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Studies have shown that theory of mind, emotion regulation and pragmatic abilities are negatively affected in people with obsessive-compulsive disorder  ( OCD). We aimed to investigate theory of mind (ToM) abilities, social responsiveness, pragmatic language, and emotion regulation skills in children with OCD and to compare them to healthy controls. This study was designed as a single-center, cross-sectional, case-control study. ToM abilities were evaluated  via  “Reading the Mind in the Eyes Test” (RMET), “Faces Test”, “Faux-Pas Test”, “Comprehension Test” and “Unexpected Outcomes Test”. Social responsiveness, pragmatic language and emotion regulation were evaluated by Social Responsiveness Scale (SRS), Children’s Communication Checklist- Second Edition (CCC-2), Difficulties in Emotion Regulation Scale (DERS) and Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). Within the study period, we enrolled 85 adolescents (42 with OCD and 43 controls). The OCD group performed significantly lower than healthy controls in the Faux Pass and Comprehension tests ( p  = 0.003 for both). We found a statistically significant difference between groups in terms of the goal, strategy, non-acceptance subscales of the DERS ( p  &lt; 0.001,  p  = 0.006,  p  = 0.008, respectively) as well as the total DERS score ( p  &lt; 0.001). CY-BOCS total scores correlated significantly and negatively with Comprehension, Faux Pas and Unexpected Outcomes tests, and positively with CCC total, SRS total and DERS total scores. In regression analysis the DERS, SRS and CCC tests emerged as significant predictors of CY-BOCS total score. Addressing ToM, pragmatic, and ER difficulties when planning the treatment of young people with OCD may contribute to positive outcomes.

Emotion dysregulation and social communication problems but not ToM properties may predict obsessive-compulsive disorder symptom severity