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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Available from: James F Leckman, Jan 25, 2016
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    • "Each of these models appeared to reliably capture the adult OC field, including for example the symptom dimensions of symmetry/ordering , hoarding, contamination/cleaning, and obsessions/checking (Mataix-Cols et al. 2005). Comparable symptom dimensions have been suggested for younger age groups (Bloch et al. 2008), yet these dimensions are primarily derived from adult OCD research. From a more age-specific and comprehensive bottom-up perspective, De Caluwé and De Clercq (2014) constructed an item pool of youth OC symptoms (i.e., the Youth Obsessive-Compulsive Symptoms Scale; YOCSS), and proposed a three-factor structure with an Obsessive , Compulsive and Order/Clean/Perfect Factor (or Symptom Domain), that was replicated in an independent sample. "
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    ABSTRACT: In order to better understand the heterogeneous nature of Obsessive-Compulsive (OC) symptoms, a typological or a dimensional approach can be used to structure the variety of symptoms into a set of core components. However, there is still no consensus on which approach is the most robust to predict several OC-related criterion measures, especially in adolescents. From this perspective, the current study empirically identified OC classes (i.e., types), and explored whether types or dimensions are the strongest predictors of adolescent OC-related criterion variables. To identify OC classes, we conducted latent class analysis on the Youth Obsessive- Compulsive Symptoms Scale (YOCSS; De Caluwé and De Clercq 2014) that was completed by 682 community and referred adolescents (71.4 % girls, 12–18 years old, mean age = 15.67, SD = 1.53), and we also computed OC dimension scores as outlined in De Caluwé and De Clercq (2014). We subsequently used hierarchical regression analysis to examine the incremental validity of the OC classes beyond the OC domains, and vice versa, in predicting several OC-related criterion variables that were completed by the adolescents or their mothers (N = 325). The results indicated that the two identified OC classes only differed quantitatively but not qualitatively, hence reflecting severity classes, and also showed that OC domains have significant effects beyond the effects of the OC classes, whereas the reverse did not hold. The dimensional approach appears to have the strongest predictive value for OC symptomatology in adolescents, leading to clinical implications for conceptualization and assessment of obsessive and compulsive problems in younger age groups.
    Full-text · Article · Dec 2015 · Journal of Psychopathology and Behavioral Assessment
    • "When investigating sensory phenomena in relation to OCS in patients with TS, recent research indicates that a dimensional approach should be considered. More specifically , factor analytic studies using the Yale-Brown Obsessive- Compulsive Scale (Y-BOCS) have suggested that OCS in patients with OCD can be divided into 3–5 dimensions; genetic, neuroimaging, and treatment studies have supported the utility of this approach [11] [12]. Additionally, comorbid tic disorders can be related to the symmetry/ordering dimension of OCS in adults with OCD [13] and the aggressive/checking dimension of OCS in children and adolescents with OCD [14]. "
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    ABSTRACT: Objectives: Sensory phenomena, including premonitory urges, are experienced by patients with Tourette syndrome (TS) and obsessive-compulsive disorder (OCD). The goal of the present study was to investigate such phenomena related to tics, obsessive-compulsive symptoms (OCS), and global functioning in Japanese patients with TS. Methods: Forty-one patients with TS were assessed using the University of São Paulo Sensory Phenomena Scale (USP-SPS), the Premonitory Urge for Tics Scale (PUTS), the Yale Global Tic Severity Scale (YGTSS), the Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS), and the Global Assessment of Functioning (GAF) Scale. Results: USP-SPS and PUTS total scores were significantly correlated with YGTSS total and vocal tics scores. Additionally, both sensory phenomena severity scores were significantly correlated with DY-BOCS total OCS scores. Of the six dimensional OCS scores, the USP-SPS scores were significantly correlated with measures of aggression and sexual/religious dimensions. Finally, the PUTS total scores were significantly and negatively correlated with GAF scores. Conclusions: By assessing premonitory urges and broader sensory phenomena, and by viewing OCS from a dimensional approach, this study provides significant insight into sensory phenomena related to tics, OCS, and global functioning in patients with TS.
    No preview · Article · Sep 2015 · Comprehensive psychiatry
    • "When considering the impact of OCS on global functioning among TS patients, recent research findings indicate that a dimensional approach for examining OCS should be considered. Factor analytic studies using the Yale–Brown Obsessive–Compulsive Scale (Y-BOCS) have suggested that OCS among patients with OCD can be divided into 3–5 dimensions, and genetic, neuroimaging, and treatment studies have supported the usefulness of this approach (Stewart et al., 2007; Bloch et al., 2008). In addition, a relationship has been found between comorbid tic disorders and the symmetry/ordering (Labad et al., 2008) and aggressive/checking (Nikolajsen et al., 2011) dimensions of OCS among OCD patients. "
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    ABSTRACT: This study investigated the relationships between tics, obsessive-compulsive symptoms (OCS), and impulsivity, and their effects on global functioning in Japanese patients with Tourette syndrome (TS), using the dimensional approach for OCS. Fifty-three TS patients were assessed using the Yale Global Tic Severity Scale, the Dimensional Yale-Brown Obsessive-Compulsive Scale, the Impulsivity Rating Scale, and the Global Assessment of Functioning Scale. Although tic severity scores were significantly and positively correlated with OCS severity scores, impulsivity severity scores were not significantly correlated with either. The global functioning score was significantly and negatively correlated with tic and OCS severity scores. Of the 6 dimensional OCS scores, only aggression scores had a significant negative correlation with global functioning scores. A stepwise multiple regression analysis showed that only OCS severity scores were significantly associated with global functioning scores. Despite a moderate correlation between tic severity and OCS severity, the impact of OCS on global functioning was greater than that of tics. Of the OCS dimensions, only aggression had a significant impact on global functioning. Our findings suggest that it is important to examine OCS using a dimensional approach when analyzing global functioning in TS patients.
    No preview · Article · Jan 2015 · Psychiatry Research
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