ذات دلالة إحصائية بين المرضى والأسوياء في المخططات المعرفية اللاتکيفية والتشويه المعرفي في اتجاه المرضى، کما وجدت فروق بين المجموعات المرضية الثلاثة في المخططات المعرفية اللاتکيفية والتشويه المعرفي.وأظهرت النتائج أيضا وجود علاقة ارتباطية موجبة بين المخططات المعرفية اللاتکيفية والتشوهات المعرفية لدى المجموعات المرضية. The study aimed to determine the differences maladaptive cognitive schemas and aspects of cognitive distortion between depressed patients, obsessive-compulsive patients, obsessive-compulsive personality disorder patients, and control sample in the dimensions. It also aimed to find out the nature of the relationship between the maladaptive cognitive schemas and cognitive distortion among depressive patients, obsessive-compulsive disorder patients, and those with obsessive personality disorder. The study sample consisted of 209 individuals divided into two groups: the first group consisted of (165) patients, including (60) patients with depression, (38) patients with obsessive-compulsive disorder, and (67) patients with obsessive-compulsive personality disorder, while the second group consisted of (45) person as a control sample, and the ages ranged from 17-45 years with a mean age of (27.6) and a standard deviation of (7.43). The Cognitive Distortions Scale, the maladaptive Cognitive Schemes Scale and the Personality Disorders Diagnostic Questionnaire were applied to all included subjests. The results revealed that there were statistically significant differences between patients and control sample in the maladaptive cognitive schemas and cognitive distortion in the direction of the patients. Also there were differences between the three disease groups in the maladaptive cognitive schemas and cognitive distortion. Moreover a positive correlation between the maladaptive cognitive schemas and cognitive distortions was found among the disease groups.

Objective Emotion regulation is an important skill to cultivate in patients with obsessive-compulsive disorder (OCD) for helping with the positive prognosis of their disease. Patients with OCD exhibit higher rates of impulsivity compared to healthy volunteers. According to previous studies, there is significant impairment in the quality of life in OCD. Despite their importance, no study has yet been conducted on the interrelation of these clinical parameters in OCD patients. We investigated the relationship between disease severity, emotional dysregulation, impulsivity, and quality of life in untreated OCD patients.Methods This study included 40 untreated outpatients with a diagnosis of OCD. We applied the following form and scales: Sociodemographic and clinical data form, the Yale-Brown Obsessive Compulsive Scale, the Difficulties in Emotion Regulation Scale, the Barratt Impulsiveness Scale Short Form, and the World Health Organization Quality of Life Scale Short Form.Results We found a positive relationship (p<0.001) between emotional dysregulation and impulsivity in OCD patients. A positive relationship (p=0.003) was identified between disease severity and emotional dysregulation, while an inverse relationship (p<0.001) was observed between disease severity and quality of life-psychological health. Increased impulsivity and emotional dysregulation were also associated with a deterioration in quality of life.Conclusion There is a significant positive relationship between emotional dysregulation and impulsivity in OCD patients. These clinical parameters may serve as important targets for treatment approaches in OCD patients and thus should be considered in the future work.

Obsessive-compulsive disorder (OCD) is a debilitating mental health condition that impacts daily functioning. In addition to classical symptoms, emotion regulation (ER), alexithymia and maladaptive coping are thought to be involved in the symptomology and maintenance of the disorder. This study aims to investigate the relationship between ER, alexithymia and coping in adolescents with a sole diagnosis of OCD. The study comprised of 93 participants with OCD and 92 healthy controls. Patients with any psychiatric disorder other than OCD were set as exclusion criteria. A sociodemographic form, Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children, Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS), Difficulties in Emotion Regulation Scale (DERS), Toronto Alexithymia Scale (TAS) and KidCOPE were applied. The TAS and DERS scores of participants with every subscale, except awareness in DERS, and the KIDCOPE-Avoidant Coping scores were significantly higher in the OCD group (p < 0.05). A positive and moderately significant relationship was identified between the CY-BOCS-Obsession, CY-BOCS-Compulsion and CY-BOCS-Total scores and the DERS-Total (p < 0.05). Linear regression analysis revealed that CY-BOCS-Total scores significantly predicted DERS-Total scores in a positive direction even when TAS-Total and KidCOPE scores were controlled (p= 0.001). Difficulties in ER mediated the relationship between OCD and the severity of negative coping (b = 0.064, 95% CI (0.036-0.097)). There is limited evidence regarding the specific contribution of OCD with emotion dysregulation, alexithymia and avoidant coping. Our study suggests a possible relationship with OCD and these parameters, highlighting the need to develop effective intervention techniques tailored to this population.

