Revista multidisciplinaria

investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025

Emotional Dysregulation as a Factor in Obsessive-Compulsive

Disorder: A Systematic Review

DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a106

244-267

Emotional Dysregulation as a Factor

in Obsessive-Compulsive Disorder: A

Systematic Review

Desregulación Emocional Como Factor del

Trastorno Obsesivo Compulsivo: Una Revisión

Sistemática

Fabián Martínez 1, Geovanny Reivan 2

1 1 Catholic University of Cuenca. Graduate in Psychology Clinic;

fabian.martinez.09@est.ucacue.edu.ec. Loja, Ecuador.

2 Catholic University of Cuenca. PhD in Psychology; greivano@ucacue.edu.ec . Cuenca, Ecuador.

How to cite:

Martínez Calle, F. P., & Reivan Ortiz, G. G. (2025). Emotional Dysregulation as a Factor in Obsessive-

Compulsive Disorder: A Systematic Review. Multidisciplinary Journal of Contemporary Research, 3(2), 244–267.

https://doi.org/10.58995/redlic.rmic.v3.n2.a106

Article Information

Received: 20-01-2025

Accepted: 02-04-2025

Published: 01-07-2025

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Funding Sources

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own resources.

Conicts of Interest

No conicts of interest are declared.

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Leucemia de células dendríticas plasmocitoides

- estudio y diagnóstico de un caso 49 -49

González González Camila Raquel, Matute Aguiar Joselyn Nayeli, Rodríguez Ver-

dugo Alejandra Valentina.

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del licenciante o lo recibe por el uso que hace de la obra.

Resumen de licencia - Texto completo de la licencia

Review article. Revista MultidisciplinariaInvestigación Contemporánea.

Vol. 3 - No. 2, pp. 244 - 267. July-December, 2025. e-ISSN: 2960-8015

DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a106

Revista multidisciplinaria

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DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a90

Leucemia de células dendríticas plasmocitoides

- estudio y diagnóstico de un caso 32 -49

Artículo Caso clínico. Revista multidisciplinaria investigación Contemporánea.

Vol. 3 - No. 2, pp. 32 - 49. julio-diciembre, 2025. e-ISSN: 2960-8015

Leucemia de células dendríticas

plasmocitoides - estudio y diagnóstico

de un caso

Leucemia de células dendríticas plasmocitoides - estudio y

diagnóstico de un caso

Información del artículo:

Recibido: 05-12-2024

Aceptado: 21-02-2025

Publicado: 01-07-2025

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reclamos jurisdiccionales en mensajes publi-

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No presentan conicto de intereses.

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Usted es libre para Compartir —copiar y redistribuir el material en cual-

quier medio o formato— y Adaptar el documento —remezclar, transformar

y crear a partir del material— para cualquier propósito, incluso para nes

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Puede hacerlo en cualquier forma razonable, pero no de forma tal que sugie-

ra que tiene el apoyo del licenciante o lo recibe por el uso que hace de la obra

1 Docente Investigador; pedro.faican@ucacue.edu.ec. Azogues, Ecuador.

2 Estudiante; ibelice.dutan.44@est.ucacue.edu.ec. Azogues, Ecuador.

3 Estudiante; camila.gonzalez.66@est.ucacue.edu.ec. Azogues, Ecuador.

4 Estudiante; joselyn.matute.44@est.ucacue.edu.ec. Azogues, Ecuador.

5 Estudiante; alejandra.rodriguez.60@est.ucacue.edu.ec. Azogues, Ecuador.

Faicán Rocano Pedro Fernando 1, Dután Pérez Ibelice Salomé 2, González González Camila

Raquel 3, Matute Aguiar Joselyn Nayeli 4, Rodríguez Verdugo Alejandra Valentina 5

DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a90

Cómo citar:

Faican Rocano, P. . F., Dután Pérez, I. S. ., González González, C. R. ., Rodríguez Verdugo, A. V. ., & Matute Aguiar, J.

N. . (2025). Leucemia de células dendríticas plasmocitoides - estudio y diagnóstico de un caso.

Revista Multidisci-

plinaria Investigación Contemporánea

, 3(2), 32-49. https://doi.org/10.58995/redlic.rmic.v3.n2.a90

Revista multidisciplinaria

investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025

Emotional Dysregulation as a Factor in Obsessive-Compulsive

Disorder: A Systematic Review

DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a106

245-267

Summary

Obsessive-Compulsive Disorder (OCD) is characterized by recurrent intrusive

thoughts that generate repetitive behavioral or mental responses. This study

describes the relationship between OCD and Emotional Dysregulation ( ED ),

dened as the difculty in adequately managing emotions, which constitutes a key

factor in the severity of symptoms. Through a systematic review in Scopus , Web

of Science , and Google Scholar , using the PRISMA method, 8 articles validated

with STROBE and CONSORT were analyzed. The results highlight that the most

common forms of EED in OCD include low emotional clarity, non-acceptance of

emotions, impulsive behaviors due to poor emotional management, and emotional

avoidance. It is concluded that the lack of emotional clarity and acceptance

are the main factors that aggravate obsessions and compulsions. Therefore,

it is recommended to address EED as a central element in psychotherapeutic

interventions to treat OCD.

