Impulsivity in patients with obsessive-compulsive disorder: exploring the mediating effect of cognitive emotion regulation strategies and depressive symptoms

Gang Ye^1,2Meiling Chen²Liangjun Lin²Jia Li²Qichun Liu²Yanting Zhang²Zhen Tang²Ruihua Hou^3*Xiang Dong Du^1,2*

• ¹Soochow University, Suzhou, China
• ²Suzhou Guangji Hospital, Soochow University Affiliated Guangji Hospital, Suzhou, China
• ³Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom

Background: The underlying mechanism of impulsivity in obsessive-compulsive disorder (OCD) patients is complex and still unclear. Previous studies have not thoroughly explored whether impulsivity in OCD patients is a result of the obsessive-compulsive symptoms themselves or other contributing factors. This study aimed to explore whether cognitive emotion regulation strategies and depressive symptoms mediate the relationship between the severity of obsessive-compulsive symptoms and impulsivity in a clinical population with OCD. Methods: This was a case-control study that recruited 65 OCD patients (male/female=31/34) and 65 healthy controls (male/female =23/42), matched for age, gender, and education level. Demographic and clinical data were collected, and the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Beck Depression Inventory-II (BDI-II), Barratt Impulsiveness scale-11 (BIS-11) and Cognitive Emotion Regulation Questionnaire (CERQ) were adopted. Results: OCD patients scored higher on BIS-11 attentional and non-planning impulsivity and total scores (all p<0.05). On CERQ, OCD patients showed elevated maladaptive strategies (self-blame, rumination, catastrophizing, blaming others) and reduced adaptive strategies (positive reappraisal) (all p<0.05). Attentional impulsivity positively correlated with OCD severity, depression, and maladaptive strategies (all p<0.05). Non-planning impulsivity and BIS-11 total scores positively correlated with depression and negatively with adaptive strategies (all p<0.05). After adjusting for age, gender, depression level, there was only a significant negative correlation between BIS-11 non-planning impulsiveness and CERQ maladaptive strategies (r=-0.28, p<0.05). Mediation analyses revealed significant indirect effects of OCD severity on impulsivity via adaptive strategies/depression (β=0.13, 95% CI: 0.03~0.24, p=0.012) and via maladaptive strategies/depression (β=0.09, 95% CI: 0.00~0.23, p=0.042), but no significant direct or total effects. Conclusions: OCD symptom severity indirectly influences impulsivity through emotion regulation strategies and depressive symptoms, highlighting the need to target these mediators in clinical interventions.