Emotional Dysregulation and Psychiatric Morbidity in Women with Polycystic Ovary Syndrome: A Case–Control Study from a Moroccan Population

Emotional Dysregulation and Psychiatric Morbidity in Women with Polycystic Ovary Syndrome: A Case–Control Study from a Moroccan Population | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Emotional Dysregulation and Psychiatric Morbidity in Women with Polycystic Ovary Syndrome: A Case–Control Study from a Moroccan Population El khansa Layoussifi, Oumaima Azim, Saja Akermi, Roukaya Benjelloun This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9255440/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Polycystic ovarian syndrome (PCOS) is a common endocrine condition marked by hormonal, metabolic, and reproductive abnormalities. Although there is still a lack of data from North African populations, emerging evidence points to an increased susceptibility to psychiatric disorders and emotional dysregulation. This study aimed to assess the prevalence of emotional dysregulation and psychiatric disorders among Moroccan women with PCOS, as well as the correlations between these conditions and clinical and demographic factors . Methods : A cross-sectional case-control study that included 70 matched controls and 75 women with PCOS was carried out. The Difficulties in Emotion Regulation Scale (DERS) was used to measure emotional dysregulation, and the Mini International Neuropsychiatric Interview (MINI) was used to measure psychiatric disorders. Results: The prevalence of psychiatric disorders was significantly higher in women with PCOS than in controls (94.7% vs. 77.1%; p = 0.002). Increased odds of mood disorders (AOR = 3.37; p = 0.001), anxiety disorders (AOR = 1.99; p = 0.043), and eating disorders (AOR = 3.84; p = 0.046) were all independently linked to PCOS. The PCOS group had higher DERS total scores (92.9±18.1 vs. 79.4±13.8; p<0.001), especially in the areas of impulse control, goal-directed behavior, emotional awareness, and emotional clarity. A sedentary lifestyle was linked to higher levels of emotional dysregulation. Conclusion Regardless of sociodemographic variables, Moroccan women with PCOS have a high prevalence of mental illnesses and emotional dysregulation. These results emphasize the necessity of multidisciplinary care that includes psychological therapies and lifestyle changes, as well as systematic mental health screening. Polycystic ovary syndrome psychiatric disorders emotional dysregulation depression anxiety eating disorders Morocco Background One of the most prevalent endocrine conditions affecting women of childbearing age is polycystic ovarian syndrome (PCOS), sometimes referred to as Stein-Leventhal syndrome. It is a multifactorial condition with a variety of biological and clinical manifestations. Infertility, irregular menstruation, and chronic anovulation are the main ways that PCOS impacts reproduction. It may also be accompanied by metabolic issues such as insulin resistance, obesity, and a higher risk of type 2 diabetes, as well as clinical or biological indicators of hyperandrogenism (hirsutism, acne, alopecia). On ultrasonography, a multifollicular ovarian appearance can be seen ( 1 ). PCOS is the most common endocrinopathy in women of reproductive age, with an estimated global prevalence of 6% to 13%, according to the diagnostic criteria used (NIH 1990, Rotterdam 2003, or AES 2006) ( 2 , 3 ). Furthermore, a number of studies have shown that women with PCOS have a high prevalence of psychiatric disorders, in particular anxiety and depression. According to international meta-analyses, these patients are much more likely than women without this syndrome to experience symptoms of anxiety and depression. The prevalence of anxiety may surpass 60%, while the average rates of depression are approximately 30%. Other psychological issues, such as eating disorders, low self-esteem, and an elevated risk of suicide, often coexist with these disorders ( 4 – 7 ). Recent research indicates that emotional regulation issues may be a key transdiagnostic mechanism in PCOS, going beyond categorical psychiatric diagnoses. The psychological vulnerability seen in this population may be explained by the fact that affected women display more severe emotional dysregulation and maladaptive emotional strategies than control women ( 8 ). According to certain studies, women with PCOS in the Middle East and North Africa (MENA region) have high rates of anxiety and depression disorders. The data that is currently available, however, is still sparse and inconsistent. The prevalence of psychiatric disorders and emotional regulation issues in women with PCOS has not yet been systematically evaluated in any large-scale study conducted in Morocco or the Maghreb region as a whole, indicating a severe lack of local data ( 9 , 10 ). By examining the psychological aspect of PCOS in a sociocultural setting that is still understudied, the current study aims to close this gap. In order to support a more thorough and integrated approach to the care of these patients, the primary goals are to evaluate the prevalence of psychiatric disorders and emotional regulation issues in women with PCOS and to examine their correlation with different clinical and sociodemographic factors. Methods Participants and Study Design Between October 2024 and October 2025, 145 women of reproductive age participated in a cross-sectional case-control study. 75 patients with a confirmed diagnosis of polycystic ovarian syndrome (PCOS) based on the Rotterdam criteria (2003) made up the case group, whereas 70 healthy women without a history of PCOS made up the control group. In cooperation with gynecologists working in private practices, as well as at Mohammed VI International University Hospital and Cheikh Khalifa International University Hospital, participants with PCOS were recruited. To guarantee sociodemographic comparability between the two groups, control participants were chosen at random from the general population. Criteria for Inclusion and Exclusion Women of childbearing age who could give informed consent were eligible to participate. Participants had to have a verified diagnosis of polycystic ovarian syndrome (PCOS) in order to be admitted to the case group. Pregnancy, menopause, the existence of neurological, endocrine, or genetic comorbidities, and a history of psychiatric disorders or current psychiatric treatment were among the exclusion criteria. Procedure for collecting Data To maintain confidentiality, interviews were done face-to-face in a private setting. The principal investigator, who had previously received training in the use of standardised evaluation instruments, conducted all assessments. Participants gave written informed consent after being fully informed about the study's methods and goals prior to enrolment. Every piece of information was gathered anonymously. Assessment Tools A structured questionnaire was administered and included: Sociodemographic and clinical variables : age, body mass index, education, marital status, socioeconomic status, lifestyle habits, and medical history. Psychiatric assessment : The Mini International Neuropsychiatric Interview (MINI), validated in Moroccan Arabic, was used to diagnose major psychiatric disorders according to DSM-IV criteria. Emotional regulation assessment : Emotional dysregulation was evaluated using the Difficulties in Emotion Regulation Scale (DERS), a 36-item instrument covering six subdimensions. Higher scores indicate greater emotional dysregulation. Ethical considerations The scientific and ethical committee of the Faculty of Medicine, Mohammed VI University of Sciences and Health approved the research protocol. All patients and participants consented to participate in the study.The researchers received no funds, and they declared no conflict of interest. Statistical Analysis All statistical analyses were performed using the Jamovi platform. Continuous variables are presented as means ± standard deviations, while categorical variables are summarized as frequencies and percentages. Initial explorations of group differences and associations were conducted using Student’s t-tests, chi-square tests, and Pearson correlation analyses. To further examine the independent relationships between PCOS status, psychiatric conditions, emotional dysregulation, and relevant sociodemographic or clinical factors, multivariable linear and logistic regression models were applied. Statistical significance was set at p < 0.05. Results I. Descriptive Findings 1. Sociodemographic Characteristics There were 70 women in the control group and 75 women with PCOS in the study. Age, education level, marital status, place of residence, and employment status were all approximately comparable between the two groups. Compared to women in the control group, PCOS participants had a slightly higher average body mass index and a higher percentage of sedentary lifestyles. Table 1 lists every participant's clinical and sociodemographic details. Table 1. Sociodemographic characteristics of the participants Variable PCOS group (N = 75) Control group (N = 70) Age (years) 26.1 ± 4.44 (18–43) 27.4 ± 4.46 (18–40) BMI (kg/m²) 27.0 ± 6.03 (17.9–43) 25.7 ± 4.5 (16.2–41.8) Urban residence (%) 88.0 82.9 University education (%) 85.3 85.7 Single (%) 77.3 72.9 Nulliparous (%) 84.0 84.3 Living with family (%) 50.7 48.6 Students / unemployed (%) 49.3 50.0 Regular/irregular employment (%) 50.7 50.0 Monthly income (%) 0–2000 MAD 16.0 8.6 2000–5000 MAD 10.7 15.7 5000–10,000 MAD 29.3 41.4 >10,000 MAD 44.0 34.3 Substance use (%) 13.3 10.0 No medication (%) 76.0 94.3 Oral