Keywords: Obsessive Compulsive Disorder, Emotional Regulation, Emotional

Dysregulation

Resumen

El Trastorno Obsesivo Compulsivo (TOC) se caracteriza por pensamientos

intrusivos recurrentes que generan respuestas conductuales o mentales

repetitivas. Este estudio describe la relación entre el TOC y la Desregulación

Emocional (DsE), denida como la dicultad para gestionar adecuadamente las

emociones, y que constituye un factor clave en la severidad de los síntomas. A

través de una revisión sistemática en Scopus, Web of Science y Google Scholar,

utilizando el método PRISMA, se analizaron 8 artículos validados con STROBE y

CONSORT. Los resultados destacan que las formas más comunes de DsE en el TOC

incluyen la poca claridad emocional, no aceptación de las emociones, conductas

impulsivas por mal manejo emocional y evitación emocional. Se concluye que la

falta de claridad y aceptación emocional son los principales factores que agravan

las obsesiones y compulsiones. Por ello, se recomienda abordar la DsE como un

elemento central en las intervenciones psicoterapéuticas para tratar el TOC.

Palabras clave: Trastorno Obsesivo Compulsivo, Regulación Emocional,

Desregulación Emocional

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Revista multidisciplinaria

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DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a106

Desregulación Emocional Como Factor del Trastorno Obsesivo

Compulsivo: Una Revisión Sistemática 246 - 267

1. Introducción

El Trastorno Obsesivo Compulsivo (TOC) es una enfermedad mental crónica

y debilitante, caracterizada por obsesiones (pensamientos, imágenes o im-

pulsos intrusivos recurrentes) y compulsiones (acciones mentales o conduc-

tuales repetitivas) que afectan el bienestar de quienes lo padecen (American

Psychiatric Association, 2013). Las obsesiones pueden incluir pensamientos

inmorales, preocupaciones por la contaminación o dudas patológicas (Pur-

don, 2021). Las compulsiones buscan prevenir un resultado percibido como

desastroso y pueden manifestarse en rituales mentales o conductas eviden-

tes, como lavarse las manos o vericar constantemente si una puerta está ce-

rrada (Sibrava et al., 2011). El TOC severo es una forma grave del trastorno,

caracterizada síntomas frecuentes que pueden ocupar desde 4 horas al día

hasta cada momento de vigilia, impactando negativamente en el bienestar de

la persona (Huppert & Foa, 2005).

La prevalencia global del TOC es del 1% al 2%, siendo el cuarto trastor-

no mental más común en Europa, con tasas entre el 0.1% y 2.3% (Fawcelt et

al., 2020; Pampaloni et al., 2022). Las mujeres tienen mayor riesgo, con una

tasa del 1.5% frente al 1.0% en hombres (Fawcelt et al., 2020). Las obsesiones

más frecuentes incluyen miedo a la contaminación, daño personal, obsesio-

nes con la simetría y pensamientos prohibidos, mientras que las compulsio-

nes más comunes son el lavado, comprobaciones constantes y evitación de

desencadenantes (Veale & Roberts, 2014).

La Regulación Emocional (RE) consiste en los procesos mediante los

cuales las personas inuyen en sus emociones, ya sea en su experiencia o

expresión, y puede activarse de forma consciente o inconsciente dependien-

do de metas o necesidades (Gross, 1999; Aldao et al., 2010). Gratz y Roemer

(2004) destacan dimensiones clave de una RE saludable, como claridad emo-

cional, acceso a estrategias, conductas orientadas a objetivos, consciencia

emocional, aceptación de emociones y control de impulsos. Por otro lado, la

Desregulación Emocional (DsE) se reere a la incapacidad de gestionar las

1. Introduction

Obsessive-Compulsive Disorder (OCD) is a chronic and debilitating

mental illness characterized by obsessions (recurring intrusive thoughts,

images, or impulses) and compulsions (repetitive mental or behavioral

actions) that affect the well-being of those who suffer from it (American

Psychiatric Association). Association , 2013). Obsessions may include

immoral thoughts, contamination worries, or pathological self-doubt

( Purdon, 2021). Compulsions seek to prevent a perceived disastrous

outcome and may manifest in mental rituals or overt behaviors, such as

hand-washing or constantly checking whether a door is locked ( Sibrava

et al., 2011). Severe OCD is a severe form of the disorder, characterized by

frequent symptoms that can occupy from 4 hours a day to every waking

moment, negatively impacting a person’s well-being ( Huppert & Foa ,

2005).

