The mediating role of mentalization and interoception in the relationship between childhood trauma and obsessive-compulsive disorder

Obsessive-Compulsive Disorder is a psychiatric disorder affecting approximately 1% to 3% of the global population and is more prevalent among women than men (Brock et al., 2024; Fawcett et al., 2020; Ruscio et al., 2010). The presence of childhood traumas in individuals diagnosed with obsessive-compulsive disorder has been associated with a more severe course of the disorder, emphasizing the importance of addressing traumatic experiences within psychotherapy (Kessler et al., 2010; Kyrios et al., 2018). The literature highlights the significance of the body in psychological well-being, its role in trauma, and its use as a resource and a secure base in psychotherapeutic interventions (Ogden et al., 2006; van der Kolk, 1994). Although research on the relationship between mentalization and interoception is limited, it has been suggested that understanding one's own internal states may facilitate the ability to comprehend the internal states of others. Within this framework, elucidating the mechanisms between interoception and mentalization may contribute to interventions aiming to enhance mentalization by supporting interoceptive awareness (Ondobaka et al., 2017). The present study aimed to investigate the serial multiple mediation role of mentalization and interoception in the relationship between childhood traumas and obsessive-compulsive disorder symptoms in a clinical sample and a control group. Between May 2024 and May 2025, 66 adult outpatients diagnosed with obsessive-compulsive disorder at NP Feneryolu Medical Center, Department of Psychiatry, and 62 individuals without any psychiatric diagnosis during the same period were included in the study. The data collection instruments comprised the Demographic Information Form, Multidimensional Assessment of Interoceptive Awareness Scale-II, Childhood Trauma Questionnaire, Mentalization Questionnaire, Dimensional Obsessive-Compulsive Scale, and Acute Stress Symptoms Scale–Adult. The collected data were analyzed using the SPSS v.21 statistical software package. The analyses revealed that the serial multiple mediation roles of interoception and mentalization in the relationship between childhood traumas and obsessive-compulsive disorder symptoms were not statistically significant in either the obsessive-compulsive disorder or the control group. However, acute stress symptoms-one of the controlled variables in the model-emerged as a strong predictor of obsessive-compulsive disorder symptoms within the obsessive-compulsive disorder group. Furthermore, in the control group, acute stress was found to significantly reduce mentalization capacity and increase obsessive-compulsive disorder symptoms. Future research should consider larger samples, conduct longitudinal studies to better capture the effects of interoception and mentalization, and assess the distinct dimensions of interoception more comprehensively.