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

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 impulsiveness 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 impulsiveness positively correlated with OCD severity, depression, and maladaptive strategies (all p < 0.05). Non-planning impulsiveness 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 analysis 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.