The global prevalence of OCD is 1% to 2%, making it the fourth most

common mental disorder in Europe, with rates between 0.1% and 2.3%

( Fawcelt et al., 2020 ; Pampaloni et al., 2022 ). Women are at higher risk,

with a rate of 1.5% versus 1.0% in men ( Fawcelt et al., 2020 ). The most

frequent obsessions include fear of contamination, self-harm, obsessions

with symmetry, and forbidden thoughts, while the most common

compulsions are washing, constant checking, and avoidance of triggers (

Veale & Roberts, 2014 ).

Emotional Regulation (ER) consists of the processes by which people

inuence their emotions, whether in their experience or expression, and

can be activated consciously or unconsciously depending on goals or needs

( Gross , 1999; Aldao et al., 2010). Gratz and Roemer (2004) highlight key

dimensions of a healthy ER, such as emotional clarity, access to strategies,

goal-oriented behaviors, emotional awareness, acceptance of emotions

and impulse control. On the other hand, Emotional Dysregulation (

ED ) refers to the inability to manage emotions appropriately, leading

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to maladaptive responses that affect psychological well-being. This

phenomenon is related to difculties in selecting emotion regulation

strategies and to the severity of OCD symptoms ( Aldao et al., 2010).

Psychotherapeutic work focused on emotional dysregulation ( ED)

in anxiety disorders and OCD has shown a positive impact on symptom

remission and high adaptability to patient needs (Moral and Hervás , 2017).

Emotional regulation strategies such as emotional awareness, emotional

clarity, acceptance of emotions, impulse control, and goal-oriented

behaviors are key to developing prevention and treatment programs ( See

et al., 2022).

First-line treatments combine Selective Serotonin Reuptake

Inhibitors (SSRIs) with Cognitive Behavioral Therapy (CBT), particularly

Exposure and Response Prevention (ERP), which has been shown to be

highly effective in reducing symptoms (Del Casale et al., 2019; Pittenger

and Bloch , 2014; Skapinakis et al., 2016; Öst et al., 2015). However, its

implementation is limited due to practical constraints, lack of resources,

and concerns about patients’ fears of exposure and potential side effects

(Colman et al., 2024).

2. Methodology

A systematic evaluation was carried out of the documents found

on the scientic digital platforms Scopus , Web of Science , and Google

Scholar , which were accessed through the Virtual Library of the Catholic

University of Cuenca, introducing thesaurus nomenclature according to

each platform, as shown in Table 1. The inclusion criteria for the articles

were: a) they must have been published since 2018, b) they must be written

in English or Spanish, c) they must use experimental or quasi-experimental

methodology, d) they must use populations of all ages. The exclusion

criteria were dened as: a) they must have limited access, b) they must be

books, c) their content must not have the correlation analysis between DsE

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or RE and OCD. Initially adding between the three databases, there was

a total of 50 articles selected to analyze, after discarding those that were

repeated or that were written in a language other than English or Spanish,

a total of 37 articles were obtained, with this an exhaustive review of titles,

contents and accessibility of each document was carried out, having at the

end a total of 8 articles that were used for this study, the entire process

mentioned above was carried out using the PRISMA Declaration Flowchart

( Preferred Reporting Items for Systematic reviews and Meta- Analyses ),

which serves as a tool to promote quality, transparency and consistency

in the presentation of ndings from systematic review research, detailed

in Figure 1. In addition to this, the methodological quality of the selected

articles was analyzed by applying the STROBE Initiative Declaration “

Strengthening the Reporting of Observational studies in Epidemiology

”, which allowed us to recognize the elements necessary to measure

the quality of selected articles and, likewise, the CONSORT Statement “

Consolidated” was used for this. Standards of Reporting Trials ”, the results

of which are shown in Table 3 and Table 4 respectively.

Table 1. Advanced search

Database Thesaurus nomenclature

Web of Science OCD (Topic) emotion regulation (Topic) treatment

(Topic)

Scopus

(TITLE-ABS-KEY ( ocd ) AND TITLE-ABS-KEY

( emotion AND regulation ) AND TITLE-ABS-

KEY (treatment ) ) AND PUBYEAR > 2017 AND

PUBYEAR < 2025 AND ( LIMIT-TO ( LANGUAGE

, “English” ) ) AND ( LIMIT-TO ( DOCTYPE , “ ar

“ ) ) AND ( LIMIT-TO ( SUBJAREA , “NEUR” ) OR

LIMIT-TO ( SUBJAREA , “PSYC” ) OR LIMIT-TO (

SUBJAREA , “MEDI” ) )

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Google Scholar

“OCD” AND “emotion regulation” AND “treatment”

without the words: “ Meta analysis “ “medicine”

“diagnosis” “psychiatry”

Note. Source: Martínez & Reivan (2025)

Figure 1. Flowchart of the different phases of the systematic review, based

on Urrútia & Bonll (2010). Source: Martínez & Reivan (2025).

