Specific Obsessive-compulsive Disorder Symptom Research Articles

Investigation of Theory of Mind, Disgust Sensitivity, and Mental Contamination in Patients with Obsessive-Compulsive Disorder

Objective: The aim of this study is to examine the relationships between theory of mind (ToM), disgust sensitivity, and mental contamination patients with obsessive-compulsive disorder (OCD). Methods: In this cross-sectional study, 37 patients with OCD and 45 healthy volunteers with similar socio-demographic characteristics were enrolled at the Silifke State Hospital Department of Psychiatry between October 2023 and March 2024. We utilized the Padua Inventory - Washington State University Revision, the Dokuz Eylül Theory of Mind Index, the Disgust Scale — Revised, and the Vancouver Obsessive-Compulsive Inventory — Mental Contamination Scale. Results: Patients with OCD exhibited significantly higher sensitivity to disgust (mean ± standard deviation 68.19±12.28) and mental contamination (mean ± standard deviation= 25.54± 7.64) compared to healthy controls. Although the differences in ToM abilities approached significance, they did not reach statistical significance. A significant correlation was identified between the subscale of "disgust related to contamination" and "checking compulsions" (r = 0.433), as well as with "obsessive thoughts about harming oneself/others" (r = 0.515). No significant correlation was found between mental contamination and the other variables (r = 0.240). Conclusion: The findings highlight impairments in certain ToM skills among patients with OCD, alongside elevated disgust sensitivity and mental contamination, relative to controls. The significant correlations between disgust sensitivity and specific OCD symptoms emphasize the influence of disgust in exacerbating certain compulsive behaviors. These insights contribute to our understanding of the interactions between OCD symptoms, ToM abilities, and disgust sensitivity.

Clinician-reported challenges associated with delivery of exposure with response prevention for patients with obsessive-compulsive disorder

Exposure with response prevention (E/RP) within cognitive behavior therapy (CBT) is recognized as a critical therapeutic element that drives clinical improvement in the behavioral treatment of obsessive-compulsive disorder (OCD). However, many clinicians encounter a number of barriers when implementing E/RP for patients with OCD, negatively impacting patient outcomes. To understand and better address these challenges, we conducted a survey with 228 clinicians to capture the experiences of mental health providers that use E/RP to treat patients with OCD, and identify challenges they may experience when implementing this form of evidence-based care. We found that the majority of clinicians sampled endorsed facing barriers in implementing E/RP for patients with OCD. Additionally, we found that specific OCD symptom domains were identified by clinicians as difficult to complete exposures for within and between treatment sessions. Ultimately, this investigation identifies some of the challenges faced by clinicians using E/RP to treat patients with OCD, and offers several future research directions to pave the way toward addressing these barriers and improving treatment outcomes.

Metacognitive profiles in children and adolescents with obsessive-compulsive disorder

It has been suggested that maladaptive metacognition (beliefs and strategies) is related to the development and maintenance of obsessive-compulsive disorder (OCD). The aims of the study were to explore whether subgroups of pediatric OCD patients could be identified based on self-reported generic metacognition, and to compare these potential subgroups with a non-clinical control group. Additionally, differences between subgroups were examined across demographic (age and sex) and clinical characteristics (OCD severity and insight, types of OCD symptoms, and co-occurring symptoms). The study included a pooled sample of 157 pediatric OCD patients (age 7–18 years) and 58 non-clinical controls. Latent profile analyses supported a model with three profiles characterized by low, moderate, and high levels of maladaptive metacognition relative to the control group. Children and adolescents with higher age, greater OCD severity, specific OCD symptoms (e.g., aggressive, sexual, somatic, religious, and self-rated obsessing symptoms), and/or co-occurring internalizing symptoms (including anxiety and depressive symptoms) had a higher probability of belonging to a group with higher levels of maladaptive metacognition. The emergent profiles indicate heterogeneity in metacognition and clinical expression among children and adolescents with OCD, suggesting that generic metacognition could be a possible treatment target for some of these patients.