antidiabetic treatment (%) 2.7 0 Hormonal treatment (%) 10.7 0 Other treatments (%) 10.6 5.7 Sedentary lifestyle (%) 56.0 35.7 BMI:body mass index MAD:Moroccan dirham 2. Prevalence of Psychiatric Disorders The overall prevalence of at least one psychiatric disorder was significantly higher in the PCOS group (94.7%) compared with controls (77.1%). Mood disorders were the most common (80.0% in PCOS vs. 54.3% in controls), followed by anxiety disorders (65.3% vs. 48.6%) and eating disorders (14.7% vs. 4.3%). Other psychiatric disorders showed no notable group differences. Detailed distributions are provided in Table 2. Table 2. Prevalence of psychiatric disorders by group Disorder PCOS (N = 75) Controls (N = 70) Mood disorders 60 (80.0%) 38 (54.3%) Anxiety disorders 49 (65.3%) 34 (48.6%) Obsessive–compulsive disorder (OCD) 10 (13.3%) 2 (2.8%) Eating disorders 11 (14.7%) 3 (4.3%) Post-traumatic stress disorder (PTSD) 8 (10.7%) 9 (12.9%) Psychotic disorders 8 (10.7%) 7 (10.0%) Substance use disorders 3 (4.0%) 1 (1.4%) Suicide risk 14 (18.7%) 8 (11.4%) 3. Emotional Regulation (DERS Scores) Compared to controls, women with PCOS had substantially higher total DERS scores, indicating more emotional dysregulation overall. Additionally, the PCOS group performed higher on a number of subdimensions, including impulse control, goal-directed behaviour, emotional awareness, and emotional clarity; however, differences in the non-acceptance and strategies subscales were less pronounced. These findings are summarised in Table 3. Table 3. DERS scores by group Dimension Description PCOS (Mean ± SD) Controls (Mean ± SD) DERS Total Global emotional regulation score 92.9 ± 18.1 79.4 ± 13.8 NONACCEPT Non-acceptance of emotional responses 13.8 ± 4.88 13.1 ± 3.92 GOALS Difficulties engaging in goal-directed behavior 15.4 ± 4.23 11.5 ± 2.87 IMPULSE Impulse control difficulties 15.6 ± 4.43 12.8 ± 3.04 AWARE Lack of emotional awareness 17.0 ± 5.44 13.5 ± 4.57 STRATEGIES Limited access to emotion regulation strategies 18.4 ± 4.65 16.9 ± 4.06 CLARITY Lack of emotional clarity 12.8 ± 4.09 11.5 ± 2.57 DERS: Difficulties in Emotion Regulation Scale 4. Descriptive Summary Compared with controls, women with PCOS showed: higher prevalence of psychiatric disorders, especially mood, anxiety, and eating disorders; greater emotional dysregulation across several DERS domains. II. Analytical Findings 1. Factors Associated With Psychiatric Disorders 1.1. PCOS Status vs. Controls Univariate comparisons demonstrated significantly higher psychiatric morbidity in the PCOS group. Logistic regression showed that PCOS was independently associated with increased odds of: any psychiatric disorder (AOR ≈ 5.26, p = 0.005), mood disorders (AOR = 3.37, p = 0.001), anxiety disorders (AOR = 1.99, p = 0.043), eating disorders (AOR = 3.84, p = 0.046). These findings confirm PCOS as an independent predictor of psychiatric vulnerability (see Table 4). Table 4. Comparison of psychiatric disorder prevalence according to PCOS status Psychiatric disorders Controls (N = 70) PCOS (N = 75) Total (N = 145) p value Overall psychiatric morbidity ≥ 1 psychiatric disorder, n (%) 54 (77.1%) 71 (94.7%) 125 (86.2%) 0.002 No psychiatric disorder, n (%) 16 (22.9%) 4 (5.3%) 20 (13.8%) Mood disorders Present, n (%) 38 (54.3%) 60 (80.0%) 98 (67.6%) < 0.001 Absent, n (%) 32 (45.7%) 15 (20.0%) 47 (32.4%) Anxiety disorders Present, n (%) 34 (48.6%) 49 (65.3%) 83 (57.2%) 0.041 Absent, n (%) 36 (51.4%) 26 (34.7%) 62 (42.8%) Eating disorders Present, n (%) 3 (4.3%) 11 (14.7%) 14 (9.7%) 0.034 Absent, n (%) 67 (95.7%) 64 (85.3%) 131 (90.3%) 1.2. Sociodemographic and Clinical Variables Substance use was the only factor associated with psychiatric disorders in descriptive analyses, showing an inverse association among women with PCOS. However, this relationship did not persist in the adjusted regression model, likely due to the small number of substance users. No other sociodemographic, socioeconomic, or biometric variables were significantly linked to psychiatric morbidity (Table 5). Table 5. Psychoactive substance use and prevalence of psychiatric disorders by group Group Substance use ≥ 1 psychiatric disorder, n (%) No psychiatric disorder, n (%) p value PCOS (N = 75) No 64 (90.1%) 1 (25.0%) < 0.001 Yes 7 (9.9%) 3 (75.0%) Controls (N = 70) No 48 (88.9%) 15 (93.8%) 0.569 Yes 6 (11.1%) 1 (6.3%) 2. Factors Associated With Emotional Dysregulation (DERS Scores) 2.1. PCOS Status vs. Controls PCOS status was significantly associated with higher total DERS scores and with elevated scores in GOALS, IMPULSE, AWARE, and CLARITY subscales. Group differences in NONACCEPT and STRATEGIES were smaller and did not reach strong statistical significance (Table 6). Table 6. Raw DERS scores according to PCOS status DERS dimension PCOS (N = 75) Mean ± SD Controls (N = 70) Mean ± SD p value DERS total score 92.9 ± 18.1 79.4 ± 13.8 < 0.001 NONACCEPT (Non-acceptance) 13.8 ± 4.88 13.1 ± 3.92 0.355 GOALS (Goal-directed behavior) 15.4 ± 4.23 11.5 ± 2.87 < 0.001 IMPULSE (Impulse control) 15.6 ± 4.43 12.8 ± 3.04 < 0.001 AWARE (Emotional awareness) 17.0 ± 5.44 13.5 ± 4.57 < 0.001 STRATEGIES (Regulation strategies) 18.4 ± 4.65 16.9 ± 4.06 0.051 CLARITY (Emotional clarity) 12.8 ± 4.09 11.5 ± 2.57 0.019 2.2. Sociodemographic and Clinical Predictors Among women with PCOS, a sedentary lifestyle was found to be a significant predictor of increased emotional dysregulation. It was linked to specific increases in the NONACCEPT, IMPULSE, and AWARE subdomains as well as higher overall DERS scores. No other clinical or demographic factors revealed any significant correlations. (Table 7). Table 7. Effect of physical activity on DERS scores by group DERS dimension Physical activity PCOS Mean ± SD (N) p value Controls Mean ± SD (N) p value DERS total Never 97.6 ± 16.91 (42) 0.052 80.0 ± 14.6 (25) 0.589 Occasionally 86.9 ± 16.96 (22) 80.8 ± 14.0 (26) Regularly 87.2 ± 20.99 (11) 76.8 ± 12.8 (19) NONACCEPT Never 15.1 ± 5.35 0.035 13.4 ± 4.51 0.097 IMPULSE Never 16.9 ± 4.14 0.020 12.7 ± 2.75 0.612 AWARE Never 18.4 ± 5.22 0.039 14.5 ± 4.76 0.272 3. Analytical Summary PCOS independently predicted: increased risk of multiple psychiatric disorders (mood, anxiety, eating disorders); higher emotional dysregulation, particularly in goal‑directed behavior, impulse control, emotional awareness, and clarity; greater dysregulation among sedentary participants. Discussion 1. Positioning in International Literature This study offers fresh perspectives on the sociocultural context of North Africa by being the first to concentrate exclusively on psychiatric disorders and emotional dysregulation in Moroccan women with PCOS. For instance, Asdaq and Yasmin (2020) reported high rates of anxiety and depression in Saudi Arabia, which is consistent with the results observed in other Arab and Muslim populations (11). The British study by Williams et al. (2022) (8) revealed that the women in our study have more emotional regulation issues than those reported in European cohorts when compared to international data. These disparities may be caused by a number of factors, such as societal pressures, the stigma attached to mental illnesses, physical appearance standards, and restricted access to mental health services. 2. Psychological Impact of PCOS Mood Disorders Eighty percent of women with PCOS had mood disorders, which was much higher than the prevalence seen in the control group. These findings align with the global literature, which emphasizes a strong correlation between PCOS and bipolar or depressive disorders, as demonstrated by extensive cohort studies carried out in Korea between 2002 and 2020 (12,13). The reliability of these findings is strengthened by the application of the MINI, a validated and structured diagnostic interview (14,15). Anxiety Disorders Anxiety disorders were also much more common in women with PCOS (65.3%) than in participants in the control group, which is consistent with the findings of systematic reviews by Brutocao et al. (2018) (16) and Infante‑Cano et al. (2025) (17). The high rates observed in this study may reflect both the clinical setting in which the participants were recruited and the sensitivity of the structured interviews used for psychiatric screening. Eating Disorders Eating disorders affected 14.7% of women with PCOS, a higher percentage than that observed in the control group, which is consistent with the findings of recent reviews by Almhmoud et al. (2024) (18) and Cooney et al. (2024) (19) . These observations once again highlight the complex relationship between PCOS, body image, and disordered eating behaviors. 3. Emotional Regulation Profile in PCOS In our study, PCOS patients showed significantly greater emotional dysregulation than participants in the control group (p < 0.001). This difference was particularly evident in several dimensions, including the ability to maintain goal-oriented behavior (GOALS), impulse control (IMPULSE), emotional awareness (AWARE), and emotional clarity (CLARITY). Prior studies in Italy (20), Egypt (21), and Canada (22) similarly report difficulties with emotional recognition, impulsivity, and body dissatisfaction in women with PCOS. 4. The Function of Physical Activity Regular exercise was linked to lower levels of psychiatric symptoms and improved emotional regulation (p < 0.001), suggesting that exercise may be protective in this population. These results correlate with the qualitative investigation of Umamaheswar and Bhatbolan (2025) and recent international guidelines (Teede et al, 2023) (23), which highlight the significance of removing psychosocial and educational barriers to encourage physical activity among PCOS patients (24). 