Relevance: Emotional dysregulation is often identified in a variety of mental disorders and shows high comorbidity between them. The presence of emotional regulation disorders can be assessed using various tools, but the most popular is the Difficulty in Emotional Regulation Scale (DERS), which is used to assess emotional regulation disorders in different populations, including adults and adolescents, and is widely used both in research and clinical practice. The purpose of the study: to create a Ukrainian-language version of the Difficulties in Emotional Regulation Scale (DERS) and its cross-cultural adaptation among adolescents and adults, with validity assessment and testing in patients with anorexia nervosa and their parents/caregivers. Methods: The study included 58 adolescents with anorexia nervosa and 97 of their parents/guardians who constituted the main study groups, as well as 50 healthy adolescents and 89 of their parents/guardians as a control group. The full version of the 36-item DERS Emotional Regulation Difficulties Scale was used for validation. The study was conducted in compliance with basic bioethical standards. All patients consented to participate in the study, after which a full clinical examination was conducted: demographic data were collected and screening for emotional regulation disorders was performed using the DERS scale. Statistical analysis was performed using the IBM SPSS23 program. Results: The analysis of the data obtained showed high reliability and validity of the Ukrainian version of the Difficulties in Emotional Regulation Scale (DERS) for screening emotional regulation disorders. Calculations of the α-Cronbach's coefficient based on the results of the test and retest (14 days later) confirmed the internal consistency of the DERS (0.7 and 0.7, respectively). The intraclass correlation coefficient was 0.976 (p&lt;0.05) for adolescents and 0.987 (p&gt;0.05) for adults. Student's paired t-test did not reveal significant differences between the test-retest groups (p&gt;0.05). Subsequently, a study to validate the DERS scale was conducted on adolescents with anorexia nervosa and their parents/guardians. Our results of the DERS survey showed significantly higher scores on the total DERS score in patients with anorexia nervosa (143.70±11.170) and their parents/guardians (141.85±11. 006) compared to healthy adolescents (54.23±6.01) and their parents/guardians (47.61±7.87) of the control group, p&lt;0.0001, indicating a high level of emotional regulation disorder in patients with anorexia nervosa and their parents/guardians. Conclusions: The Ukrainian version of the DERS emotional regulation difficulty scale was created and cross-cultural adaptation was performed for further use in the Ukrainian-speaking population. The Ukrainian version of the DERS scale has a sufficient level of reliability that allows it to be used for scientific purposes and in clinical practice.

Emotion dysregulation in youths with obsessive-compulsive disorder and its implication for treatment - an exploratory study from the TECTO trial: A protocol and statistical analysis plan