Increases in functional connectivity between the default mode network and sensorimotor network correlate with symptomatic improvement after transcranial direct current stimulation for obsessive-compulsive disorder

BackgroundNon-invasive neuromodulation is a promising intervention for obsessive-compulsive disorder (OCD), although its neurobiological mechanisms of action are still poorly understood. Recent evidence suggests that abnormalities in the connectivity of the default mode network (DMN) and the supplementary motor area (SMA) with other brain regions and networks are involved in OCD pathophysiology. We examined if transcranial direct current stimulation (tDCS) alters these connectivity patterns and if they correlate with symptom improvement in treatment-resistant OCD. MethodsIn 23 patients from a larger clinical trial (comparing active tDCS to sham) who underwent pre- and post-treatment MRI scans, we assessed resting-state functional MRI (rs-fMRI) data. The treatment involved 30-minute daily tDCS sessions for four weeks (weekdays only), with the cathode over the SMA and the anode over the left deltoid. We conducted whole-brain connectivity analysis comparing active tDCS-treated to sham-treated patients. ResultsWe found that active tDCS, but not sham, led to connectivity increasing between the DMN and the bilateral pre/postcentral gyri (p = 0.004, FDR corrected) and temporal-auditory areas plus the SMA (p = 0.028, FDR corrected). Also, symptom improvement was directly associated with connectivity increasing between the left lateral sensorimotor network and the left precuneus (r = 0.589, p = 0.034). LimitationsLimited sample size (23 participants with resting-state neuroimaging), inability to analyze specific OCD symptom dimensions (e.g., harm, sexual/religious, symmetry/checking, cleaning/contamination). ConclusionsThese data offer novel information concerning functional connectivity changes associated with non-invasive neuromodulation interventions in OCD and can guide new brain stimulation interventions in the framework of personalized interventions.

Implicit aggressive self-concept in patients with obsessive-compulsive disorder: Results from an approach-avoidance task

Background and objectivesPatients with obsessive-compulsive disorder (OCD) have reported higher anger and aggression than healthy individuals in previous studies using explicit measures. However, studies using implicit measures have demonstrated mixed results. The aim of the present study was to investigate implicit aggressiveness in OCD using an approach-avoidance task (AAT). MethodsSeventy-eight patients with OCD and 37 healthy controls underwent structured clinical interviews and measures of anger, OCD, and depressive symptoms as well as a computerized AAT that included aggressive, peaceful, negative, and positive stimuli. ResultsIn line with previous studies, patients with OCD reported higher scores on explicit anger. With respect to the implicit measure, repeated measures ANOVAs did not show any differences in mean reaction times for pushing compared to pulling aggressive versus peaceful and negative versus positive words. However, analyses of specific OCD symptom dimensions demonstrated significantly faster reaction times for pulling compared to pushing aggressive words for patients with high scores in the OCD symptom dimensions obsessing and hoarding. LimitationsEighty percent of patients with OCD showed psychiatric comorbidities and all were seeking treatment. ConclusionThe present study supports previous studies reporting the absence of higher aggressiveness in patients with OCD compared to healthy controls using implicit measures. However, in contrast to previous studies, we found an implicit approach bias towards aggressive self-statements for OCD patients scoring high in the symptom dimensions obsessing and hoarding compared to healthy controls. Future studies should further elucidate putative functional relationships between different OCD symptom dimensions and implicit aggressiveness.

A Randomized Controlled Trial of OC-Go for Childhood Obsessive–Compulsive Disorder: Augmenting Homework Compliance in Exposure With Response Prevention Treatment