5. Biological and Psychosocial Mechanisms Numerous biological processes linked to PCOS may have an impact on emotional control and mental health. These include intestinal dysbiosis, insulin resistance, hyperandrogenism, chronic low-grade inflammation, and hyperactivity of the hypothalamic-pituitary-adrenal axis. Anxiety, depression, or eating disorders may develop as a result of these different biological factors interfering with emotional regulation processes (25). In addition to these biological processes, psychosocial elements are crucial. In situations where femininity is closely linked to motherhood, the physical symptoms of PCOS, such as changes in body appearance and aesthetics, as well as fertility problems, can lead to identity and social distress. Research from the Maghreb and the Middle East confirms that infertility and body image issues have a major emotional impact on women with PCOS (26,27). 6. Clinical Implications The findings highlight several priorities for care: Routine mental health screening , using validated tools such as the PHQ‑9, GAD‑7, and DERS‑F36, is warranted given the high psychiatric burden. Multidisciplinary management integrating endocrinology, gynecology, psychiatry, psychology, and nutrition should be standard practice. Psychotherapeutic interventions such as cognitive‑behavioral therapy, mindfulness‑based approaches, stress‑management training, yoga, and other evidence‑based therapies may improve emotional regulation and overall psychological health (28–31). Lifestyle modification , including structured physical activity and balanced nutrition, remains a core component of treatment for both physical and psychological outcomes in PCOS (32–34). 7. Limitations Causal inference is not possible due to the cross-sectional design; selection bias may be introduced by the small sample size and hospital-based recruitment. Because physical activity levels were self-reported, there was a greater chance of measurement error. The results' specificity is limited by the lack of a male comparison group or a group with different gynecological conditions. 8. Prospects for Further Research In order to elucidate causal pathways and investigate the development of psychiatric symptoms and emotional regulation in women with PCOS, future research should incorporate longitudinal designs. Research is required to create culturally appropriate interventions, integrated programs that incorporate physical exercise, psychotherapy, and nutrition education, and healthcare provider awareness campaigns. Further research on teenagers may shed light on the early factors that contribute to psychiatric vulnerability. Conclusion Our study shows that women with polycystic ovary syndrome (PCOS) have a particularly high prevalence of mood disorders, anxiety, eating disorders, and emotional dysregulation, regardless of most sociodemographic variables. These disorders result from complex biological (hyperandrogenism, HHS axis dysregulation, insulin resistance, low-grade inflammation) and psychosocial (cosmetic issues, fertility difficulties, cultural norms) mechanisms, highlighting the importance of multidisciplinary, patient-centered care. With this in mind, it seems essential that clinicians be trained in the systematic screening of psychiatric disorders in patients with PCOS. Appropriate care should include personalized interventions that incorporate the promotion of physical activity, dietary adjustments, and psychotherapeutic support when necessary. Finally, future research conducted in the Maghreb context could deepen our understanding of the psychopathological mechanisms associated with PCOS. This work would be particularly useful for developing integrated care programs aimed at simultaneously improving the metabolic and mental health of this population. Abbreviations AOR Adjusted Odds Ratio AES Androgen Excess Society BMI Body Mass Index DERS Difficulties in Emotion Regulation Scale DSM IV Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition GAD-7 Generalized Anxiety Disorder-7 HHS Hyperactivity of the Hypothalamic–Pituitary–Adrenal Axis MAD Moroccan Dirham MENA Middle East and North Africa MINI Mini International Neuropsychiatric Interview NIH National Institutes of Health OCD Obsessive–Compulsive Disorder PCOS Polycystic Ovary Syndrome PHQ-9 Patient Health Questionnaire-9 PTSD Post-Traumatic Stress Disorder Declarations Ethics approval and consent to participate The study protocol was approved by the Ethics Committee of the Faculty of Medicine, Mohammed VI University of Sciences and Health and was conducted in full accordance with established ethical guidelines for biomedical research. All participants consented to participate in the study. Consent for publication The manuscript includes only anonymized demographic and medical history information; therefore, individual patient consent for publication is not applicable Availability of data and materials All data generated or analysed during this study are included in this published article. Competing interests The authors declare that they have no competing interests. Funding The study received no funding. Authors’ contributions EL: conceived and designed the study, and drafted the manuscript. SA: collected clinical and demographic data and analyzed the results as part of her doctoral medical thesis which was supervised by RB and EL. OA: performed data analysis and interpretation and translated the manuscript RB: reviewed the manuscript critically and provided intellectual input. All authors read and approved the final manuscript. 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Front Psychol 13:796594. doi:10.3389/fpsyg.2022.796594 Tan Y, Duan R, Wen C (2024) Efficacy of acupuncture for depression: a systematic review and meta-analysis. Front Neurosci 18:1347651. doi:10.3389/fnins.2024.1347651 Rao V, Pena A, James A, Phadke A, Grover J, Blendis E et al (2024 ) The role of meditation and mindfulness in the management of polycystic ovary syndrome: a scoping review. Front Endocrinol (Lausanne) 15:1295705. doi:10.3389/fendo.2024.1295705 Verma A, Upadhyay V, Saxena V (2023) Effect of Yoga Therapy on Health Outcomes in Women With Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. Am J Lifestyle Med 17(1):73‑92. doi:10.1177/15598276211029221 Sabag A, Patten RK, Moreno-Asso A, Colombo GE, Dafauce Bouzo X, Moran LJ et al (2024) Exercise in the management of polycystic ovary syndrome: A position statement from Exercise and Sports Science Australia. J Sci Med Sport 27(10):668‑77. doi:10.1016/j.jsams.2024.05.015 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9255440","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":617611390,"identity":"efb89dda-24cd-4d36-8a9e-2ec3d7aa0e8c","order_by":0,"name":"El khansa Layoussifi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+klEQVRIiWNgGAWjYDACdijNxnyw4cAHBgY5wlqYYVrYEhsPzmBgMCZeCwNbAvNhHgaGRII6+JmZn0l8bKuz52Njbjhs27YtQb7/AOuGH3i0SDazmUnObDuc2MbG2HA4t+12nsGNBLabPXi0GBxmMJPmbTuQwCbfCNZSbCDBwHaDB48W+8Ps34Ba6uzZQLZYtt1OnN9/gO3mH3y2MPOAbGFmBDuMEailAWjjbXy2SBzmKbaccQ7il4M9524bG9xIbLstg0cLf3v7xhsfyurs5dvYH3/4UXZbTr7/8LGbb/BoAQIWCTQBxgb8GoCR+YGQilEwCkbBKBjhAABvQk9twDaH6gAAAABJRU5ErkJggg==","orcid":"","institution":"Faculty of Medicine, Mohammed VI University of Science and Health","correspondingAuthor":true,"prefix":"","firstName":"El","middleName":"khansa","lastName":"Layoussifi","suffix":""},{"id":617611391,"identity":"be7bfc5d-7ea2-47c9-adec-93b2d16016d9","order_by":1,"name":"Oumaima Azim","email":"","orcid":"","institution":"Faculty of Medicine, Mohammed VI University of Science and Health","correspondingAuthor":false,"prefix":"","firstName":"Oumaima","middleName":"","lastName":"Azim","suffix":""},{"id":617611392,"identity":"93782ddd-bc57-40b5-92db-ba64326a7713","order_by":2,"name":"Saja Akermi","email":"","orcid":"","institution":"Faculty of Medicine, Mohammed VI University of Science and Health","correspondingAuthor":false,"prefix":"","firstName":"Saja","middleName":"","lastName":"Akermi","suffix":""},{"id":617611393,"identity":"d64e2542-932a-4c96-aa99-f427a66dab4f","order_by":3,"name":"Roukaya Benjelloun","email":"","orcid":"","institution":"Faculty of Medicine, Mohammed VI University of Science and Health","correspondingAuthor":false,"prefix":"","firstName":"Roukaya","middleName":"","lastName":"Benjelloun","suffix":""}],"badges":[],"createdAt":"2026-03-28 22:38:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9255440/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9255440/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108266172,"identity":"35d488a6-5c68-41d8-a40c-7c7461ccd42d","added_by":"auto","created_at":"2026-05-01 09:55:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":415952,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9255440/v1/84ca07ce-b8ff-4655-8e55-744829985d86.