Adverse childhood experiences and gender influence treatment seeking behaviors in obsessive–compulsive disorder Francesco Benedetti, Sara Poletti ⁎ , Daniele Radaelli, Elena Pozzi, Chiara Giacosa 1 , Enrico Smeraldi Department of Clinical Neurosciences, Scientific Institute and University Vita-Salute, San Raffaele, Milan Abstract Background: Exposure to adverse childhood experiences (ACE) increases the risk of adult physical and mental health disorders, including obsessive–compulsive disorder (OCD), and influences adult brain structure and function. ACE could influence the use of psychotropic drugs in adulthood, and treatment seeking behaviors. Methods: We assessed the severity of ACE in a sample of 31 healthy controls and 66 patients with OCD who were consecutively referred for hospitalization and were either drug-naïve or drug-treated. In addition, we explored the possible clinical relevance of ACE with two additional analyses: (a) a discriminant function analysis with sex and ACE as factors, and (b) a logistic regression with use of medication as dependent variable and ACE as factor. Results: Despite comparable age, years at school, age at onset of illness, duration of illness, and severity of illness (Y-BOCS), adult drug- naïve patients reported lower exposure to ACE and later contacts with mental health professionals than drug-treated. This effect was particularly evident in female patients compared to males. Conclusions: The interaction of gender with factors linked with the early familial environment biased access to psychiatric care and use of medication, independent of OCD-associated factors such as severity of symptoms or duration of illness. The need for medications of patients could be higher in families where OCD symptomatology is associated with ACE. © 2013 Elsevier Inc. All rights reserved. 1. Introduction The relationship between childhood emotional and physical abuse and neglect, and later occurrence of physical and mental health disorders [1], has been extended to OCD [2,3], dimensions of OCD psychopathology [4,5], and OC symptoms in the general population [6]. Aspects of parenting may contribute to the development of OCD among offspring, with independent but additive environmental and genetic risk [7]. Shared environmental factors, such as parenting and family environment, have been reported to account for 16% of the variance in OCD psychopathology in childhood [8]. The possible influence of sex on the resilience to the detrimental effects of early stress is debated [9], but a higher specific sensitivity to family conflict has been described in females [10]. Considering OCD, environmental influences could explain the stability of OC symptoms throughout childhood in girls, while mainly additive genetic factors accounted for stability of OC symptoms in boys [11]. The magnitude and type of the genetic and environmental influences on OCD may differ as the children enter puberty, with differences reported at 12 years of age [8]. The relevance of adverse childhood experiences (ACE) in psychopathological conditions has been confirmed by recent brain imaging studies. Among healthy humans, the offspring of families marked by harsh parenting with overt family conflict and deficient nurturing (“risky families”, RF) had higher activation of prefrontal cortex and reduced activation of limbic structures when observing fearful or angry facial expressions, but higher activations in the amygdala when forced to actively engage with these stimuli, thus suggesting a counterproductive difficulty in regulating emotional Available online at www.sciencedirect.com ScienceDirect Comprehensive Psychiatry xx (2013) xxx – xxx www.elsevier.com/locate/comppsych ⁎ Corresponding author. Istituto Scientifico Ospedale San Raffaele, Department of Clinical Neurosciences, San Raffaele Turro, Via Stamira d’Ancona 20, Milano, Italy. Tel.: +39 02 26433156; fax: +39 02 26433265. E-mail address: poletti.sara@hsr.it (S. Poletti). 1 Current affiliation: Department of Psychology, Concordia University, Montreal, Canada. 0010-440X/$ – see front matter © 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.comppsych.2013.08.028