The current study investigates a novel digital tool designed to address barriers to out-of-session homework adherence in exposure with response prevention (ERP) for child obsessive-compulsive disorder (OCD). The OC-Go platform allows clinicians to create and push tailored interactive protocol- or symptom-specific assignments to patients on their mobile devices, providing in-the-moment step-by-step directions, encouragement, accountability, and a sense of therapeutic presence for patients during out-of-office exposures. The platform also facilitates objective measurement of homework and allows providers to support one another through a shared and searchable crowdsourced library with hundreds of assignable exposures and psychoeducation activities for specific OCD symptoms. The current study tested the usability and feasibility of the OC-Go platform with ERP stakeholders (OCD therapists, patients, and parents; N = 172) using the System Usability Scale (SUS). The study also tested the efficacy of OC-Go for augmenting homework adherence and clinical response using a randomized controlled, crossover design in a sample of 28 treatment-seeking youth with OCD. Participants randomized to standard ERP exhibited a homework adherence rate of 68.4% (95% CI [65.6, 71.0]), those randomized to ERP with OC-Go exhibited a greater adherence rate of 83.3% (95% CI [80.8, 85.6], p < .001). Both groups experienced large declines in Children’s Yale–Brown Obsessive–Compulsive Scale-rated OCD (d = 1.31, p < .001), though participants randomized to begin ERP with OC-Go exhibited clinically significant greater improvement (p = .05), translating into an additional augmented treatment response at the Week 6 primary end point (d = 0.36) and the Week 12 treatment end point (d = 0.72). Stakeholders rated OC-Go in the 90th percentile for usability on the SUS, indicative of a highly usable and easy-to-learn technology. Initial evidence supports OC-Go as a feasible and effective adjunct to improve out-of-office exposure measurement, adherence, and treatment response in ERP for child OCD.

Obsessive-Compulsive Symptom Dimensions and Their Relationships with Obsessive Beliefs: A Structural Equation Modeling Analysis.

Dysfunctional beliefs are central in the development and maintenance of obsessive-compulsive disorder (OCD) as well as its treatment. Yet, research suggests that not all dysfunctional beliefs are equally important for each of the symptom dimensions of OCD. However, results are inconsistent in that studies contradict each other regarding the associations between specific symptom dimensions and belief domains. The aim of the present study was to clarify which belief domain is specifically associated with which OCD symptom dimension. Results could help to tailor treatments more specifically to the patient's OCD symptom dimension. In- and outpatients with OCD (N = 328; 43.6% male and 56.4% female) filled out questionnaires on symptom dimensions of OCD (Obsessive-Compulsive Inventory Revised) and dysfunctional beliefs (Obsessive Beliefs Questionnaire). A structural equation model analysis was conducted to identify the associations between dysfunctional beliefs and symptom dimensions. Our results showed that perfectionism/intolerance of uncertainty was associated with hoarding and symmetry/ordering, (2) overestimation of threat/inflated responsibility was associated with checking compulsions, and (3) importance of thoughts/control of thoughts was associated with obsessing. These results were largely supported by a backward selection. Our results demonstrated associations of specific dysfunctional beliefs and specific OCD symptom dimensions. However, future studies are necessary to replicate these findings with other measures (e.g., clinician ratings).

Relationship between white matter alterations and contamination subgroup in obsessive compulsive disorder: A diffusion tensor imaging study.

Approximately 2%-3% of the world population suffers from obsessive-compulsive disorder (OCD). Several brain regions have been involved in the pathophysiology of OCD, but brain volumes in OCD may vary depending on specific OCD symptom dimensions. The study aims to explore how white matter structure changes in particular OCD symptom dimensions. Prior studies attempt to find the correlation between Y-BOCS scores and OCD patients. However, in this study, we separated the contamination subgroup in OCD and compared directly to healthy control to find regions that exactly related to contamination symptoms. To evaluate structural alterations, diffusion tensor imaging was acquired from 30 OCD patients and 34 demographically matched healthy controls. Data were processed using tract-based spatial statistics (TBSS) analysis. First, by comparing all OCD to healthy controls, significant fractional anisotropy (FA) decreased in the right anterior thalamic radiation, right corticospinal tract, and forceps minor observed. Then by comparing the contamination subgroup to healthy control, FA decreases in the forceps minor region. Consequently, forceps minor plays a central role in the pathophysiology of contamination behaviors. Finally, other subgroups were compared to healthy control and discovered that FA in the right corticospinal tract and right anterior thalamic radiation is reduced.