Theoretical models of emotion regulation difficulties in anorexia nervosa (AN) specify a role for factors that predispose to or precipitate emotion dysregulation. The current study considered whether childhood abuse (i.e., emotional, sexual, physical) might be related to emotion regulation difficulties and eating disorder symptom severity in patients with AN. Childhood abuse was hypothesized to relate to AN symptoms indirectly via emotion dysregulation. Participants were 188 patients with AN presenting to an intensive treatment facility. The Childhood Trauma Questionnaire, Difficulties in Emotion Regulation Scale, and Eating Disorder Examination were used to assess childhood abuse, emotion dysregulation, and AN symptom severity, respectively. Of the three forms of childhood abuse, reports of emotional abuse were most strongly related to emotion regulation difficulties and AN symptom severity. Mediation analyses revealed that emotion dysregulation significantly explained the relationship between childhood emotional abuse and AN symptomatology, and mediation effects did not differ by AN subtype (i.e., restricting vs. binge-eating/purging). Findings provide initial support for a model in which childhood emotional abuse precipitates emotion dysregulation and the development of AN. Future studies with longitudinal designs and control groups are necessary to examine the direction and specificity of these cross-sectional associations

BACKGROUND: Previous studies have shown that childhood emotional maltreatment (CEM) plays a role in development of disordered eating behaviors (DEBs). Difficulty in emotion regulation is another factor influencing disordered eating. This study was directed to examine the association between CEM and DEB among students, by considering the emotion dysregulation as a mediator. METHODS: This correlational study was conducted in form of a cross-sectional design, using structural equation modeling (SEM) to analyze the data collected from 401 non-native undergraduate students through convenience sampling method. Childhood Trauma Questionnaire (CTQ) was used to assess childhood emotional abuse and neglect. Emotion dysregulation and DEB were respectively measured using the Difficulties in Emotion Regulation Scale (DERS) and Eating Attitude Test (EAT). RESULTS: The partial mediation model of difficulties in emotion regulation in the association between CEM and DEB among male and female students had a good fit to the data. The outcomes of the gender specificity of structural relations in the model confirmed gender invariance of the structural model. All regression weights in the model were statistically significant and the CEM and emotion dysregulation variables accounted for 22%, 17%, and 35% of the variance of DEB among the entire sample, female students, and male students, respectively. CONCLUSION: The outcomes are in line with research findings suggesting a relationship between CEM and DEB and confirm the role of emotion dysregulation as a mediator. The results highlight the importance of assessment of childhood experiences in treatment of eating disorders and introduce emotion regulation as a significant target for intervention.

A widely used measure of emotion dysregulation, the Difficulties in Emotion Regulation Scale (DERS), may insufficiently cover a number of potentially important aspects of emotional dysregulation. A new measure of emotional dysregulation, the Emotional Dysregulation Questionnaire (EDQ) was therefore developed based upon an eight-factor model of the construct. The DERS and the EDQ were administered to a community sample (N=362; 183 female, 179 male), along with a number of measures of psychopathology associated with emotional dysregulation. The capacity of the EDQ and the DERS to account for the emotional dysregulation associated with these different types of psychopathology was then compared. In several of the psychopathologies examined, the EDQ could account for more variation than the DERS, suggesting that it more comprehensively assessed the emotion regulation deficits associated with these issues. Results suggest the EDQ possesses several advantages relative to the DERS, allowing for a more comprehensive and accurate assessment of emotional dysregulation. Emotional dysregulation is a common component of many psychological disorders. The Difficulties in Emotion Regulation Scale is one of the primary self-report measures used to asses these difficulties, however, concerns exist that it may not comprehensively assess the construct of emotional dysregulation. A new self-report measure of comparable length, the Emotional Dysregulation Questionnaire has been developed, with this new measure possessing several advantages relative to the DERS with regard to the assessment of emotional dysregulation. The use of this measure in clinical practice may more accurately identify the emotion regulation deficits present in clients.

