Meta-Analysis of the Symptom Structure of Obsessive-Compulsive Disorder

Yale Child Study Center, 230 South Frontage Rd., New Haven, CT 06520, USA.
American Journal of Psychiatry (Impact Factor: 12.3). 11/2008; 165(12):1532-42. DOI: 10.1176/appi.ajp.2008.08020320
Source: PubMed


OCD is a clinically heterogeneous condition. This heterogeneity has the potential to reduce power in genetic, neuroimaging, and clinical trials. Despite a mounting number of studies, there remains debate regarding the exact factor structure of OCD symptoms. The authors conducted a meta-analysis to determine the factor structure of the Yale-Brown Obsessive Compulsive Scale Symptom Checklist.
Studies were included if they involved subjects with OCD and included an exploratory factor analysis of the 13 Yale-Brown Obsessive Compulsive Scale Symptom Checklist categories or the items therein. A varimax-rotation was conducted in SAS 9.1 using the PROC FACTOR CORR to extract factors from sample-size weighted co-occurrence matrices. Stratified meta-analysis was conducted to determine the factor structure of OCD in studies involving children and adults separately.
Twenty-one studies involving 5,124 participants were included. The four factors generated were 1) symmetry: symmetry obsessions and repeating, ordering, and counting compulsions; 2) forbidden thoughts: aggression, sexual, religious, and somatic obsessions and checking compulsions, 3) cleaning: cleaning and contamination, and 4) hoarding: hoarding obsessions and compulsions. Factor analysis of studies including adults yielded an identical factor structure compared to the overall meta-analysis. Factor analysis of child-only studies differed in that checking loaded highest on the symmetry factor and somatic obsessions, on the cleaning factor.
A four-factor structure explained a large proportion of the heterogeneity in the clinical symptoms of OCD. Further item-level factor analyses are needed to determine the appropriate placement of miscellaneous somatic and checking OCD symptoms.

