EMOTION REGULATION STRATEGIES AND THEIR ASSOCIATION WITH DISABILITY IN OBSESSIVE-COMPULSIVE DISORDER

Obsessive-Compulsive Disorder (OCD) is a chronic, debilitating neuropsychiatric condition that significantly impacts an individual’s quality of life and ability to function across multiple domains. Characterized by the presence of obsessions—recurrent and persistent thoughts, impulses, or images that are experienced as intrusive and distressing— and compulsions—repetitive behaviors or mental acts performed to reduce the distress associated with obsessions—OCD often leads to a vicious cycle of anxiety and maladaptive coping. These symptoms are time-consuming (typically taking more than an hour per day), ego-dystonic, and are not attributable to the physiological effects of a substance or another medical condition (ICD-10, WHO, 1992; DSM 5, APA, 2013). The condition can severely disrupt an individual’s personal, social, occupational, and academic functioning, resulting in a marked decline in overall psychosocial well-being. OCD commonly begins in adolescence or early adulthood and follows a chronic course if left untreated. It is equally prevalent in both sexes, although the onset in males tends to be earlier. The disorder is frequently comorbid with other psychiatric conditions such as depression, anxiety disorders, tic disorders, and body dysmorphic disorder, further compounding its impact and complicating its treatment. Despite the availability of evidence based pharmacological (e.g., SSRIs) and psychological treatments (e.g., Cognitive Behavioral Therapy with Exposure and Response Prevention), many individuals experience only partial remission or relapse, underlining the need to investigate other f actors that contribute to symptom persistence and functional outcomes. Epidemiologically, OCD is recognized as a common psychiatric disorder. According to the Epidemiological Catchment Area (ECA) study conducted in the United States, the lifetime prevalence of OCD ranged from 1.9% to 3.3% (ECA, 1984). The National Comorbidity Survey Replication (NCS-R) reported a slightly lower lifetime prevalence of 2.3% (Kessler et al., 2005). In global contexts, prevalence estimates vary: in Iran, it stands at 1.8%, and in Singapore, at 3%. Studies in India have also reported prevalence rates between 0.6% to 3%, depending on the population sampled and assessment methodology. Importantly, a significant portion of the population experiences subclinical obsessive-compulsive symptoms—manifesting patterns that resemble OCD but do not meet full diagnostic criteria. These subthreshold forms can still lead to distress and functional impairment, and they may represent a prodromal stage of the disorder (Weissman et al., 1994). Given t his spectrum of symptom severity, understanding the broader implications of OCD on functioning is critical. One such domain deserving closer scrutiny is emotion regulation—the processes by which individuals influence which emotions they have, when they have them, and how they experience and express these emotions (Gross, 1998). Adaptive emotion regulation strategies (such as cognitive reappraisal, positive refocusing, and planning) enable individuals to manage negative affect and cope effectively with life’s stressors. In contrast, maladaptive strategies (such as rumination, self-blame, catastrophizing, and suppression) have been linked to a host of psychological difficulties, including anxiety and mood disorders (Garnefski & Kraaij, 2006; Nolen-Hoeksema et al., 2008). In OCD, emotion dysregulation plays a particularly central role, as individuals often report intense feelings of guilt, fear, and distress in response to intrusive thoughts, which they then attempt to neutralize through compulsive behaviors. Over time, reliance on maladaptive strategies not only perpetuates the obsessive-compulsive cycle but also undermines self-efficacy and resilience, thereby aggravating functional disability. The association between emotion regulation and clinical outcomes in OCD has received increasing empirical attention in recent years. Studies suggest that difficulties in emotion regulation are associated with greater symptom severity, poorer insight, and reduced treatment responsiveness in OCD. However, fewer studies have explicitly examined the impact of emotion regulation on functional disability—a key determinant of long-term prognosis and recovery. Disability, in the context of mental illness, is defined as the degree to which symptoms interfere with an individual’s ability to carry out age appropriate and culturally expected roles and responsibilities. It is not merely the presence of symptoms, but the extent of functional impairment, that determines the overall burden of illness. In the Indian context, the Indian Disability Evaluation and Assessment Scale (IDEAS)— developed by the Rehabilitation Committee of the Indian Psychiatric Society and endorsed by the Government of India—is used to assess disability in individuals with mental illness. The scale evaluates functioning across four domains: self-care, interpersonal activities, communication and understanding, and work. Each domain is rated on a 5-point scale from 0 (no disability) to 4 (profound disability), and the total score reflects the level of disability, categorized as mild (score 1–6), moderate (7–13), severe (14–19), or profound (20 and above). In cases where the mental illness has lasted for more than two years, a weightage of 1.5 times the total score is applied to account for chronicity. The IDEAS scale is widely used for certifying disability in clinical settings and plays a crucial role in accessing benefits and rehabilitation services under the Rights of Persons with Disabilities (RPWD) Act, 2016. Despite the clear utility of the IDEAS scale and the known role of emotion regulation in OCD, limited research has examined how specific emotion regulation strategies influence the level of disability in individuals with OCD. Given that OCD is often associated with high levels of functional impairment even when symptom severity appears moderate, it becomes essential to explore the mediating or moderating effects of cognitive-emotional processes. Understanding these associations can inform more tailored and effective interventions aimed not just at reducing symptoms but at improving overall functioning and quality of life. Hence, this study aims to explore the patterns of cognitive emotion regulation strategies and their relationship with functional disability in i ndividuals diagnosed with Obsessive Compulsive Disorder, using the IDEAS scale as a measure of disability severity. By identifying specific maladaptive and adaptive strategies that are linked with higher or lower levels of disability, the study seeks to provide empirical evidence for integrating emotion regulation training into therapeutic programs for OCD, particularly in the Indian context.