Número de registros o citas identificadas

en las búsquedas:

� Scopus: (n=19)

� Web of Science: (n=14)

� Google Scholar: (n=17)

Número total de registros o citas: (n=50)

Número total de registros duplicados:

(n=9)

Artículos a texto completo excluidos, y

razón de su exclusión:

No se tuvo acceso al contenido:

(n=23)

No se estudia la relación entre DsE o

RE y TOC:

(n=8)

No es un manuscrito, es un libro:

(n=2)

Número total de artículos excluidos:

(n=33)

Número total de registros o citas únicas cribadas después

de eliminar los duplicados:

(n=41)

Número total de estudios incluidos en la síntesis

cualitativa de la revisión sistemática:

(n=8)

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Table 2. Assessment of the quality of the studies based on the STROBE

checklist

STROBE score

Articles

Title and summary

Context/Basis

Goals

Study design

Context

Participants

Variables

Data sources/measures

Biases

Sample Size

Quantitative Variables

Statistical Methods

Participants

Descriptive data

Variable data

Main results

Other analyses

Key Results

Limitations

Interpretation

Generality

Financing

( Yap et al.,

2018)

( Khosravani ,

et al., 2018)

( Shameli et

al., 2019)

( McKenzie et

al., 2020)

( McKenzie et

al., 2020)

( Eichholz et

al., 2020)

(Ferreira et al.,

2021)

( Naji , et al.,

2022)

(+) Green box = Submitted-reported, 1 pt; (P) Gray box = Partially submitted-

reported, 0.5 pt; (?) White box = Not submitted-reported, 0 pts.

Note. Source: Martínez & Reivan (2025)

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Desregulación Emocional Como Factor del Trastorno Obsesivo

Compulsivo: Una Revisión Sistemática 251 - 267

Tabla 3. Evaluación de la calidad de los estudios basada en la lista de comprobación del

CONSORT

Puntuación CONSORT

Artículos

(Yap et al., 2018) ?+++P+?++?P+++++?+?

(Khosravani, et al.,

2018) ?+++?+P++?P+++++?+?

(Shameli et al., 2019) ?+++P+?++?P? + ? + ? ? + +

(McKenzie et al.,

2020) ?+++P+P++?P+++++?+?

(McKenzie et al.,

2020) ?+++P+?++?P+++++?++

(Eichholz et al., 2020) ? + + + P+?++?P+++++?+?

(Ferreira et al.,2021) ?+++P+?++?P+++++?++

(Naji, et al., 2022) ? + + + + P? + + ? P+++++?++

(+) Casilla de color verde = Presentado-reportado, 1pt; (P) Casilla de color gris = Parcialmente presentado-reportado, 0.5pt; (?) Color blan-

co= No presentado-reportado, 0pts.

Nota. Fuente: Martínez & Reivan (2025)

Título

Resumen

Introducción 1

Introducción 2

Método 1

Método 2

Método 3

Método 4

Método 5

Método 6

Método 7

Método 8

Resultados 1

Resultados 2

Resultados 3

Discusión 1

Discusión 2

Discusión 3

Otra información

PPP

PP PPPPPP

? ?

??????

Table 3. Assessment of the quality of studies based on the CONSORT

checklist

CONSORT Score

Articles

Qualication

Summary

Introduction 1

Introduction 2

Method 1

Method 2

Method 3

Method 4

Method 5

Method 6

Method 7

Method 8

Results 1

Results 2

Results 3

Discussion 1

Discussion 2

Discussion 3

Other information

( Yap et al., 2018)

( Khosravani , et al.,

2018)

( Shameli et al., 2019)

( McKenzie et al., 2020)

( Eichholz et al., 2020)

(Ferreira et al., 2021)

( Naji , et al., 2022)

(+) Green box = Submitted-reported, 1 pt; (P) Gray box = Partially submitted-

reported, 0.5 pt; (?) White box = Not submitted-reported, 0 pts.

Note. Source: Martínez & Reivan (2025)

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5. Development

Below, in this section, the characteristics, factors analyzed and quality

scores of each article reviewed are presented in Table 4:

Table 4. Selected articles, characteristics of the studies and factors

analyzed:

No. Reference Study Features

Factors Analyzed

STROBE

ptj MAX

22 pts

CONSORT

ptj MAX 19

pts

OCD DsE

Obsessions Compulsions Complex Factor Characteristics

“Emotion regula-

tion difculties in

obsessive-compul-

sive disorder”

( Yap et al., 2018)

Australia; N=365; experimental;

Difculties in Emotion Regula-

tion Scale (DERS); Dimensional

Obsessive-Compulsive Disorder

Scale (DOCS); Yale-Brown

Obsessions and Compulsions

Scale (Y-BOCS).

