CompulSafety The interplay of stress regulation and attachment style in obsessive-compulsive disorder

This thesis presents a neuroimaging study and a meta-analysis to examine how psychological distress contributes to symptom onset and deterioration in obsessive-compulsive disorder (OCD), and whether attachment insecurity could be an underlying vulnerability factor.
The meta-analysis quantified associations between OCD and both attachment anxiety and avoidance. The fMRI study compared 23 OCD patients and 23 healthy controls using a within-subjects design with counterbalanced stress induction and control sessions. Over an hour after stress induction, participants underwent resting-state scanning, a symptom provocation task, and a face matching task. The resting-state scan assessed the balance between habitual and goal-directed networks. The other tasks examined salience network reactivity. Attachment insecurity was included as a covariate in the face matching task analysis to explore its potential moderating role.
The hypothesis that psychological distress would shift functional connectivity toward the habitual network, particularly in OCD patients, was not confirmed. Instead, results suggested that OCD patients struggled to shift from self-referential processing to goal-directed behavior under stress. Contrary to expectations, OCD patients showed reduced reactivity in the dorsal anterior cingulate cortex to emotionally salient images under stress, suggesting that healthy individuals more effectively reappraise negative stimuli during stress adaptation.
No interaction was found between attachment insecurity and OCD status in neural responses. However, a broader analysis showed robust effects of attachment insecurity on the neural stress response, independent of OCD diagnosis.