Potential Mediating Roles of Thought-Action Fusion and Schizotypal Traits in the Relationship Between Childhood Trauma and Obsessive-Compulsive Disorder

Abstract Background: Although the relationship between Childhood Trauma (CT) and Obsessive Compulsive Disorder (OCD) is well known, and evidence indicates the involvement of Thought-Action Fusion (TAF) and schizotypal traits in OCD, no studies to date have examined the potential mediating roles of TAF and schizotypal traits in the relationship between CT and OCD. In this study, we hypothesized that TAF and/or schizotypal traits—both of which are linked to cognitive distortions—may mediate the association between specific subtypes of CT and OCD symptoms. Methods: We performed a cross-sectional study with 83 patients with OCD aged 18–65, using Yale Brown Obsessive-Compulsive Scale (YBOCS), The Childhood Trauma Questionnaire-Short Form (CTQ-SF), The Thought–Action Fusion Scale (TAFS), and Schizotypal Personality Questionnaire-Brief (SPQ-B) to assess childhood traumatic experiences, OCD severity, the tendency to integrate thoughts into behaviors, and the severity of schizotypal traits. Descriptive, correlational, regression and mediation analyses were used to determine the extent of the relationship between CT and OCD. Results: No statistically significant correlation was observed between the YBOCS and the TAFS-R scores. The YBOCS total, obsession and compulsion scores showed significant correlations with SPQ-B total and SPQ-B interpersonal traits. Significant positive correlations were found between the YBOCS scores and emotional abuse, physical abuse, and emotional neglect. Emotional abuse was significantly associated with cognitive perceptual and disorganized traits, and TAF total, TAF moral, TAF likelihood self, and TAF likelihood others. Emotional neglect was significantly associated with SPQ-B total, interpersonal and cognitive-perceptual traits, and TAF likelihood-self. Additionally, physical neglect was significantly associated with SPQ-B total, cognitive perceptual, and disorganized traits. The mediation analysis indicated that the SPQ-B total significantly mediated the relationship between emotional abuse and emotional neglect and YBOCS total. Conclusions: Contrary to expectations, neither the moral nor likelihood dimensions of TAF were significantly associated with OCD severity. As hypothesized, the indirect effects of emotional abuse and emotional neglect on OCD through total schizotypy were significant. Clinicians treating individuals who develop new or worsening OCD following trauma exposure should consider the role of schizotypal traits for both cognitive therapy and pharmacological treatment.