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Emotional Dysregulation and Psychiatric Morbidity in Women with Polycystic Ovary Syndrome: A Case–Control Study from a Moroccan Population","fulltext":[{"header":"Background","content":"\u003cp\u003eOne of the most prevalent endocrine conditions affecting women of childbearing age is polycystic ovarian syndrome (PCOS), sometimes referred to as Stein-Leventhal syndrome. It is a multifactorial condition with a variety of biological and clinical manifestations. Infertility, irregular menstruation, and chronic anovulation are the main ways that PCOS impacts reproduction. It may also be accompanied by metabolic issues such as insulin resistance, obesity, and a higher risk of type 2 diabetes, as well as clinical or biological indicators of hyperandrogenism (hirsutism, acne, alopecia). On ultrasonography, a multifollicular ovarian appearance can be seen (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePCOS is the most common endocrinopathy in women of reproductive age, with an estimated global prevalence of 6% to 13%, according to the diagnostic criteria used (NIH 1990, Rotterdam 2003, or AES 2006) (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFurthermore, a number of studies have shown that women with PCOS have a high prevalence of psychiatric disorders, in particular anxiety and depression. According to international meta-analyses, these patients are much more likely than women without this syndrome to experience symptoms of anxiety and depression. The prevalence of anxiety may surpass 60%, while the average rates of depression are approximately 30%. Other psychological issues, such as eating disorders, low self-esteem, and an elevated risk of suicide, often coexist with these disorders (\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRecent research indicates that emotional regulation issues may be a key transdiagnostic mechanism in PCOS, going beyond categorical psychiatric diagnoses. The psychological vulnerability seen in this population may be explained by the fact that affected women display more severe emotional dysregulation and maladaptive emotional strategies than control women (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAccording to certain studies, women with PCOS in the Middle East and North Africa (MENA region) have high rates of anxiety and depression disorders. The data that is currently available, however, is still sparse and inconsistent. The prevalence of psychiatric disorders and emotional regulation issues in women with PCOS has not yet been systematically evaluated in any large-scale study conducted in Morocco or the Maghreb region as a whole, indicating a severe lack of local data (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBy examining the psychological aspect of PCOS in a sociocultural setting that is still understudied, the current study aims to close this gap. In order to support a more thorough and integrated approach to the care of these patients, the primary goals are to evaluate the prevalence of psychiatric disorders and emotional regulation issues in women with PCOS and to examine their correlation with different clinical and sociodemographic factors.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eParticipants and Study Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBetween October 2024 and October 2025, 145 women of reproductive age participated in a cross-sectional case-control study. 75 patients with a confirmed diagnosis of polycystic ovarian syndrome (PCOS) based on the Rotterdam criteria (2003) made up the case group, whereas 70 healthy women without a history of PCOS made up the control group.\u003c/p\u003e\n\u003cp\u003eIn cooperation with gynecologists working in private practices, as well as at Mohammed VI International University Hospital and Cheikh Khalifa International University Hospital, participants with PCOS were recruited. To guarantee sociodemographic comparability between the two groups, control participants were chosen at random from the general population.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCriteria for Inclusion and Exclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWomen of childbearing age who could give informed consent were eligible to participate. Participants had to have a verified diagnosis of polycystic ovarian syndrome (PCOS) in order to be admitted to the case group. Pregnancy, menopause, the existence of neurological, endocrine, or genetic comorbidities, and a history of psychiatric disorders or current psychiatric treatment were among the exclusion criteria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProcedure for collecting Data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo maintain confidentiality, interviews were done face-to-face in a private setting. The principal investigator, who had previously received training in the use of standardised evaluation instruments, conducted all assessments. Participants gave written informed consent after being fully informed about the study\u0026apos;s methods and goals prior to enrolment. Every piece of information was gathered anonymously.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssessment Tools\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA structured questionnaire was administered and included:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eSociodemographic and clinical variables\u003c/strong\u003e: age, body mass index, education, marital status, socioeconomic status, lifestyle habits, and medical history.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003ePsychiatric assessment\u003c/strong\u003e: The Mini International Neuropsychiatric Interview (MINI), validated in Moroccan Arabic, was used to diagnose major psychiatric disorders according to DSM-IV criteria.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eEmotional regulation assessment\u003c/strong\u003e: Emotional dysregulation was evaluated using the Difficulties in Emotion Regulation Scale (DERS), a 36-item instrument covering six subdimensions. Higher scores indicate greater emotional dysregulation.\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eEthical considerations\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe scientific and ethical committee of the Faculty of Medicine, Mohammed VI University of Sciences and Health approved the research protocol. All patients and participants consented to participate in the study.The researchers received no funds, and they declared no conflict of interest.\u003c/p\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eStatistical Analysis\u003c/h2\u003e\n \u003cp\u003eAll statistical analyses were performed using the Jamovi platform. Continuous variables are presented as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations, while categorical variables are summarized as frequencies and percentages. Initial explorations of group differences and associations were conducted using Student\u0026rsquo;s t-tests, chi-square tests, and Pearson correlation analyses. To further examine the independent relationships between PCOS status, psychiatric conditions, emotional dysregulation, and relevant sociodemographic or clinical factors, multivariable linear and logistic regression models were applied. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eI. Descriptive Findings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1. Sociodemographic Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere were 70 women in the control group and 75 women with PCOS in the study. Age, education level, marital status, place of residence, and employment status were all approximately comparable between the two groups. Compared to women in the control group, PCOS participants had a slightly higher average body mass index and a higher percentage of sedentary lifestyles. Table 1 lists every participant\u0026apos;s clinical and sociodemographic details.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eTable 1. Sociodemographic characteristics of the participants\u003c/strong\u003e\u003c/h3\u003e\n\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\" width=\"598\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePCOS group (N = 75)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eControl group (N = 70)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e26.1 \u0026plusmn; 4.44 (18\u0026ndash;43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27.4 \u0026plusmn; 4.46 (18\u0026ndash;40)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBMI (kg/m\u0026sup2;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27.0 \u0026plusmn; 6.03 (17.9\u0026ndash;43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25.7 \u0026plusmn; 4.5 (16.2\u0026ndash;41.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eUrban residence (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e88.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e82.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eUniversity education (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e85.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e85.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSingle (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e77.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e72.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNulliparous (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e84.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e84.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eLiving with family (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e50.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e48.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eStudents / unemployed (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e49.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e50.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eRegular/irregular employment (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e50.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e50.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMonthly income (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003e0\u0026ndash;2000 MAD\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003e2000\u0026ndash;5000 MAD\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003e5000\u0026ndash;10,000 MAD\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e29.