Early adversity links more to transdiagnostic than obsessive-compulsive disorder (OCD)-specific features: Findings from a large multinational study.

introductionWhile some studies have linked early adversity to obsessive-compulsive disorder (OCD), not all findings are consistent, and the nature of these associations remains unclear. In particular, it is uncertain whether childhood trauma is more strongly related to features specific to OCD (e.g. onset age, severity, symptom dimensions) or to broader, clinical characteristics commonly observed in OCD but also in other psychiatric conditions (e.g., anxiety and depressive symptoms). The Global OCD study provided an opportunity to investigate these associations in a large multinational investigation of adult OCD.

methodsA total of 268 individuals with OCD and 256 age- and sex-matched healthy controls (HCs) completed the Childhood Trauma Questionnaire (CTQ). CTQ total scores were compared between groups. Within the OCD group, regression models were used to examine associations between CTQ scores (total and subscale totals) and OCD-specific features (e.g., OCD onset age, OCD severity, obsessive-compulsive symptom dimensions) controlling for site, sex, age, socio-economic status (SES), and severity of anxiety and depression symptoms. Exploratory analyses further examined the association of CTQ with impulsivity/compulsivity scores, level of insight, and also severity of anxiety and depression symptoms controlling for covariates. All outcomes were fit as continuous (linear model), except OCD onset age, which was analyzed as a binary variable (<18 vs. ≥18 years). Statistical significance was set at p < 0.05 with correction for multiple comparisons in the exploratory analyses.

resultsIndividuals with OCD, regardless of study site or sex, reported significantly higher levels of childhood trauma than HCs. Within the OCD group, no significant associations were found between overall childhood trauma severity (CTQ total score) and OCD-specific features (OCD onset age, OCD severity, and obsessive-compulsive symptom dimensions). Notably, greater severity of physical trauma (abuse and neglect) in childhood was significantly associated with more severe harm-related obsessive-compulsive symptoms. Exploratory analyses found greater childhood trauma (CTQ total and subscale scores) was significantly associated with impulsivity/compulsivity, level of insight, and severity of anxiety and depression symptoms.

conclusionChildhood adversity appears to be more closely associated with broader clinical characteristics commonly detected in psychiatry rather than to features specific to OCD. These findings support prior research indicating that early trauma contributes broadly to psychiatric vulnerability rather than specifically to OCD. Nevertheless, the association of childhood physical trauma with harm-related obsessive-compulsive symptoms suggests the potential relevance of distinct forms of early adversity for particular OCD presentations. Further research is needed to clarify the mechanisms that underlie these associations, and their implications for treatment.