The relationship between theory of mind functions and attachment styles in obsessive compulsive disorder

Aim: Various levels of neuropsychological impairments are known in patients with obsessive compulsive disorder (OCD). In recent years, research on Theory of Mind (ToM) functions and attachment styles has increased in OCD. In this study, it was aimed to investigate whether there is a difference between OCD patiants and healthy controls in terms of ToM skills and attachment styles, and whether there is a relationship between obsessive-compulsive symptoms, ToM skills and attachment styles in patients with OCD. Materials and Methods: 42 patients diagnosed with OCD according to DSM-5 diagnostic criteria and 42 healthy controls matched for age, gender and education level were included in our study. Sociodemographic and Clinical Data Form, Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Padua Inventory-41-R (PI), Adult Attachment Style Scale (AASS), Hinting Task (HT) and Reading the Mind in the Eyes Test (RMET) was applied to all participants. Results: In the OCD group, HT (p: 0.001) and RMET (p: 0.006) performances were found to be significantly weak compared to the control group, and both test scores were found to be negatively and significantly correlated with the scores from the BAI in the patient group (p: 0.001 and p: 0.003, respectively). In our study, it was found that anxious/ambivalent (p: <0.001) and avoidant attachment (p: <0.001) dimensions were significantly higher in the OCD group, and this difference remained significant when the severity of depressive symptoms was controlled. When the relationship between attachment dimensions and CC skills in OCD patients is examined; While there was a negative and significant relationship between avoidant (p: 0.006) and anxious/ambivalent attachment (p: 0.024) dimensions, and HT scores, there was no significant relationship between RMET performances and attachment dimensions (p: 0.055 and p: 0.057, respectively). When the effect of depressive symptoms was controlled, only the relationship between avoidant attachment size and HT scores remained significant in patients with OCD (p: 0.007). While there was no significant relationship between PI total score with subscale scores and HT with RMET performance, a significant positive correlation between anxious/ambivalent attachment dimension and PI total score with contamination/washing, rumimation, impulses, precision symptom sub-dimensions was observed in the OCD grup. In the OCD group; a negative and significant relationship was found between the avoidant attachment dimension and the checking sub-dimension of obsessive-compulsive symptoms (p:0,05), no significant correlation was found between the avoidant attachment dimension and the scores obtained from the PI total score and other symptom subscales. Conclusion: In this study, it was observed that both affective and cognitive ToM skills in OCD were weaker than healthy controls, and both anxious/ambivalent and avoidant attachment dimensions in OCD were higher. In our study, a significant negative relationship was observed between the insecure attachment dimensions and cognitive ToM skills in OCD patients. In addition, there was a significant relationship between obsessive-compulsive symptoms and anxious/ambivalent attachment, and no significant relationship was found between ToM and symptoms. The discovery of impairments in OCD and recent evidence for their relationship may contribute to understanding the effects of neurodevelopmental processes in this disorder, as well as in this disorder that is relatively highly low response to treatment, the development of new treatment methods that take into account the attachement and ToM skills. Key Words: Obsessive Compulsive Disorder, Theory of Mind, Mentalization, Attachment