Unacceptable

thoughts;

Responsibili-

ty; Symmetry;

Pollution

Control rituals;

Symmetry;

Decontamination

rituals

DsE causes an increa-

se in the severity of

symptoms .

DsE : Non-acceptance

of emotions, inability

to achieve goals when

distressed, problems

controlling impulses,

limited access to ER

strategies.

18.5 13

“Difculties in

emotion regulation

and symptom

dimensions in

patients with ob-

sessive-compulsive

disorder”

( Khosravani , et al.,

2018)

Iran; N=160; quasi-experimental

; DERS; Y-BOCS; Obsessi-

ve-Compulsive Inventory-Revi-

sed (OCI-R)

Doubt; Was-

hing concern;

Obsession;

Mental neu-

tralization

Checking; Orde-

ring; Washing and

cleaning

DsE was a signi-

cant predictor of

checking/doubting,

obsession, mental

neutralization, and

ordering symptoms .

Non-acceptance of

emotional responses,

low emotional aware-

ness, limited access to

ER, non-acceptance of

emotions

19 12

“The Effectiveness

of Emotion-Fo-

cused Therapy

on Emotion

Regulation Styles

and Severity of

Obssesive -Com-

pulsive Symptoms

in Women with

Obssesive -Com-

pulsive Disorder”

( Shameli et al.,

2019)

Iran; N=24; quasi-experimental

; Emotion-Focused Therapy

(EFT) Protocol

Fear of conta-

mination; Fear

of aggression;

Need for

symmetry;

Forbidden

thoughts

Washing and cle-

aning; Checking;

Reinforcing com-

pulsions; Memory

review; Avoiding

triggers

The results showed

that there was a

signicant difference

between the test and

study groups in terms

of concealment style

and OCD severity

after the intervention.

Decreased emotional

awareness

Maladaptive beha-

viors due to poor

emotional manage-

ment.

16 11

“Variability in

emotion regulation

in pediatric

obsessive-com-

pulsive disorder:

Associations with

symptom presenta-

tion and response

to treatment”

( McKenzie et al.,

2020)

Australia; N=137; experimen-

tal; Child Behavior Checklist

(CBCL)

Fear of conta-

mination; Fear

of aggression;

Need for

symmetry;

Forbidden

thoughts

Washing and cle-

aning; Checking;

Reinforcing com-

pulsions; Memory

review; Avoiding

triggers

DsE is related to

internalizing and ex-

ternalizing symptoms

Lack of emotional

awareness

Negative emotional

responses

20 13.5

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“Examining

parent-report of

Children’s emotion

regulation in

pediatric OCD:

Associations with

symptom severity,

externalizing be-

havior and family

accommodation”

( McKenzie et al.,

2020)

Australia; N=76; experimental;

CBCL

Fear of conta-

mination; Fear

of aggression;

Need for

symmetry;

Forbidden

thoughts

Washing and cle-

aning; Checking;

Reinforcing com-

pulsions; Memory

review; Avoiding

triggers

Lability/Negativity

correlates positively

and signicantly

with externalizing

symptoms

Lack of emotional

awareness

Negative emotional

responses

21 14

“Self-compassion

and emotion regu-

lation difculties

in obsessive-com-

pulsive disorder”

( Eichholz et al.,

2020)

Germany; N=90; quasi-experi-

mental ; DERS; Self-Compas-

sion Scale (SCS)

Fear of conta-

mination; Fear

of aggression;

Need for

symmetry;

Forbidden

thoughts

Washing and cle-

aning; Checking;

Reinforcing com-

pulsions; Memory

review; Avoiding

triggers

DsE was positively

associated with

increased severity of

OCD symptoms

Low emotional awa-

reness

Emotional avoidance

Non-acceptance of

emotions

Distress caused by

emotional responses

19 13

“Stress Inuences

the Effect of Obses-

sive-Compulsive

Symptoms on Emo-

tion Regulation”

(Ferreira et al.,

2021)

Portugal; N=65; experimental;

Emotional Regulation Ques-

tionnaire (ERQ)

Fear of conta-

mination; Fear

of aggression;

Need for

symmetry;

Forbidden

thoughts

Washing and cle-

aning; Checking;

Reinforcing com-

pulsions; Memory

review; Avoiding

triggers

Stress acts as an

inuencing factor on

DsE , causing an in-

crease in the severity

of symptoms.

