Gender Differences in OCD Severity in Offspring of Individuals with OCD, Anxiety Disorders, or Depressive Disorders: The Mediating Role of Parentification

Abstract

Obsessive-compulsive disorder (OCD) exhibits notable gender differences, yet mechanisms like parentification remain underexplored. Children of parents with internalizing psychopathology form a high-risk group for experiencing OCD and parentification, making this population particularly relevant in this context. This study examined whether parentification mediates the relationship between female gender and OCD severity, adjusting for anxiety and depression severity. For this purpose, 516 offspring aged 13–26 years of patients with OCD, anxiety disorders, or depressive disorders were selected, using baseline data from the ARIADNE high-risk cohort. Offspring self-reported gender and completed DSM-IV-based questionnaires assessing OCD, anxiety, and depressive severity, while parentification was indexed with a parent-reported dichotomous item. Hypotheses were tested with linear and multiple regressions and mediation analyses controlling for anxiety and depression severity. Female gender was associated with higher OCD severity, with parentification initially showing a significant mediating role. After adjustment, the association between female gender and parentification became nonsignificant, and the mediating effect was no longer observed. Notably, parentification remained independently associated with OCD severity. Exploratory item-level analyses revealed gender differences in cleaning compulsions and compulsive precision, persisting after adjustment. Overall, gender differences in OCD appear largely explained by comorbid internalizing symptoms in this high-risk sample. Parentification functions as a general vulnerability factor for OCD rather than a mechanism underlying gender differences in overall severity. Family role dynamics should be assessed early on and across genders, which may help prevent maladaptive trajectories.