强迫症患者的神经质人格和不成熟防御机制在童年创伤与强迫症状中的中介作用

Mediating effects of neuroticism and immature defense on relationship between childhood trauma and obsessive-compulsive symptoms in patients with obsessive-compulsive disorder

目的·探讨强迫症患者童年创伤、人格特质及心理防御机制特点,以及人格特质、防御方式在童年创伤与强迫症状之间的中介作用。方法·纳入113例符合美国《精神障碍诊断与统计手册》(第五版)(Diagnostic and Statistical Manual of Mental Disorders-5,DSM-5)诊断标准的强迫症患者(强迫症组),以及66例年龄、性别、受教育程度相匹配的健康志愿者(对照组)。使用Yale-Brown强迫症状量表(Yale-Brown Obsessive-Compulsive Scale,Y-BOCS)评估强迫症患者的症状严重程度;使用童年创伤问卷(Childhood Trauma Questionnaire,CTQ)评估患者16岁前的创伤经历;使用大五人格量表(NEO Five-Factor Inventory,NEO-FFI)测量其人格特质;使用防御方式问卷(Defense Style Questionnaire, DSQ)评估患者的防御方式类型,分析患者的童年创伤、强迫症状、人格与防御机制之间的相关性,及人格与防御机制在童年创伤与强迫症状间的中介作用。结果·强迫症组患者情感虐待[8(5,25)分vs 6(5,22)分]、不成熟防御机制[(4.65±1.01)分vs(3.60±0.99)分]评分高于对照组(均P<0.05)。强迫症患者Y-BOCS总分与CTQ中情感虐待分量表评分(r=0.211,P<0.05)、不成熟防御机制(r=0.274, P<0.05)呈正相关;NEO-FFI中神经质与不成熟防御机制呈正相关(r=0.468, P<0.05)。中介模型显示不成熟防御机制在情感虐待与强迫症状间起完全中介作用,中介作用大小为0.088 (95%CI 0.003~0.173,P<0.05);神经质在情感虐待和不成熟防御机制间起部分中介作用,中介作用大小为0.117 (95%CI 0.014~0.219,P<0.05)。结论·相比于健康人群,强迫症患者经历了更多童年期情感及躯体创伤,具有异常的神经质、外向性及尽责性的人格特质,倾向于使用不成熟防御机制。情感虐待通过神经质人格影响了不成熟防御机制,进而对强迫症状产生了影响。

Objective·To explore the characteristics of childhood trauma, personality traits and defense mechanism in the patients with obsessive-compulsive disorder(OCD), and investigate the mediating effects of personality traits and defense style on the relationship between childhood trauma and obsessive-compulsive symptoms in the OCD patients. Methods·Totally 113 patients with OCD who met the criteria of Diagnostic and Statistical Manual of Mental Disorders-5(DMS-5), and 66 age-and gendermatched health controls with similar education level distribution were selected. Yale-Brown Obsessive-Compulsive Scale(Y-BOCS)was used to evaluate the severity of obsessive-compulsive symptoms. Childhood Trauma Questionnaire(CTQ) was used to evaluate the childhood trauma experience. NEO Five-Factor Inventory(NEO-FFI) was used to measure the personality traits. Defense Style Questionnaire(DSQ) was used to evaluate the defense style. The correlations among childhood experience, obsessive-compulsive symptoms, personality traits and defense style as well as mediating role of personality traits and defense style between childhood trauma and obsessive-compulsive symptoms were analyzed. Results·Compared with the health controls, the OCD patients showed higher scores of emotional abuse [8(5, 25) points vs 6(5, 22) points, P<0.05] and immature defense [(4.65±1.01) points vs(3.60±0.99) points, P<0.05]. In the OCD patients, the scores of emotional abuse(r=0.211, P<0.05) and immature defense(r=0.274, P<0.05) were positively correlated with the total scores of Y-BOCS, and the neuroticism scores of NEO-FFI were positively correlated with the total scores of Y-BOCS(r=0.468, P<0.05). The pathway analysis showed the indirect effect from emotional abuse to YBOCS via immature defense was 0.088(95%CI 0.003-0.173, P<0.05). The immature defense played a completely mediated role,and indirect effect from emotional abuse to immature defense via neuroticism was 0.117(95%CI 0.014-0.219, P<0.05).Conclusion·Compared with healthy people, OCD patients have experienced more emotional and physical childhood trauma, and have abnormal personality traits of neuroticism, extraversion and conscientiousness. They tend to use immature defense mechanisms.The emotional abuse has an impact on immature defense via neuroticism, and finally affect the obsessive-compulsive symptoms.