Emotional suppres-

sion 21 14

“Mediating Role of

Difculties in Emo-

tion Regulation

and Experimental

Avoidance in the

Relationship Be-

tween Attachment

Styles and Severity

of Relationship

Obsessive-Com-

pulsive Disorder

Symptoms”

( Naji , et al., 2022)

Iran; N=531; experimental;

DERS; Relationship Obses-

sive-Compulsive Inventory

(ROCI); Acceptance and Action

Questionnaire II (AAQ-II);

Fear of conta-

mination; Fear

of aggression;

Need for

symmetry;

Forbidden

thoughts

Washing and cle-

aning; Checking;

Reinforcing com-

pulsions; Memory

review; Avoiding

triggers

DsE had a mediating

role in attachment

styles and symptom

severity

Lack of emotional cla-

rity, poor emotional

management

16.5 14

Note. Source: Martínez & Reivan (2025)

In addition, the individual results analysis of each study was also

carried out with its respective contribution, specifying the type of DsE or

RE associated with the severity of the symptoms:

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3.1. Resultados de los estudios revisados

3.1.1. Estudio 1

En este artículo autoría de Yap et al. (2018), Diﬁcultades de Regulación Emocional en

el Trastorno Obsesivo-Compulsivo, cuyo objetivo fue examinar las dicultades en

RE y su implicación en la gravedad de los síntomas de TOC, por lo que se rea-

lizaron dos estudios con distintas muestras, el primero con una comunitaria

(n=306), y el segundo con una clínica (n=59). Las dicultades en la regulación

de las emociones, especialmente la no aceptación de las emociones, los pro-

blemas de mayor incapacidad para lograr objetivos cuando se está angustia-

do, los problemas para controlar los impulsos y el acceso limitado a las es-

trategias de regulación de las emociones cuando se experimentan emociones

negativas, afectan de forma diferencial a las etapas de identicación, selec-

ción, aplicación y supervisión de la regulación de las emociones en el TOC,

por lo que los síntomas de este patología se ven agravados. Debido a esto se

reconoce la importancia del rol que la RE tiene al momento de predecir la

gravedad de síntomas.

3.1.2. Estudio 2

El estudio de Khosravani et al. (2018) Diﬁcultades en la Regulación de las Emociones

y Dimensiones de los Síntomas en Pacientes con Trastorno Obsesivo-Compulsivo, contando

al grupo de control la población total fue de 160 personas, a las cuales se les

aplicó Y-BOCS, OCI-R y DERS. Los resultados arrojaron que la no aceptación

de las respuestas emocionales, el acceso limitado a estrategias de regulación

de las emociones y las dicultades de control de los impulsos se relaciona-

ban positivamente con las seis dimensiones sintomáticas de la TOC: preo-

cupaciones de lavado, comprobación/duda, obsesión, neutralización mental,

ordenación y acaparamiento. Las dicultades para llevar a cabo conductas

dirigidas a objetivos mostraron correlaciones de mayor signicancia y po-

sitivas con las preocupaciones de lavado, obsesionarse, comprobar/dudar y

3.1. Results of the reviewed studies

3.1.1. Study 1

In this article authored by Yap et al. (2018), Di󰤰culties in Emotional

Regulation in Obsessive-Compulsive Disorder, whose objective was to examine

the difculties in ER and their implication in the severity of OCD

symptoms, so two studies were carried out with different samples, the rst

with a community sample (n=306), and the second with a clinical sample

(n=59). Difculties in emotion regulation, especially the non-acceptance

of emotions, problems of greater inability to achieve goals when distressed,

problems controlling impulses and limited access to emotion regulation

strategies when experiencing negative emotions, differentially affect the

stages of identication, selection, application and supervision of emotion

regulation in OCD, so the symptoms of this pathology are aggravated. Due

to this, the importance of the role that ER has in predicting the severity of

symptoms is recognized.

3.1.2. Study 2

The study by Khosravani et al. (2018) Di󰤰culties in Emotion Regulation

and Symptom Dimensions in Patients with Obsessive-Compulsive Disorder ,

counting the control group, the total population was 160 people, to whom

Y-BOCS, OCI-R and DERS were applied. The results showed that the non-

acceptance of emotional responses, limited access to emotion regulation

strategies and difculties in impulse control were positively related to

the six symptomatic dimensions of OCD: washing, checking/doubting,

obsessing, mental neutralizing, ordering and hoarding. Difculties in

carrying out goal-directed behaviors showed more signicant and positive

correlations with washing, obsessing, checking/doubting and ordering

concerns. Lack of emotional awareness was positively associated with all

six dimensions of OCD symptoms, except for ordering.

