Research looks to better understand pediatric OCD patients' difficulties with emotional regulation

A new study is suggesting children with obsessive-compulsive disorder (OCD) may experience more difficulties with emotional regulation (ER) than non-clinical controls and greater efforts are needed to improve outcomes in children with OCD. The researchers found children with OCD demonstrated more ER difficulties during a frustration task compared to non-clinical controls as rated by investigators.This study is unique because it is the first to employ a multi-informant and multi-method approach to examine ER in children with OCD concurrently. Most studies are based on self-reports and very few have examined how these difficulties are expressed across modalities. The researchers theorize that taking a closer look at this issue may hold important diagnostic and therapeutic information.“This was a terrific study, looking at emotion regulation challenges in youth with OCD. The multi-informant and multi-method approach adds to the growing body of literature looking at this topic. In this study, the data matches what we see clinically, where those experiencing OCD often experience emotion regulation difficulties as well,” said Maria Fraire, program director at the OCD Institute for Children & Adolescents (OCDI Jr.) at McLean Hospital and Harvard Medical School in Boston. In the study, the challenges with ER were identified by the children and their parents and were observable to investigators. The authors noted these difficulties were not expressed in terms of autonomic functioning. OCD is estimated to occur in approximately 3% of children and adolescents. It is associated with repetitive and intrusive thoughts, urges, images, or impulses (obsessions) and/or repetitive behaviours or mental acts (compulsions). The present study is a sub-study of a larger randomized controlled trial (The TECTO trial) designed to test treatment efficacy of cognitive behavioural therapy (CBT) for 121 children with OCD (clinicaltrials.gov NCT03595098). “These findings are absolutely relevant and could contribute to improving treatment outcomes. In our residential treatment program, our primary treatment approach is exposure and response prevention, and we frequently incorporate learning general emotion regulation skills as well. The key is teaching when to use these emotion regulation skills versus when to lean into anxiety and discomfort in the service of treating OCD,” said Fraire. Dr. Gabrielle A. Carlson, a board-certified child and adolescent psychiatrist at Stony Brook Medicine and professor of Psychiatry and Pediatrics at Stony Brook University’s Renaissance School of Medicine in New York, said these findings are intriguing and start to answer important questions. However, there is still a significant lack of clinical data on children with OCD and behavioural problems. “This particular study is not useful to the clinician with agitated, anxious and dysregulated kids in their practices since responses to the DERS are not given and that is what clinicians need to see more precisely,” she said. In the current study, children with OCD and their parents reported more ER difficulties. However, the team found that while the children with OCD displayed more behavioural emotional difficulties during a frustrating task, there were no distinct OCD psychophysiological aberrations in relation to a frustrating task.The study included 211 children aged eight through 17 years in Denmark. In this cohort, 121 children had OCD and 90 were included as non-clinical controls. Child ER difficulties were assessed with The Difficulties in Emotion Regulation Scale (self-report and parent-report). The researchers also conducted a Tangram frustration task with investigator-rated behaviour, self-rated frustration and heart rate variability (HRV). Emily Bilek, a child and adolescent psychologist at University of Michigan Health, said the study found that youth with OCD have more dysregulation both at baseline, and in response to frustrating tasks than do their healthy peers. However, the researchers also found that youth with OCD did not have a larger increase in dysregulation in response to frustration than healthy youth. “This all suggests that youth with OCD have emotion regulation difficulties that arise for them both in response to frustration but also in the absence of frustrating tasks. These findings were not particularly surprising to me, as they are in line with literature on emotion regulation in adults with OCD, as well as among other studies of youth with OCD,” Bilek told the Medical Post.Ethnicity was not assessed as this is not routine practice in the Danish healthcare system. While the children with OCD and non-clinical controls were comparable in terms of age and sex, the children with OCD demonstrated lower IQ scores compared to non-clinical controls. Among the 121 children with OCD, 71 had at least one comorbid disorder and 21 were taking medication for other somatic or psychiatric conditions.Dr. Carlson, who is also past president of the American Academy of Child and Adolescent Psychiatry, said when the findings from the full study are assembled, they should presumably be clinically useful. “Hopefully, we will know if one form or another of CBT helps with the emotion dysregulation in OCD kids. What components are dysregulated, how dysregulated do they get, and how does that inform us about what to do next?” Dr. Carlson told the Medical Post.Bilek noted that one question raised in the article is whether these emotion regulation difficulties may impact youths’ ability to engage in the gold-standard treatment for OCD, exposure and response prevention (ERP). ERP involves doing activities to elicit feared intrusive thoughts or obsessions and then resisting the urge to engage in fear-neutralizing rituals or compulsions. “It requires a great deal of executive functioning, and likely emotional regulation to voluntarily face fears in this way. Future research might examine whether some youth with OCD may benefit from emotion regulation training prior to or in tandem with ERP for OCD,” said Bilek.Fraire said the current study helps lay a foundation for better understanding these issues in this patient population. “While it was noted that the heart rate variability did not differ between those with OCD and the control group, I would be curious to see in future studies if there may be differences in how the two groups interpreted elevated heart rates, which may have contributed to the group differences in reported frustration at the end of the task,” said Fraire. References:Lykke Thoustrup C, Blair RJ, Heidenheim Christensen S, et al. Emotion regulation difficulties in children and adolescents with obsessive-compulsive disorder: A multi-informant and multi-method study. Journal of Anxiety Disorders Volume 111, April 2025, 103002. https://doi.org/10.1016/j.janxdis.2025.103002

Research looks to better understand pediatric OCD patients' difficulties with emotional regulation

Register for free access or login.

Related Topics

Business Topic