Facets of adult attachment style in patients with obsessive-compulsive disorder

Literature data did not show univocal evidence in discriminating which form of attachment insecurity is involved in obsessive-compulsive disorder (OCD): both anxiety and avoidance was related to OCD symptomatology. No study used the Attachment Style Questionnaire (ASQ) that allows for investigation of differentiated facets of attachment anxiety and of avoidance. We investigated: (1) whether individuals with OCD differed from controls in the facets of attachment security (anxiety and avoidance), (2) which attachment facets predicted a diagnosis of OCD, controlling for socio-demographics and obsessive beliefs, (3) which attachment facets predicted specific OCD symptoms, controlling for socio-demographics and obsessive beliefs.Two hundred seventy participants (135 OCD patients and 135 matched controls) completed the Obsessive-Compulsive Inventory-Revised, Obsessive Beliefs Questionnaire-46 and ASQ. OCD patients reported respectively lower and higher levels on confidence and attachment anxiety than controls. Higher need of approval was the most important predictor of OCD diagnosis beyond the other attachment facets, and even of the obsessive beliefs. Using multivariate generalised linear models, the two facets of attachment anxiety, the need for approval (that predicted higher levels of obsessing and ordering symptoms), and preoccupation with relationships (that predicted higher hoarding symptoms) seemed to explain variance over and above OCD-related beliefs and socio-demographics. Discomfort with closeness contributed to the predictions of ordering symptoms.In conclusion, the interpersonal dynamics related to attachment in OCD patients should be carefully considered during assessment and treatment of OCD patients in clinical practice.

How do daily routines and situational factors affect the severity of obsessive-compulsive disorder?

BackgroundDaily routine and situations may worsen, stabilise, or improve symptoms of obsessive-compulsive disorder (OCD). We investigated which factors OCD patients perceived to be related to the worsening of their OCD symptoms and their relationship to patients’ OCD symptom severity. MethodsSeven-hundred and forty-two OCD patients completed the Yale-Brown Obsessive-Compulsive Scale as a measure of OCD symptom severity and the Yale OCD Natural History Questionnaire assessing perception of impact of environmental and routine factors on symptoms. We conducted univariate exploratory analyses and a multivariate regression. ResultsReporting of worsening OCD symptoms when having a meal (B = 0.093, p = 0.008), during hot weather (B = 0.153, p < 0.001) and while watching television (B = 0.080, p = 0.039) was associated with more severe OCD symptoms. ConclusionPeople with more severe OCD report symptom worsening while having a meal, when exposed to higher temperatures, and whilst watching television. While our study may be limited by its cross-sectional design (limiting inferences of causality) and analysis of broad (rather than specific) OCD symptoms, our findings point to a potential common biological abnormality that is disturbed by certain events in OCD. We present clinical implications of our findings and areas for further exploration.

The transdiagnostic nature of disgust propensity: An examination of its associations with anxiety and obsessive compulsive-related disorder symptoms

Significant research highlights the role of disgust propensity in obsessive-compulsive disorder (OCD) and other anxiety-based diagnoses and suggests that heightened disgust propensity may be a transdiagnostic risk factor for these disorders. However, OCD was reclassified from an anxiety to an obsessive-compulsive and related disorder (OCRD), due in part to OCD being associated with a range of non-anxiety affective experiences, including disgust. A fair amount of work has examined the relationship between disgust, OCD, and anxiety disorders; less information is available on its relation to the OCRDs. The present study examined associations between specific domains of disgust propensity and self-reported symptoms of several anxiety disorders, OCD, body dysmorphic disorder (BDD), and hoarding in two non-clinical samples. Results showed that specific phobia, OCD, and BDD symptoms were consistently and strongly correlated with disgust domains. Results of multivariate regression analyses indicated replicable relationships between animal-reminder disgust and specific phobia symptoms, core disgust and animal phobia symptoms, and contamination disgust and cleaning symptoms, controlling for negative affect, anxiety sensitivity, and experiential avoidance. Results were inconsistent for panic, BDD, and hoarding symptoms. These results partially support the argument that the OCRDs are more distinct than similar and that OCD and some anxiety disorders are defined by common psychological processes.