Objective: The Difficulties in Emotion Regulation Scale (DERS) is a widely used self-report measure of subjective emotion ability, as defined by a prominent clinically derived model of emotion regulation (Gratz and Roemer, 2004). Although the DERS is often used in treatment and research settings for adults with emotional (i.e., anxiety, mood, obsessive-compulsive, or trauma-related) disorders, its psychometric properties are not well-characterized in this population.Method: We examined the psychometric properties of the DERS and three popular short forms (DERS-16; DERS-18; and DERS-SF) in a large (N = 427) sample of treatment-seeking adults with one or more DSM-5 emotional disorders.Results: For the original DERS, internal consistency was strong for all subscales except Awareness. A bifactor structure consisting of one general emotion dysregulation factor and five uncorrelated specific factors corresponding to the original DERS subscales (excluding Awareness) provided the best fit. A series of structural equation models (SEMs) demonstrated unique incremental contributions of the general factor and several specific factors to explaining concurrent clinical severity. The general factor and one specific factor (Goals) also prospectively predicted treatment outcome following a naturalistic course of outpatient cognitive-behavioral therapy (CBT) in a subset of participants (n = 202) for whom discharge data were available. Specifically, more severe emotion dysregulation at intake predicted better CBT response, while more severe impairment in goal-directed activity when distressed predicted worse CBT response. All three short forms showed a robust bifactor structure and good internal consistency and convergent validity vis-à-vis the original measure, albeit with a slight decrement in incremental utility (1–3% less variance explained in clinical severity).Conclusion: With the Awareness items excluded, the DERS showed good internal consistency and a robust bifactor latent structure. The general factor and several specific factors incrementally and prospectively predicted clinical severity and treatment outcome, which suggests that the DERS may have clinical and predictive utility in treatment-seeking adults with emotional disorders. Additional research is needed to establish convergent and discriminant validity in this population. The use of a short form in lieu of the full DERS may be sufficient for many general clinical and research purposes, particularly when participant burden is a concern.

C-reactive protein (CRP), a marker of systemic inflammation, has been associated with major depressive disorder (MDD) and posttraumatic stress disorder (PTSD). Emotion dysregulation is a transdiagnostic risk factor for many psychological disorders associated with chronic inflammatory state. The objective of this study was to determine whether inflammation is associated with emotion dysregulation in women with type 2 diabetes mellitus (T2DM). We examined associations between trauma exposure, MDD, PTSD, emotion dysregulation, and CRP among 40 African-American women with T2DM recruited from an urban hospital. Emotion dysregulation was measured using the Difficulties in Emotion Regulation Scale. PTSD and MDD were measured with structured clinical interviews. Child abuse and lifetime trauma load were also assessed. Analyses showed that both emotion dysregulation and current MDD were significantly associated with higher levels of CRP (p < 0.01). Current PTSD was not significantly related to CRP. In a regression model, emotion dysregulation was significantly associated with higher CRP (p < 0.001) independent of body mass index, trauma exposure, and MDD diagnosis. These findings suggest that emotion dysregulation may be an important risk factor for chronic inflammation beyond already known risk factors among women with T2DM, though a causal relationship cannot be determined from this study.

The Social Cognition and Object Relations Scale-Global rating method (SCORS-G) is a coding system that assesses the cognitive and emotional aspects of interpersonal functioning in narrative materials. This study aimed to validate the Korean version of the SCORS-G using card from the Thematic Apperception Test (1, 2, 3BM, 4, 13MF, 12M, 14). The Personality Assessment Inventory, NEO-Five Factor Inventory, Inventory of Interpersonal Problems, Interpersonal Cognitive Distortions Scale, Difficulties in Emotional Regulation Scale, and Thematic Apperception Test (TAT) were administered to 215 undergraduate students. The reliability and validity of the SCORS-G were tested by rating TAT protocols according to the scoring criteria. The level of interrater reliability for 8 dimensions of the SCORS-G was mostly acceptable. Based on existing literature, we established a two-factor model consisting of the cognitive and emotional factors and verified a model fit using confirmatory factor analysis. As a result, the model fit was good, which suggests that the factor structure of the SCORS-G is valid. Furthermore, the cognitive and emotional factors of the SCORS-G had a significant correlation with various psychopathologies, personality traits (Big-5), interpersonal problems, cognitive distortion, and emotional dysregulation. We provide an interpretation guideline for the clinical utility of SCORS-G based on the present and previous studies, and discuss the clinical implications and limitations of this study.