Associations between childhood trauma, intolerance of uncertainty, and symptom severity in obsessive-compulsive...

Childhood trauma (CT) has been associated with obsessive-compulsive disorder (OCD), but its relationship with obsessive-compulsive symptom (OCS) severity remains inconsistent. Intolerance of uncertainty (IU) may represent one of the cognitive processes underlying this association. The present study aimed to examine differences in CT and IU between patients with OCD and healthy controls (HCs), and to test whether IU mediates the relationship between CT and OCS severity.

This study included 82 patients with OCD and 82 healthy controls (HCs) matched on age and sex. CT was assessed using the Childhood Trauma Questionnaire-33 (CTQ-33), IU using the Intolerance of Uncertainty Scale-Short Form (IUS-12), and OCS severity using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS).

Patients with OCD had significantly higher scores than HCs on all CTQ-33 subscales and on IU measures. In particular, the patient group showed higher IUS-12 total scores than the HC group (39.30 ± 10.42 vs. 32.11 ± 8.62, p < 0.001), with higher prospective anxiety (22.11 ± 5.13 vs. 20.11 ± 4.59, p = 0.009) and inhibitory anxiety scores (17.19 ± 5.99 vs. 12.00 ± 4.82, p < 0.001). Within the patient group, physical abuse was the only CT dimension significantly associated with total Y-BOCS scores (r = 0.248, p = 0.025), whereas IU was positively associated with symptom severity (IUS-12 total: r = 0.346, p = 0.001). Path analysis showed that CT was associated with IU (β = 0.238, p = 0.023), IU was associated with OCS severity (β = 0.329, p = 0.007), and the direct effect of CT on OCS severity was no longer significant after IU was included in the model (c' = 0.209, p = 0.093), supporting partial mediation.

CT appears to be elevated in patients with OCD, although its association with symptom severity is not uniform across trauma dimensions. IU may represent an important cognitive mechanism linking CT to OCS severity. These findings suggest that assessing and addressing IU may contribute to more individualized clinical approaches in OCD.