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e41.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003e\u0026gt;10,000 MAD\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e44.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e34.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSubstance use (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNo medication (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e76.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e94.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOral antidiabetic treatment (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eHormonal treatment (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOther treatments (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSedentary lifestyle (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e56.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e35.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;BMI:body mass index\u003c/p\u003e\n\u003cp\u003eMAD:Moroccan dirham\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Prevalence of Psychiatric Disorders\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe overall prevalence of at least one psychiatric disorder was significantly higher in the PCOS group (94.7%) compared with controls (77.1%). Mood disorders were the most common (80.0% in PCOS vs. 54.3% in controls), followed by anxiety disorders (65.3% vs. 48.6%) and eating disorders (14.7% vs. 4.3%). Other psychiatric disorders showed no notable group differences. Detailed distributions are provided in Table 2.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eTable 2. Prevalence of psychiatric disorders by group\u003c/strong\u003e\u003c/h3\u003e\n\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDisorder\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePCOS (N = 75)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eControls (N = 70)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMood disorders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e60 (80.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e38 (54.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAnxiety disorders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e49 (65.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e34 (48.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eObsessive\u0026ndash;compulsive disorder (OCD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10 (13.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2 (2.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eEating disorders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11 (14.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3 (4.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePost-traumatic stress disorder (PTSD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8 (10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9 (12.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePsychotic disorders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8 (10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7 (10.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSubstance use disorders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3 (4.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 (1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSuicide risk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14 (18.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8 (11.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e3. Emotional Regulation (DERS Scores)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCompared to controls, women with PCOS had substantially higher total DERS scores, indicating more emotional dysregulation overall. Additionally, the PCOS group performed higher on a number of subdimensions, including impulse control, goal-directed behaviour, emotional awareness, and emotional clarity; however, differences in the non-acceptance and strategies subscales were less pronounced. These findings are summarised in Table 3.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eTable 3. DERS scores by group\u003c/strong\u003e\u003c/h3\u003e\n\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDimension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDescription\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePCOS (Mean \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eControls (Mean \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDERS Total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eGlobal emotional regulation score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e92.9 \u0026plusmn; 18.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e79.4 \u0026plusmn; 13.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNONACCEPT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNon-acceptance of emotional responses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13.8 \u0026plusmn; 4.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13.1 \u0026plusmn; 3.92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGOALS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDifficulties engaging in goal-directed behavior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15.4 \u0026plusmn; 4.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11.5 \u0026plusmn; 2.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eIMPULSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eImpulse control difficulties\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15.6 \u0026plusmn; 4.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12.8 \u0026plusmn; 3.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAWARE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLack of emotional awareness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e17.0 \u0026plusmn; 5.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13.5 \u0026plusmn; 4.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSTRATEGIES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLimited access to emotion regulation strategies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18.4 \u0026plusmn; 4.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16.9 \u0026plusmn; 4.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eCLARITY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLack of emotional clarity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12.8 \u0026plusmn; 4.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11.5 \u0026plusmn; 2.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;DERS: Difficulties in Emotion Regulation Scale\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4. Descriptive Summary\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCompared with controls, women with PCOS showed:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003ehigher prevalence of psychiatric disorders, especially mood, anxiety, and eating disorders;\u003c/li\u003e\n \u003cli\u003egreater emotional dysregulation across several DERS domains.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eII. Analytical Findings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1. Factors Associated With Psychiatric Disorders\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.1. PCOS Status vs. Controls\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUnivariate comparisons demonstrated significantly higher psychiatric morbidity in the PCOS group. Logistic regression showed that PCOS was independently associated with increased odds of:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eany psychiatric disorder (AOR \u0026asymp; 5.26, p = 0.005),\u003c/li\u003e\n \u003cli\u003emood disorders (AOR = 3.37, p = 0.001),\u003c/li\u003e\n \u003cli\u003eanxiety disorders (AOR = 1.99, p = 0.043),\u003c/li\u003e\n \u003cli\u003eeating disorders (AOR = 3.84, p = 0.046).\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThese findings confirm PCOS as an independent predictor of psychiatric vulnerability (see Table 4).\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eTable 4. Comparison of psychiatric disorder prevalence according to PCOS status\u003c/strong\u003e\u003c/h3\u003e\n\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePsychiatric disorders\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eControls (N = 70)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePCOS (N = 75)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (N = 145)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eOverall psychiatric morbidity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026ge; 1 psychiatric disorder,\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e54 (77.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e71 (94.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e125 (86.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNo psychiatric disorder,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16 (22.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4 (5.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20 (13.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMood disorders\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePresent, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e38 (54.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e60 (80.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e98 (67.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAbsent, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e32 (45.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e47 (32.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAnxiety disorders\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePresent, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e34 (48.