Linking insomnia and OCD symptoms during the coronavirus pandemic: Examination of prospective associations

There is considerable concern in the mental health community about the psychological consequences of the coronavirus pandemic and who may be most vulnerable. Obsessive-compulsive disorder (OCD) symptoms may be particularly sensitive to the context of the pandemic. Previous research suggests insomnia symptoms may contribute to increased OCD symptoms over time, particularly during times of stress, such as the pandemic. The present study examined pre-coronavirus outbreak insomnia symptoms as a predictor of post-coronavirus outbreak OCD symptoms in a sample of community adults who completed a 2016 survey study and were re-contacted on April 1, 2020 (N = 369). Results revealed a small significant increase in OCD symptoms following the coronavirus outbreak and a small significant decrease in insomnia symptoms. Pre-coronavirus outbreak insomnia symptoms significantly predicted increases in post-coronavirus outbreak OCD symptoms. Similar results were found for specific OCD symptom facets with the exception of washing and hoarding symptoms, which were unrelated to pre-coronavirus insomnia symptoms. There was no evidence for a reverse effect of prior OCD symptoms on insomnia symptoms during the pandemic. These findings suggest those with insomnia symptoms prior to the coronavirus pandemic may be vulnerable to increases in some OCD symptoms during the pandemic. The implications for preventing adverse psychological responses during the coronavirus pandemic are discussed.

Obsessive-compulsive symptoms and their links to depression and anxiety in clinic- and community-based pediatric samples: A network analysis

BackgroundSymptoms of depression and anxiety are common in children with obsessive-compulsive disorder (OCD) and associated with more severe OCD, greater impairment, and worse treatment outcome. Beyond twin studies showing that genetic factors contribute to the high co-occurrence, few studies have examined how OCD, depression, and anxiety are linked in youth, and current studies often fail to account for OCD and anxiety heterogeneity. MethodsNetwork analysis was used to investigate how OCD were linked to depression and anxiety in multinational youth diagnosed with OCD (total n = 419) and in school-recruited, community-based samples of youth (total n = 2 991). ResultsInitial results aligned with earlier work showing that severity of obsession-related symptoms are important in linking OCD to depression in youth with OCD. However, when symptom content of OCD (e.g., washing, ordering) was fully taken into account and when measures of anxiety were included, specific OCD symptom dimensions (primarily obsessing and doubting/checking) were linked to specific anxiety dimensions (primarily panic and generalized anxiety) which in turn were linked to depression. These results were replicated in three separate community-based samples from Chile, Italy, and Spain using different measures of anxiety and depression. LimitationsCross-sectional data were analyzed which precludes causal inference. Self-report measures were used. ConclusionsYouth with OCD with symptoms related to doubting/checking and obsessing should be carefully assessed for symptoms of panic and generalized anxiety. Non-responders to standard OCD treatment may benefit from interventions targeting panic and generalized anxiety, but more research is needed to test this hypothesis.

Obsessive compulsive disorder and thought action fusion: Relationships with eating disorder outcomes

Obsessive Compulsive Disorder (OCD) is among the most common psychiatric comorbidities with eating disorders (EDs) and most studies have only examined this relationship at a diagnostic level. More research is needed to determine whether specific symptom domains and cognitive patterns commonly observed in OCD are most salient among individuals with clinically significant EDs, and whether these symptoms appear to change and/or influence treatment outcomes. Thought Action Fusion (TAF) is one cognitive pattern that may underlie OCD-ED comorbidity. The current study assessed 112 adolescent and adult female patients at a residential ED treatment facility on levels of ED severity, OCD symptom severity, and TAF at pre- and post-treatment. All OCD symptom dimensions were positively correlated with ED severity at pretreatment, with Obsessing, Neutralizing and Ordering OCD symptoms being most elevated. TAF was also positively correlated with ED severity at pre-treatment, and higher levels of TAF at pretreatment significantly predicted greater ED severity at post-treatment after controlling for all other OCD symptoms. Improvements in TAF specific to thoughts about others also predicted improvements in ED severity after controlling for changes in OCD symptoms. Clinically, these results indicate that efforts targeting specific OCD symptom dimensions and TAF in addition to ED-focused treatment as usual may be beneficial for enhancing overall treatment outcomes.

Propensity to Sexual Response among Adults with Obsessive-Compulsive Disorder.

