The Mediating Role of Maladaptive Coping in the Association Between Neuroticism and Family Accommodation in Obsessive-Compulsive Disorder

Objective Family accommodation, in which relatives facilitate obsessive-compulsive symptoms, is highly prevalent in obsessive-compulsive disorder (OCD) and associated with poor treatment outcomes. Although neuroticism and maladaptive coping have been linked to OCD severity, the mechanisms by which personality traits relate to family accommodation remain poorly understood. This study examined associations between neuroticism, coping strategies, symptom severity, and family accommodation in OCD, and tested whether maladaptive coping mediates the neuroticism–family accommodation association.Methods We conducted a cross-sectional study with 149 adults diagnosed with OCD via the Structured Clinical Interview for DSM-5 at a university hospital outpatient clinic. Participants completed the Family Accommodation Scale–Patient Version, Yale-Brown Obsessive Compulsive Scale Self-Report, Big Five Inventory-44, and Brief COPE. Hierarchical regression and bootstrap-based mediation analyses (PROCESS Model 4; 5,000 bootstrap samples) were performed, controlling for age, sex, education, and symptom severity.Results OCD symptom severity (β=0.342, p<0.001) and maladaptive coping (β=0.347, p<0.001) were significantly associated with family accommodation, explaining 26.6% of its variance. Neuroticism was not directly associated with family accommodation; however, mediation analysis revealed a significant indirect association through maladaptive coping (B=0.189, 95% confidence interval [0.034 to 0.399]).Conclusion These cross-sectional findings suggest that maladaptive coping may represent a potential behavioral pathway linking neuroticism to family accommodation in OCD. While the findings provide a theoretical rationale for further investigating coping mechanisms, longitudinal and experimental studies are needed to determine whether interventions targeting maladaptive coping lead to reductions in family accommodation.