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e49 (65.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83 (57.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.041\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAbsent, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e36 (51.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e26 (34.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e62 (42.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eEating disorders\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePresent, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3 (4.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11 (14.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14 (9.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.034\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAbsent, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e67 (95.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e64 (85.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e131 (90.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e1.2. Sociodemographic and Clinical Variables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSubstance use was the only factor associated with psychiatric disorders in descriptive analyses, showing an inverse association among women with PCOS. However, this relationship did not persist in the adjusted regression model, likely due to the small number of substance users. No other sociodemographic, socioeconomic, or biometric variables were significantly linked to psychiatric morbidity (Table 5).\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eTable 5. Psychoactive substance use and prevalence of psychiatric disorders by group\u003c/strong\u003e\u003c/h3\u003e\n\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eGroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSubstance use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ge; 1 psychiatric disorder, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNo psychiatric disorder, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePCOS (N = 75)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e64 (90.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 (25.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7 (9.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3 (75.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eControls (N = 70)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e48 (88.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15 (93.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.569\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6 (11.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 (6.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e2. Factors Associated With Emotional Dysregulation (DERS Scores)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.1. PCOS Status vs. Controls\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePCOS status was significantly associated with higher total DERS scores and with elevated scores in GOALS, IMPULSE, AWARE, and CLARITY subscales. Group differences in NONACCEPT and STRATEGIES were smaller and did not reach strong statistical significance (Table 6).\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eTable 6. Raw DERS scores according to PCOS status\u003c/strong\u003e\u003c/h3\u003e\n\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDERS dimension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePCOS (N = 75) Mean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eControls (N = 70) Mean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDERS total score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e92.9 \u0026plusmn; 18.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e79.4 \u0026plusmn; 13.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNONACCEPT (Non-acceptance)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13.8 \u0026plusmn; 4.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13.1 \u0026plusmn; 3.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.355\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGOALS (Goal-directed behavior)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15.4 \u0026plusmn; 4.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11.5 \u0026plusmn; 2.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eIMPULSE (Impulse control)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15.6 \u0026plusmn; 4.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12.8 \u0026plusmn; 3.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAWARE (Emotional awareness)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e17.0 \u0026plusmn; 5.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13.5 \u0026plusmn; 4.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSTRATEGIES (Regulation strategies)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18.4 \u0026plusmn; 4.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16.9 \u0026plusmn; 4.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eCLARITY (Emotional clarity)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12.8 \u0026plusmn; 4.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11.5 \u0026plusmn; 2.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.019\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e2.2. Sociodemographic and Clinical Predictors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong women with PCOS, a sedentary lifestyle was found to be a significant predictor of increased emotional dysregulation. It was linked to specific increases in the NONACCEPT, IMPULSE, and AWARE subdomains as well as higher overall DERS scores. No other clinical or demographic factors revealed any significant correlations. (Table 7).\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eTable 7. Effect of physical activity on DERS scores by group\u003c/strong\u003e\u003c/h3\u003e\n\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDERS dimension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePhysical activity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePCOS Mean \u0026plusmn; SD (N)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eControls Mean \u0026plusmn; SD (N)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDERS total\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e97.6 \u0026plusmn; 16.91 (42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e80.0 \u0026plusmn; 14.6 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.589\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOccasionally\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e86.9 \u0026plusmn; 16.96 (22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e80.8 \u0026plusmn; 14.0 (26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eRegularly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e87.2 \u0026plusmn; 20.99 (11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e76.8 \u0026plusmn; 12.8 (19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNONACCEPT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15.1 \u0026plusmn; 5.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.035\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13.4 \u0026plusmn; 4.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.097\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eIMPULSE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16.9 \u0026plusmn; 4.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.020\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12.7 \u0026plusmn; 2.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.612\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAWARE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18.4 \u0026plusmn; 5.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.039\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14.5 \u0026plusmn; 4.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.272\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e3. Analytical Summary\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePCOS independently predicted:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eincreased risk of multiple psychiatric disorders (mood, anxiety, eating disorders);\u003c/li\u003e\n \u003cli\u003ehigher emotional dysregulation, particularly in goal‑directed behavior, impulse control, emotional awareness, and clarity;\u003c/li\u003e\n \u003cli\u003egreater dysregulation among sedentary participants.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cstrong\u003e1.\u003c/strong\u003e\u003cstrong\u003ePositioning in International Literature\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;This study offers fresh perspectives on the sociocultural context of North Africa by being the first to concentrate exclusively on psychiatric disorders and emotional dysregulation in Moroccan women with PCOS. For instance, Asdaq and Yasmin (2020) reported high rates of anxiety and depression in Saudi Arabia, which is consistent with the results observed in other Arab and Muslim populations (11).\u0026nbsp;\u003cbr\u003e\u0026nbsp;The British study by Williams et al. (2022) (8) revealed that the women in our study have more emotional regulation issues than those reported in European cohorts when compared to international data. These disparities may be caused by a number of factors, such as societal pressures, the stigma attached to mental illnesses, physical appearance standards, and restricted access to mental health services.