Background:Propensity to sexual excitation and inhibition is one of the key dimensions of sexuality. Clinicians working with Obsessive-Compulsive Disorder (OCD) patients rarely assess this and other aspects of sexuality, since treatment targets generally symptom reduction. Literature on sexual functioning in OCD patients is scarce and no study has focused on symptom subtypes, nor investigated the psychological processes related to sexual response.Objective:In the present short report, we describe an exploratory study investigating the association between symptom subtypes and propensity towards sexual excitation/inhibition in OCD patients, controlling for gender, age and antidepressant treatment.Methods:Seventy-two OCD patients (mean age = 34.50 years, 37.50% women) completed the Obsessive-Compulsive Inventory-Revised and the Sexual Inhibition/Sexual Excitation Scales.Results:Patients with more severe compulsive washing habit had a lower propensity towards excitation and a higher one towards inhibition due to threat of performance consequences (i.e., contamination with sexually transmitted diseases/having an unwanted pregnancy). Patients with more severe symptoms of checking showed a higher propensity towards inhibition due to the threat of performance consequences. Gender, age and antidepressant treatment were not related to sexual functioning.Conclusion:Specific OCD symptom subtypes may be associated with some psychological processes involved in sexual response. Sexual well-being should be carefully evaluated by practitioners and should be regarded as a treatment target. Future studies should investigate more comprehensively the processes involved in sexuality.

Accelerated rTMS in the treatment of obsessive compulsive disorder: A pilot study on safety and feasibility

Introduction Obsessive Compulsive Disorder (OCD) is a disabling psychiatric disorder with a prevalence of approximately 1–3%. Next to disruptions within the orbitofronto-subcortical loops, regions within the salience network (SN) are related to specific OCD symptoms. Of interest, non-invasive brain stimulation has been documented to modulate SN cortical-subcortical loop disturbances. Therefore medial prefrontal regions (supplementary motor area (SMA), pre-SMA and the dorsomedial prefrontal cortex (dmPFC)) could be promising targets. Because accelerated rTMS (arTMS) has been showing fast clinical responses in depression, we applied arTMS (LF) in OCD patients. Methods Seven patients (4 M, 3F, mean age: 33 years) with severe treatment resistant OCD, under treatment with stable medication regimen were enrolled. Patients received 20 sessions of 1 Hz rTMS (1200 pulses) in an accelerated protocol (2 sessions a day) during 10 weekdays. Change from baseline to endpoint and to delayed endpoint (14 days after treatment) on the Y-BOCS were the primary outcome measure. Change as a direct and delayed effect on the IDS-SR were the secondary outcome measure. Side effects were carefully monitored. Results We found statistically significant reductions of the Y-BOCS scores from baseline to endpoint and to the delayed endpoint, however, without achieving clinical response (decline of ≥ 35% at Y-BOCS). We also found a significant reduction on depression severity scores. The treatment was generally well tolerated. Headache was a common adverse effect. No epileptic insult occurred. Conclusion To our knowledge, this is the first accelerated rTMS protocol of the dmPFC in patients with OCD. These preliminary results indicate that accelerated rTMS may be safe, well-tolerated and capable of achieving significant improvement. Because this study is limited due to lack of sham condition and lack of power, further investigation is warranted.

No evidence of attentional bias toward angry faces in patients with obsessive-compulsive disorder.

Objective:Although attentional bias (AB) toward angry faces is well established in patients with anxiety disorders, it is still poorly studied in obsessive-compulsive disorder (OCD). We investigated whether OCD patients present AB toward angry faces, whether AB is related to symptom severity and whether AB scores are associated with specific OCD symptom dimensions.Method:Forty-eight OCD patients were assessed in clinical evaluations, intelligence testing and a dot-probe AB paradigm that used neutral and angry faces as stimuli. Analyses were performed with a one-sample t-test, Pearson correlations and linear regression.Results:No evidence of AB was observed in OCD patients, nor was there any association between AB and symptom severity or dimension. Psychiatric comorbidity did not affect our results.Conclusion:In accordance with previous studies, we were unable to detect AB in OCD patients. To investigate whether OCD patients have different brain activation patterns from anxiety disorder patients, future studies using a transdiagnostic approach should evaluate AB in OCD and anxiety disorder patients as they perform AB tasks under functional neuroimaging protocols.

A bifactor model of obsessive beliefs: Specificity in the prediction of obsessive-compulsive disorder symptoms.