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3.1,3, Study 3

Shameli et al. (2019) in their research, The E󰤮ectiveness of Emotion-

Focused Therapy on Emotion Regulation Styles and Severity of Obsessive-

Compulsive Symptoms in Women with Obsessive-Compulsive Disorder , aimed

to analyze the effects of Emotion-Focused Therapy (EFT) on ER styles

and the severity of obsessive-compulsive symptoms in women with

OCD. For which, pre and post treatment, the OCI-R, Y-BOCKS and DERS

instruments were used to a total population of 24 women, applying group

therapy sessions lasting 90 minutes, held twice a week for 5 weeks. EFT

develops internal control through its principles, which allowed patients

to reduce their high levels of self-criticism and feelings of shame, causing

their symptoms to decrease. Specically, patients considered the use of the

hiding style, which refers to people who manage or repress their emotions,

as the main means of generating emotion regulation. This was because,

thanks to the nal direction of the treatment, practical solutions were

sought, with the objective of replacing the usual obsessive-compulsive

strategies, increasing in turn the levels of awareness and responsibility by

reecting on their own internal relationships.

3.1,4, Study 4

This study by McKenzie et al. (2020), Variability in Emotion Regulation

in Pediatric Obsessive-Compulsive Disorder: Associations with Symptom

Presentation and Treatment Response , explored whether variability in

emotion regulation was associated with several clinical correlates of OCD

and an attenuated response to treatment. Participants in this study were

137 youth between the ages of 7 and 17 years, with a primary diagnosis

of OCD, who administered the ADIS-IV-P, CY-BOCS, BRIEF, CBCL, FAS-

SR assessment instruments. A median split of responses to the BRIEF

Baseline Emotional Control (EQ) index resulted in two groups of youth:

those with relatively higher and those with poorer EQ. The results

indicated that the group with a relatively lower EQ, that is, those who were

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not aware of their emotions and therefore relapsed into more negative

and intense emotional and behavioral responses, presented internalizing

and externalizing symptoms , generating greater severity in terms of OCD

symptoms, having a comorbid diagnosis of specic phobia, and more

Family Accommodation (FA), which refers to the actions taken by the

family nucleus to accommodate the needs of a member suffering from

psychological difculties, altering the usual dynamics. Three months after

treatment, there were fewer young people who responded to treatment in

the group with lower EQ than in the group with higher EQ; however, there

were no signicant differences in the remission of symptoms between the

groups.

3.1,5, Study 5

The study by McKenzie et al. (2020), Examining Children’s Parent-

Report of Emotion Regulation in Pediatric OCD: Associations with Symptom

Severity, Externalizing Behavior , and Family Accommodation examined

parent-reports of children and adolescents with OCD, who analyzed

the ER of 76 participants aged 7 to 17 years, in order to measure the

relationships they had with this illness and PA and ER capacities. The

Child Behavior Checklist was used for this. The results indicated that

the parent-report showed that participants’ lability/negativity was

signicantly and positively correlated with externalizing symptoms and

PA, while adaptive ER was signicantly and negatively correlated only

with externalizing symptoms; furthermore, lability/negativity predicted

externalizing symptoms , even when OCD severity was taken into account.

Lability/negativity did not predict family adjustment after controlling for

OCD severity and externalizing symptoms , however, it was a signicant

moderator of the relationship between OCD.

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jo el ajuste familiar después de controlar la gravedad del TOC y los síntomas

externalizantes, sin embargo, fue un moderador signicativo de la relación

entre el TOC.

3.1.6. Estudio 6

La investigación realizada por Eichholz et al. (2019), Auto-Compasión y Diﬁculta-

des en Regulación Emocional en Trastorno Obsesivo Compulsivo, estudió la relación

de autocompasión, las dicultades de RE, las creencias obsesivas y la severi-

dad de sintomatología de TOC en 90 pacientes a los cuales se les aplicaron

cuestionarios de autoreporte, que fueron: DERS, Y-BOCS, OCCWG y SCS. Los

resultados de análisis estadístico arrojaron que la severidad de los síntomas

y las creencias obsesivas fueron negativamente correlacionados con la auto-

compasión, por otro lado, sí que se asociaron positivamente con la DsE, adi-

cionalmente a esto la autocompasión mostró una relación negativa con la RE,

concluyendo que especícamente la poca consciencia emocional, evitación

de las emociones, el distrés ocasionado por las respuestas emocionales y la no

aceptación de emociones, son las que predicen la severidad de TOC debido a

que inuencian directamente sobre las creencias obsesivas.