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. Psychological Impact of PCOS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMood Disorders\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEighty percent of women with PCOS had mood disorders, which was much higher than the prevalence seen in the control group. These findings align with the global literature, which emphasizes a strong correlation between PCOS and bipolar or depressive disorders, as demonstrated by extensive cohort studies carried out in Korea between 2002 and 2020\u0026nbsp;(12,13). The reliability of these findings is strengthened by the application of the MINI, a validated and structured diagnostic interview\u0026nbsp;(14,15).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnxiety Disorders\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnxiety disorders were also much more common in women with PCOS (65.3%) than in participants in the control group, which is consistent with the findings of systematic reviews by Brutocao et al. (2018) (16) and Infante‑Cano et al. (2025) (17).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The high rates observed in this study may reflect both the clinical setting in which the participants were recruited and the sensitivity of the structured interviews used for psychiatric screening.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEating Disorders\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEating disorders affected 14.7% of women with PCOS, a higher percentage than that observed in the control group, which is consistent with the findings of recent reviews by Almhmoud et al. (2024) (18) and Cooney et al. (2024) (19) . These observations once again highlight the complex relationship between PCOS, body image, and disordered eating behaviors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3. Emotional Regulation Profile in PCOS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn our study, PCOS patients showed significantly greater emotional dysregulation than participants in the control group (p \u0026lt; 0.001). This difference was particularly evident in several dimensions, including the ability to maintain goal-oriented behavior (GOALS), impulse control (IMPULSE), emotional awareness (AWARE), and emotional clarity (CLARITY).\u003c/p\u003e\n\u003cp\u003ePrior studies in Italy (20), Egypt (21), and Canada (22) similarly report difficulties with emotional recognition, impulsivity, and body dissatisfaction in women with PCOS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eThe Function of Physical Activity\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Regular exercise was linked to lower levels of psychiatric symptoms and improved emotional regulation (p \u0026lt; 0.001), suggesting that exercise may be protective in this population.\u0026nbsp;\u003cbr\u003e\u0026nbsp;These results correlate with the qualitative investigation of Umamaheswar and Bhatbolan (2025) and recent international guidelines (Teede et al, 2023) (23), which highlight the significance of removing psychosocial and educational barriers to encourage physical activity among PCOS patients (24).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5. Biological and Psychosocial Mechanisms\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNumerous biological processes linked to PCOS may have an impact on emotional control and mental health. These include intestinal dysbiosis, insulin resistance, hyperandrogenism, chronic low-grade inflammation, and hyperactivity of the hypothalamic-pituitary-adrenal axis. Anxiety, depression, or eating disorders may develop as a result of these different biological factors interfering with emotional regulation processes\u0026nbsp;(25).\u003cbr\u003e\u0026nbsp;In addition to these biological processes, psychosocial elements are crucial. In situations where femininity is closely linked to motherhood, the physical symptoms of PCOS, such as changes in body appearance and aesthetics, as well as fertility problems, can lead to identity and social distress.\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Research from the Maghreb and the Middle East confirms that infertility and body image issues have a major emotional impact on women with PCOS (26,27).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6. Clinical Implications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings highlight several priorities for care:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eRoutine mental health screening\u003c/strong\u003e, using validated tools such as the PHQ‑9, GAD‑7, and DERS‑F36, is warranted given the high psychiatric burden.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eMultidisciplinary management\u003c/strong\u003e integrating endocrinology, gynecology, psychiatry, psychology, and nutrition should be standard practice.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ePsychotherapeutic interventions\u003c/strong\u003e such as cognitive‑behavioral therapy, mindfulness‑based approaches, stress‑management training, yoga, and other evidence‑based therapies may improve emotional regulation and overall psychological health (28\u0026ndash;31).\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eLifestyle modification\u003c/strong\u003e, including structured physical activity and balanced nutrition, remains a core component of treatment for both physical and psychological outcomes in PCOS\u0026nbsp;(32\u0026ndash;34).\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e7. Limitations\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Causal inference is not possible due to the cross-sectional design; selection bias may be introduced by the small sample size and hospital-based recruitment. Because physical activity levels were self-reported, there was a greater chance of measurement error. The results\u0026apos; specificity is limited by the lack of a male comparison group or a group with different gynecological conditions.\u003cbr\u003e\u003cstrong\u003e8. Prospects for Further Research\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;In order to elucidate causal pathways and investigate the development of psychiatric symptoms and emotional regulation in women with PCOS, future research should incorporate longitudinal designs. Research is required to create culturally appropriate interventions, integrated programs that incorporate physical exercise, psychotherapy, and nutrition education, and healthcare provider awareness campaigns. Further research on teenagers may shed light on the early factors that contribute to psychiatric vulnerability.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur study shows that women with polycystic ovary syndrome (PCOS) have a particularly high prevalence of mood disorders, anxiety, eating disorders, and emotional dysregulation, regardless of most sociodemographic variables.\u003c/p\u003e \u003cp\u003eThese disorders result from complex biological (hyperandrogenism, HHS axis dysregulation, insulin resistance, low-grade inflammation) and psychosocial (cosmetic issues, fertility difficulties, cultural norms) mechanisms, highlighting the importance of multidisciplinary, patient-centered care.\u003c/p\u003e \u003cp\u003eWith this in mind, it seems essential that clinicians be trained in the systematic screening of psychiatric disorders in patients with PCOS. Appropriate care should include personalized interventions that incorporate the promotion of physical activity, dietary adjustments, and psychotherapeutic support when necessary.\u003c/p\u003e \u003cp\u003eFinally, future research conducted in the Maghreb context could deepen our understanding of the psychopathological mechanisms associated with PCOS.\u003c/p\u003e \u003cp\u003eThis work would be particularly useful for developing integrated care programs aimed at simultaneously improving the metabolic and mental health of this population.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\" width=\"603\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAdjusted Odds Ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAndrogen Excess Society\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBody Mass Index\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDERS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDifficulties in Emotion Regulation Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDSM IV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDiagnostic and Statistical Manual of Mental Disorders, Fourth Edition\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGAD-7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eGeneralized Anxiety Disorder-7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eHHS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eHyperactivity of the Hypothalamic\u0026ndash;Pituitary\u0026ndash;Adrenal Axis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMAD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMoroccan Dirham\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMENA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMiddle East and North Africa\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMINI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMini International Neuropsychiatric Interview\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNIH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNational Institutes of Health\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOCD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eObsessive\u0026ndash;Compulsive Disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePCOS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePolycystic Ovary Syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePHQ-9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePatient Health Questionnaire-9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePTSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePost-Traumatic Stress Disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The study protocol was approved by the Ethics Committee of the Faculty of Medicine, Mohammed VI University of Sciences and Health and was conducted in full accordance with established ethical guidelines for biomedical research.