Although current cognitive-behavioral models suggest that maladaptive "obsessive beliefs" about threat, responsibility, uncertainty, perfectionism, importance, and control of thoughts contributes to the development of obsessive-compulsive disorder (OCD), the structure of such beliefs is unclear. The current study evaluated a bifactor model of obsessive beliefs, as assessed by the Obsessive Beliefs Questionnaire (OBQ-44), and its association with OCD symptoms in clinical (Study 1; N = 264) and nonclinical (Study 2; N = 437) samples. The goals were as follows: (a) to evaluate whether obsessive beliefs should be conceptualized as unidimensional or whether distinct dimensions should be interpreted, and (b) to use structural equation modeling to examine the extent to which distinct beliefs predict OCD symptoms above and beyond a general obsessive belief factor. Results revealed that in both clinical and nonclinical samples, a bifactor model fit the data well and significantly better than a standard three-factor model of the OBQ-44 that specified 3 separate, yet correlated factors (Responsibility/Threat Estimation, Perfectionism/Certainty, and Importance/Control of Thoughts). Despite evidence that the OBQ-44 consists of a general factor and the 3 specific factors, structural equation modeling showed that only the general factor uniquely predicted a broad OCD symptom latent factor in clinical and nonclinical samples. Although obsessive beliefs about Perfectionism/Certainty did predict symmetry and ordering symptoms of OCD when controlling for the general factor in both studies, the general factor was a more robust predictor of specific OCD symptoms than the 3 factors. These findings suggest that the general factor of the OBQ-44 may have more utility than its specific factors in predicting the heterogeneity of OCD symptoms. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Challenges in the diagnosis and treatment of pediatric obsessive-compulsive disorder.

Obsessive–compulsive disorder (OCD) affects 1%–3% of children worldwide and has a profound impact on quality of life for patients and families. Although our understanding of the underlying etiology remains limited, data from neuroimaging and genetic studies as well as the efficacy of serotonergic medications suggest the disorder is associated with the fundamental alterations in the function of cortico-striato-thalamocortical circuits. Significant delays to diagnosis are common, ultimately leading to more severe functional impairment with long-term developmental consequences. The clinical assessment requires a detailed history of specific OCD symptoms as well as psychiatric and medical comorbidities. Standardized assessment tools may aid in evaluating and tracking symptom severity and both individual and family functioning. In the majority of children, an interdisciplinary approach that combines cognitive behavioral therapy with a serotonin reuptake inhibitor leads to meaningful symptom improvement, although some patients experience a chronic, episodic course. There are limited data to guide the management of treatment-refractory illness in children, although atypical antipsychotics and glutamate-modulating agents may be used cautiously as augmenting agents. This review outlines a clinical approach to the diagnosis and management of OCD, highlighting associated challenges, and limitations to our current knowledge.

Use of an Individual-Level Approach to Identify Cortical Connectivity Biomarkers in Obsessive-Compulsive Disorder

BackgroundExisting functional connectivity studies of obsessive-compulsive disorder (OCD) support a model of circuit dysfunction. However, these group-level observations have failed to yield neuroimaging biomarkers sufficient to serve as a test for the OCD diagnosis, predict current or future symptoms, or predict treatment response, perhaps because these studies failed to account for the substantial intersubject variability in structural and functional brain organization. MethodsWe used functional regions, localized in each of 41 individual OCD patients, to identify cortical connectivity biomarkers of both global and dimension-specific symptom severity and to detect functional connections that track changes in symptom severity following intensive residential treatment. ResultsGlobal OCD symptom severity was directly linked to dysconnectivity between large-scale intrinsic brain networks—particularly among the dorsal attention, default, and frontoparietal networks. Changes within a subset of connections among these networks were associated with symptom resolution. Additionally, distinct and nonoverlapping cortical connectivity biomarkers were identified that were significantly associated with the severity of contamination/washing and responsibility for harm/checking symptoms, highlighting the contribution of dissociable neural networks to specific OCD symptom dimensions. By contrast, when we defined functional regions conventionally, using a population-level brain atlas, we could no longer identify connectivity biomarkers of severity or improvement for any of the symptom dimensions. ConclusionsOur findings would seem to encourage the use of individual-level approaches to connectivity analyses to better delineate the cortical and subcortical networks underlying symptom severity and improvement at the dimensional level in OCD patients.