Relationships between dissociation, obsessive beliefs, and self-esteem in juvenile obsessive-compulsive disorder: a case-controlled clinical study

A body of accumulating evidence showed that dissociation, obsessive-beliefs, and poor self-esteem are causally implicated in obsessive-compulsive disorder (OCD) in adult samples. This study aimed at expanding and refining the current evidence in children and adolescents. A total of 41 patients with OCD and 51 healthy individuals, aged between 11 and 17, were included in the study. The Coopersmith Self-Esteem Inventory (CSEI), Adolescent Dissociative Experiences Scale (A-DES), Revised Child Anxiety and Depression Scale – Child Version (RCADS- CV), and Obsessive Beliefs Questionnaire - Child Version (OBQ-CV) were completed by participants. The Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version DSM-5 (K-SADS PL DSM-5) and Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS-C) were further administered among juvenile OCD patients. Specific phobias (39.0%), depressive disorders (22.0%), social phobia (17.1%), and attention deficit hyperactivity disorder (12.2%) were the more prevalent comorbid clinical conditions in the OCD group. A-DES scores were significantly associated with both obsessions and compulsions subscales of the CY-BOCS-C in the clinical group. OCD-afflicted youths had lower levels of general self-esteem than healthy controls (HC). Most and foremost, low general self-esteem and maternal psychopathology significantly contributed to the development and maintenance of juvenile OCD. We found no support for the significant associations of obsessional beliefs with obsessive-compulsive symptoms. Compared to healthy youths, the results suggested that juvenile OCD seems to pursue a different developmental pathway concerning dissociative symptomatology and self-concept.