\u003c/p\u003e\n\u003cp\u003eAll participants consented to participate in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe manuscript includes only anonymized demographic and medical history information; therefore, individual patient consent for publication is not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;All data generated or analysed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The study received no funding.\u003cbr\u003e\u003cbr\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eEL: conceived and designed the study, and drafted the manuscript.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSA: collected clinical and demographic data\u0026nbsp;and analyzed the results as part of her doctoral medical thesis which was supervised by\u0026nbsp;RB and EL.\u003c/li\u003e\n \u003cli\u003eOA: performed data analysis and interpretation\u0026nbsp;and translated the manuscript\u003c/li\u003e\n \u003cli\u003eRB: reviewed the manuscript critically and provided intellectual input.\u003c/li\u003e\n \u003cli\u003eAll authors read and approved the final manuscript.\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Not applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eYildiz BO, Bozdag G, Yapici Z, Esinler I, Yarali H (2012) Prevalence, phenotype and cardiometabolic risk of polycystic ovary syndrome under different diagnostic criteria. 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Healthcare (Basel) 10(6):1118. doi:10.3390/healthcare10061118\u003c/li\u003e\n \u003cli\u003eAlnaeem L, Alnasser M, AlAli Y, Almarri F, Al Sultan AA, Almuhaysin FA, et al (2024) Depression and Anxiety in Patients With Polycystic Ovary Syndrome: A Cross-Sectional Study in Saudi Arabia. Cureus 16(1):e51530. doi:10.7759/cureus.51530\u003c/li\u003e\n \u003cli\u003eSulaiman MA, Al-Farsi YM, Al-Khaduri MM, Waly MI, Saleh J, Al-Adawi S (2017) Psychological burden among women with polycystic ovarian syndrome in Oman: a case-control study. Int J Womens Health 9:897‑904. doi:10.2147/IJWH.S145383\u003c/li\u003e\n \u003cli\u003eAsdaq SMB, Jomah S, Hasan R, Al-Baroudi D, Alharbi M, Alsubaie S, et al (2020) Impact of polycystic ovary syndrome on eating behavior, depression and health related quality of life: A cross-sectional study in Riyadh. 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Nurs Womens Health 28(3):177‑86. doi:10.1016/j.nwh.2023.11.007\u003c/li\u003e\n \u003cli\u003eAlayed KM, Alkeridy W, Alzahrani M(2021) The Multiple Mini-interviews: The Experience from a Saudi Postgraduate Residency Program Toward a More Objective Selection Process. Journal of Nature and Science of Medicine 4(2):154. doi:10.4103/JNSM.JNSM_83_20\u003c/li\u003e\n \u003cli\u003eBrutocao C, Zaiem F, Alsawas M, Morrow AS, Murad MH, Javed A (2018) Psychiatric disorders in women with polycystic ovary syndrome: a systematic review and meta-analysis. Endocrine 62(2):318‑25. doi:10.1007/s12020-018-1692-3\u003c/li\u003e\n \u003cli\u003eInfante-Cano M, Garc\u0026iacute;a-Mu\u0026ntilde;oz C, Matias-Soto J, Pineda-Escobar S, Villar-Alises O, Martinez-Calderon J (2025) The prevalence and risk of anxiety and depression in polycystic ovary syndrome: an overview of systematic reviews with meta-analysis. 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Fertil Steril 110(3):364‑79. doi:10.1016/j.fertnstert.2018.05.004\u003c/li\u003e\n \u003cli\u003eUmamaheswar M, Bhatbolan SS (2025) Barriers and facilitators to exercise participation in women with polycystic ovary syndrome: a qualitative study. BMJ Public Health 3(1):e000707. doi:10.1136/bmjph-2023-000707\u003c/li\u003e\n \u003cli\u003ePasquali R, Gambineri A (2012) Cortisol and the polycystic ovary syndrome. Expert Rev Endocrinol Metab 7(5):555‑66. doi:10.1586/eem.12.42 PubMed PMID: 30780898.\u003c/li\u003e\n \u003cli\u003eSun Y, Gao S, Ye C, Zhao W(2023) Gut microbiota dysbiosis in polycystic ovary syndrome: Mechanisms of progression and clinical applications. Front Cell Infect Microbiol 13:1142041. doi:10.3389/fcimb.2023.1142041\u003c/li\u003e\n \u003cli\u003eDewani D, Karwade P, Mahajan KS (2023) The Invisible Struggle: The Psychosocial Aspects of Polycystic Ovary Syndrome. Cureus 15(12):e51321. doi:10.7759/cureus.51321\u003c/li\u003e\n \u003cli\u003eAlamri AS, Alhomrani M, Alsanie WF, Almuqbil M, Alqarni KM, Alshehri SM, et al (2022) Role of polycystic ovarian syndrome in developing psychological burden in Saudi Arabian females: A case control study. Front Public Health 10:999813. doi:10.3389/fpubh.2022.999813\u003c/li\u003e\n \u003cli\u003eALSumri H, Szatkowski L, Gibson J, Fiaschi L, Bains M (2023) Psychosocial Impacts of Infertility among Omani Women with Polycystic Ovarian Syndrome: A Qualitative Study. Int J Fertil Steril 17(2):107‑14. doi:10.22074/ijfs.2022.550111.1310.\u003c/li\u003e\n \u003cli\u003eTang R, Yang J, Yu Y, Fang Y (2022) The effects of cognitive behavioral therapy in women with polycystic ovary syndrome: A meta-analysis. Front Psychol 13:796594. doi:10.3389/fpsyg.2022.796594\u003c/li\u003e\n \u003cli\u003eTan Y, Duan R, Wen C (2024) Efficacy of acupuncture for depression: a systematic review and meta-analysis. Front Neurosci 18:1347651. doi:10.3389/fnins.2024.1347651\u003c/li\u003e\n \u003cli\u003eRao V, Pena A, James A, Phadke A, Grover J, Blendis E et al (2024 ) The role of meditation and mindfulness in the management of polycystic ovary syndrome: a scoping review. Front Endocrinol (Lausanne) 15:1295705. doi:10.3389/fendo.2024.1295705\u003c/li\u003e\n \u003cli\u003eVerma A, Upadhyay V, Saxena V (2023) Effect of Yoga Therapy on Health Outcomes in Women With Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. Am J Lifestyle Med 17(1):73‑92. doi:10.1177/15598276211029221\u003c/li\u003e\n \u003cli\u003eSabag A, Patten RK, Moreno-Asso A, Colombo GE, Dafauce Bouzo X, Moran LJ et al (2024) Exercise in the management of polycystic ovary syndrome: A position statement from Exercise and Sports Science Australia. J Sci Med Sport 27(10):668‑77. doi:10.1016/j.jsams.2024.05.015\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Polycystic ovary syndrome, psychiatric disorders, emotional dysregulation, depression, anxiety, eating disorders, Morocco","lastPublishedDoi":"10.21203/rs.3.rs-9255440/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9255440/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePolycystic ovarian syndrome (PCOS) is a common endocrine condition marked by hormonal, metabolic, and reproductive abnormalities. Although there is still a lack of data from North African populations, emerging evidence points to an increased susceptibility to psychiatric disorders and emotional dysregulation. This study aimed to assess the prevalence of emotional dysregulation and psychiatric disorders among Moroccan women with PCOS, as well as the correlations between these conditions and clinical and demographic factors\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eA cross-sectional case-control study that included 70 matched controls and 75 women with PCOS was carried out. The Difficulties in Emotion Regulation Scale (DERS) was used to measure emotional dysregulation, and the Mini International Neuropsychiatric Interview (MINI) was used to measure psychiatric disorders.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe prevalence of psychiatric disorders was significantly higher in women with PCOS than in controls (94.7% vs. 77.1%; p = 0.002). Increased odds of mood disorders (AOR = 3.37; p = 0.001), anxiety disorders (AOR = 1.99; p = 0.043), and eating disorders (AOR = 3.84; p = 0.046) were all independently linked to PCOS. The PCOS group had higher DERS total scores (92.9±18.1 vs. 79.4±13.8; p\u0026lt;0.001), especially in the areas of impulse control, goal-directed behavior, emotional awareness, and emotional clarity. A sedentary lifestyle was linked to higher levels of emotional dysregulation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRegardless of sociodemographic variables, Moroccan women with PCOS have a high prevalence of mental illnesses and emotional dysregulation. These results emphasize the necessity of multidisciplinary care that includes psychological therapies and lifestyle changes, as well as systematic mental health screening.\u003c/p\u003e","manuscriptTitle":"Emotional Dysregulation and Psychiatric Morbidity in Women with Polycystic Ovary Syndrome: A Case–Control Study from a Moroccan Population","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-08 13:21:32","doi":"10.21203/rs.3.rs-9255440/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5b56e414-f72e-4d0e-a54e-e988c3192d67","owner":[],"postedDate":"April 8th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Rejected","date":"2026-05-01T09:51:09+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-01T09:48:27+00:00","index":13,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-01T09:55:08+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-08 13:21:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9255440","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9255440","identity":"rs-9255440","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}