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    • "Previous research has explored the potential dimensional structure of OCS in order to understand and refine its phenotypic characteristics for clinical and genetic studies. In factor analytic studies using the 13 categories from the Yale-Brown Obsessive- Compulsive Symptom Checklist (YBOCS SC), four replicable factors emerge: (Factor I) Forbidden thoughts–aggression, sexual, religious, and somatic obsessions and checking compulsions; (Factor II) Symmetry–symmetry obsessions and repeating, ordering, and counting compulsions; (Factor III) Cleaning–cleaning and contamination; and (Factor IV) Hoarding–hoarding obsessions and compulsions [Bloch et al., 2008; Hasler et al., 2007]. In an "
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    ABSTRACT: Individuals with obsessive compulsive disorder can display diverse and heterogeneous patterns of symptoms. Little is known about the relationship between obsessive-compulsive symptom (OCS) dimensions and normal personality traits, particularly those that increase risk for other internalizing disorders. In this study of 1,382 individuals from female–female twin pairs, we examined the relationship between self-report OCS dimensions derived from the Padua Inventory and Eysenck's personality traits neuroticism and extraversion. We conducted factor analysis to determine their phenotypic structure followed by twin analyses to determine their genetic and environmental sources of covariation. A three-factor solution, with dimensions corresponding to checking, aggressive obsessions, and contamination, was the best fit for the Padua OCS items. These dimensions were significantly and somewhat variably associated with neuroticism but negligibly associated with extraversion. The genetic correlations between neuroticism and these three OCS dimensions were moderate to high (0.66 with checking, 0.89 with aggressive obsessions, and 0.40 with contamination). However, the estimated genetic correlation between neuroticism and a unified latent OCS construct was smaller (0.32). Overall this study suggests that genetic, and to a smaller extent environmental, factors underlying neuroticism may act differentially as risk factors for OCS dimensions. © 2014 Wiley Periodicals, Inc.
    American Journal of Medical Genetics Part B Neuropsychiatric Genetics 12/2014; 165(8). DOI:10.1002/ajmg.b.32269 · 3.42 Impact Factor
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    • "an - rated instrument consisting of a symptom checklist and ratings of OCD - related distress , frequency , in - terference , resistance and control . Ratings were summed to create total OCD severity scores . The symptom checklist was used to calculate scores for four OCD symptom dimensions ; Symmetry , Forbidden thoughts , Cleaning and Hoarding ( Bloch et al . 2008 ) . The Children ' s Obsessive - Compulsive Inventory ( ChOCI ; Uher et al . 2008 ) was used to assess self - and parent - ratings of OCD severity . The ChOCI questionnaire mirrors the CY - BOCS . Both measures demonstrate sound psychometric properties ( Scahill et al . 1997 ; Storch et al . 2004 ; Uher et al . 2008 ) . Internal consist"
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    ABSTRACT: Depression frequently co-occurs with paediatric obsessive-compulsive disorder (OCD), yet the clinical correlates and impact of depression on CBT outcomes remain unclear. The prevalence and clinical correlates of depression were examined in a paediatric specialist OCD-clinic sample (N = 295; Mean = 15 [7 - 18] years, 42 % female), using both dimensional (Beck Depression Inventory-youth; n = 261) and diagnostic (Development and Wellbeing Assessment; n = 127) measures of depression. The impact of depressive symptoms and suspected disorders on post-treatment OCD severity was examined in a sub-sample who received CBT, with or without SSRI medication (N = 100). Fifty-one per-cent of patients reported moderately or extremely elevated depressive symptoms and 26 % (95 % CI: 18 - 34) met criteria for a suspected depressive disorder. Depressive symptoms and depressive disorders were associated with worse OCD symptom severity and global functioning prior to CBT. Individuals with depression were more likely to be female, have had a psychiatric inpatient admission and less likely to be attending school (ps < 0.01). OCD and depressive symptom severity significantly decreased after CBT. Depressive symptoms and depressive disorders predicted worse post-treatment OCD severity (βs = 0.19 and 0.26, ps < 0.05) but became non-significant when controlling for pre-treatment OCD severity (βs = 0.05 and 0.13, ns). Depression is common in paediatric OCD and is associated with more severe OCD and poorer functioning. However, depression severity decreases over the course of CBT for OCD and is not independently associated with worse outcomes, supporting the recommendation for treatment as usual in the presence of depressive symptoms.
    Journal of Abnormal Child Psychology 10/2014; 43(5). DOI:10.1007/s10802-014-9943-0 · 3.09 Impact Factor
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    • "Obsessive-compulsive disorder (OCD) is characterized by intrusive obsessions, which are often associated with anxiety, and with repetitive compulsions that seek to control that anxiety (Jenike, 2004). One common presentation of OCD is characterized by extreme contamination anxiety, often triggered by thoughts or images of, or contact with, potential contaminates such as dirt, body secretions, or mold (Bloch et al., 2008). Improving control of contamination anxiety is a key step in improving the quality of life for many individuals with OCD. "
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    ABSTRACT: Tailoring treatments to the specific needs and biology of individual patients-personalized medicine-requires delineation of reliable predictors of response. Unfortunately, these have been slow to emerge, especially in neuropsychiatric disorders. We have recently described a real-time functional magnetic resonance imaging (rt-fMRI) neurofeedback protocol that can reduce contamination-related anxiety, a prominent symptom of many cases of obsessive-compulsive disorder (OCD). Individual response to this intervention is variable. Here we used patterns of brain functional connectivity, as measured by baseline resting-state fMRI (rs-fMRI), to predict improvements in contamination anxiety after neurofeedback training. Activity of a region of the orbitofrontal cortex (OFC) and anterior prefrontal cortex, Brodmann area (BA) 10, associated with contamination anxiety in each subject was measured in real time and presented as a neurofeedback signal, permitting subjects to learn to modulate this target brain region. We have previously reported both enhanced OFC/BA 10 control and improved anxiety in a group of subclinically anxious subjects after neurofeedback. Five individuals with contamination-related OCD who underwent the same protocol also showed improved clinical symptomatology. In both groups, these behavioral improvements were strongly correlated with baseline whole-brain connectivity in the OFC/BA 10, computed from rs-fMRI collected several days prior to neurofeedback training. These pilot data suggest that rs-fMRI can be used to identify individuals likely to benefit from rt-fMRI neurofeedback training to control contamination anxiety.
    Frontiers in Behavioral Neuroscience 09/2014; 8:338. DOI:10.3389/fnbeh.2014.00338 · 3.27 Impact Factor
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