3.1.7. Estudio 7

Para este artículo de Ferreira et al. (2021), El Estrés Inﬂuye en el Efecto de los Sín-

tomas Obsesivo-Compulsivos sobre la Regulación de las Emociones, se exploran los

efectos del estrés y los síntomas obsesivos compulsivos en RE, realizado en

una muestra de 65 individuos sanos y diagnosticados con TOC, empleando

dispositivos psicométricos de autoreporte para medir los niveles de estrés a

través de la Escala de Estrés Percibido (PSS-10) , síntomas obsesivos compul-

sivos mediante Y-BOCS y OCI-R, nalmente la RE mediante las habilidades

de reevaluación y supresión de emociones con el uso del ERQ. Se aplicaron

análisis de regresión múltiple y de mediación para obtener los resultados, que

indicaron que el aumento de las puntuaciones de reevaluación se asoció con

puntuaciones de supresión más altas; además, los valores de estrés elevados

3.1,6, Study 6

The research conducted by Eichholz et al. (2019), Self-Compassion

and Di󰤰culties in Emotional Regulation in Obsessive Compulsive Disorder ,

studied the relationship of self-compassion, ER di󰤰culties, obsessive beliefs and

the severity of OCD symptoms in 90 patients who were administered self-

report questionnaires , which were: DERS, Y-BOCS, OCCWG and SCS.

The results of statistical analysis showed that the severity of symptoms

and obsessive beliefs were negatively correlated with self-compassion, on

the other hand, they were positively associated with DsE , in addition to

this self-compassion showed a negative relationship with ER, concluding

that specically the low emotional awareness, avoidance of emotions,

distress caused by emotional responses and non- acceptance of emotions,

are those that predict the severity of OCD because they directly inuence

obsessive beliefs.

3.1,7, Study 7

For this article by Ferreira et al. (2021), Stress In󰤱uences the E󰤮ect of

Obsessive-Compulsive Symptoms on Emotion Regulation , the effects of stress

and obsessive-compulsive symptoms on ER are explored, carried out in a

sample of 65 healthy individuals diagnosed with OCD, using self-report

psychometric devices to measure stress levels through the Perceived

Stress Scale (PSS-10) , obsessive-compulsive symptoms through Y-BOCS

and OCI-R, nally ER through reappraisal and emotion suppression skills

with the use of the ERQ. Multiple regression and mediation analyses were

applied to obtain the results, which indicated that increased reappraisal

scores were associated with higher suppression scores; Furthermore,

high stress levels predicted increased suppression scores and decreased

reappraisal scores. Furthermore, reappraisal abilities resulted from a

combination of a direct effect of obsessive-compulsive symptoms and

an indirect effect of stress-mediated obsessive-compulsive symptoms.

Therefore, it is concluded that the inclusion of stress management in

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treatment models for OCD is important, as it directly affects ER, which

consequently increases symptom severity.

3.1,8, Study 8

This article authored by Naji et al. (2022) Mediating Role of Di󰤰culties

in Emotion Regulation and Experimental Avoidance in the Relationship between

Attachment Styles and the Severity of Symptoms of Relationship Obsessive-

Compulsive Disorder , aims to determine the mediating role of difculties in

emotion regulation and avoidance of experimentation in the relationship

between attachment styles and the severity of Relationship Obsessive-

Compulsive Disorder (RCD), so 531 participants were selected for the

application of reagents: ECR-R, DERS, AAQ-II, ROCI. The study model t

the data perfectly, and two variables of DsE and experimental avoidance

had a mediating role in the relationship between attachment styles and

RCD symptoms. Insecure attachment styles are associated with strategies

of underregulation (disengagement from close others) and overregulation

(exaggerated emotional expressions). These strategies and difculties in

regulating emotions, with a lack of emotional clarity and maladaptive

behaviors caused by poor emotional management being key factors, can

lead to an increase in compulsive behaviors in different domains of CDD.

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4. Conclusions

There is a notable interest in the research community in the

area of psychopathology regarding the relationship between DsE and

OCD, highlighting its possible application for treatment and even as

a complement when performing exposure therapy. In this work, this

information has been analyzed and compiled to arrive at more convincing

arguments in this regard, specically when it comes to communicating

the most common specic variables of DsE and ER.

Concluding that the DsE that is frequently evident are: Little

emotional clarity, non-acceptance of emotions, behaviors driven by poor

management of emotions and emotional avoidance, which constitute the

most common specic factors that were found and that infer about the

severity of OCD symptoms, mainly because they act on obsessions and

compulsions, so it is important that this information be taken into account

to reform and integrate new objectives in the different psychotherapeutic

interventions.

Likewise, it is recommended that more research be incorporated

to demonstrate the effectiveness of enhancing ER in people with OCD

within psychotherapeutic processes and that the results be contrasted

and validated.

5. Contribution of the authors

FM: Data collection, introduction, analysis of results, discussion,

conclusions.

GR: Data collection, analysis of results, discussion, nal review of the

article.

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6. Acknowledgments

This research has been carried out thanks to the Master’s Degree in

Clinical Psychology with a Mention in Psychotherapy and the Robotics,

Automation, Intelligent and Embedded Systems Laboratory ( RobLab )

from the Catholic University of Cuenca.

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