Subclinical Obsessive-compulsive Symptoms Research Articles

Genome-Wide Association Study of Obsessive-Compulsive Symptoms including 33,943 individuals from the general population.

While 1-2% of individuals meet the criteria for a clinical diagnosis of obsessive-compulsive disorder (OCD), many more (~13-38%) experience subclinical obsessive-compulsive symptoms (OCS) during their life. To characterize the genetic underpinnings of OCS and its genetic relationship to OCD, we conducted the largest genome-wide association study (GWAS) meta-analysis of parent- or self-reported OCS to date (N = 33,943 with complete phenotypic and genome-wide data), combining the results from seven large-scale population-based cohorts from Sweden, the Netherlands, England, and Canada (including six twin cohorts and one cohort of unrelated individuals). We found no genome-wide significant associations at the single-nucleotide polymorphism (SNP) or gene-level, but a polygenic risk score (PRS) based on the OCD GWAS previously published by the Psychiatric Genetics Consortium (PGC-OCD) was significantly associated with OCS (Pfixed = 3.06 × 10-5). Also, one curated gene set (Mootha Gluconeogenesis) reached Bonferroni-corrected significance (Ngenes = 28, Beta = 0.79, SE = 0.16, Pbon = 0.008). Expression of genes in this set is high at sites of insulin mediated glucose disposal. Dysregulated insulin signaling in the etiology of OCS has been suggested by a previous study describing a genetic overlap of OCS with insulin signaling-related traits in children and adolescents. We report a SNP heritability of 4.1% (P = 0.0044) in the meta-analyzed GWAS, and heritability estimates based on the twin cohorts of 33-43%. Genetic correlation analysis showed that OCS were most strongly associated with OCD (rG = 0.72, p = 0.0007) among all tested psychiatric disorders (N = 11). Of all 97 tested phenotypes, 24 showed a significant genetic correlation with OCS, and 66 traits showed concordant directions of effect with OCS and OCD. OCS have a significant polygenic contribution and share genetic risk with diagnosed OCD, supporting the hypothesis that OCD represents the extreme end of widely distributed OCS in the population.

Error-related brain activity associated with obsessive-compulsive symptoms in youth.

Subclinical obsessive-compulsive symptoms (OCS) are common in children, and increase risk for later onset of obsessive-compulsive disorder (OCD). In pediatric patients with OCD, neuroimaging research implicates altered neural mechanisms for error-processing, but whether abnormal brain response occurs with subclinical OCS remains poorly understood. Using functional magnetic resonance imaging (fMRI), 113 youth (8-18 years; 45 female) from a community sample were scanned during an error-eliciting Go/No-Go task. OCS were assessed dimensionally using the obsessive-compulsive subscale of the Child Behavior Checklist. The association between OCS scores and error-related brain activity was examined at the whole-brain level. Lower OCS scores associated with stronger response to errors in dorsal anterior cingulate cortex (dACC), caudate, putamen, thalamus, and occipital cortex. Additionally, lower OCS related to higher capacity for inhibitory control, as indexed by greater accuracy on No-Go trials during fMRI scanning. The relationship between lower OCS and better accuracy on No-Go trials was mediated by greater error-related dACC activity. The inverse relationship between OCS and error-related activity in the dACC and extended cortical-striatal-thalamic circuitry may index an adaptive process by which subclinical OCS are minimized in youth. Further, these results identify an observable pattern of brain activity that tracks with subclinical OCS severity. Understanding the link between neural networks for error processing and the normal to abnormal range of OCS may pave the way for brain-based strategies to identify children who are more likely to develop OCD and enable the targeting of preventive strategies to reduce risk.

Early intervention in obsessive-compulsive disorder: From theory to practice

Obsessive-compulsive disorder (OCD) is frequent and often disabling. Yet, correct diagnosis and appropriate treatment implementation are usually delayed, with undesirable consequences. In this paper we review the rationale for early intervention in OCD and provide recommendations for early intervention services. Two scenarios are discussed, i.e., subclinical (prodromal) obsessive-compulsive symptoms (OCS) and full-blown OCD. Although the typical patient with OCD reports a long history of subclinical OCS, longitudinal studies suggest most individuals with OCS in the community do not convert to full-blown OCD. Thus, research on “at risk” phenotypes for OCD and how they should incorporate different risk factors (e.g., polygenic risk scores) are badly needed. For this specific scenario, preventative treatments that are cheap, well tolerated and highly scalable (e.g., lifestyle interventions) are of major interest. On the other hand, increasing evidence suggests OCD to be a progressive disorder and the severity and duration of illness to be associated with both biological changes and increased clinical complexity, including greater number of physical and psychiatric comorbidities, increased family accommodation and worse treatment response. Therefore, prompt identification and early treatment implementation for full-blown OCD are also critical for ethical, clinical and therapeutic reasons. Based on the existing findings, we argue that, regardless of focusing on subclinical OCS or clinical OCD, early intervention services need to target a childhood age group. In addition to delivering well established treatments to people with full-blown OCD early on their illness, early intervention services also need to provide psychoeducation for patients, families and teachers.

Obsessive-Compulsive Symptoms, Polygenic Risk Score, and Thalamic Development in Children From the Brazilian High-Risk Cohort for Mental Conditions (BHRCS).

Background: Thalamic volume measures have been linked to obsessive-compulsive disorder (OCD) in children and adolescents. However, it is unclear if alterations in thalamic volumes occur before or after symptom onset and if there is a relation to the presence of sub-clinical obsessive-compulsive symptoms (OCS). Here, we explore the relationship between OCS and the rate of thalamic volume change in a cohort of children and youth at high risk to develop a mental disorder. A secondary aim was to determine if there is a relationship between OCS and the individual's OCD polygenic risk score (OCD-PRS) and between the rate of thalamic volume change and the OCD-PRS.Methods: The sample included 378 children enrolled in the longitudinal Brazilian High-Risk Cohort for Mental Conditions. Participants were assessed for OCS and the symmetrized percent change (SPC) of thalamic volume across two time-points separated by 3 years, along with the OCD-PRS. Zero-altered negative binomial models were used to analyze the relationship between OCS and thalamic SPC. Multiple linear regressions were used to examine the relationship between thalamic SPC and OCD-PRS.Results: A significant relationship between OCS and the right thalamus SPC (p = 0.042) was found. There was no significant relationship between changes in thalamic volume SPC and OCD-PRS.Conclusions: The findings suggest that changes in the right thalamic volume over the course of 3 years in children may be associated to OCS. Future studies are needed to confirm these results and further characterize the specific nature of OCS symptoms associated with thalamic volumes.

Fathers' Experience of Perinatal Obsessive-Compulsive Symptoms: A Systematic Literature Review.

Perinatal Obsessive-Compulsive Disorder (pOCD) refers to the onset/exacerbation of Obsessive-Compulsive Disorder (OCD) during the perinatal period. This disorder has been studied in mothers, with limited research conducted on fathers. The aim of the current study was to conduct the first systematic review of research investigating the experience of pOCD in fathers. A systematic review was conducted via electronic searches of Scopus, ProQuest, APA PsychNet, PubMed, and EBSCOhost. There were 523 articles identified and screened for eligibility, resulting in six eligible studies included in the final review. All studies reported the presence of subclinical obsessive-compulsive symptoms in fathers during the perinatal period, with the prevalence comparable to mothers. Compared to mothers, however, fathers were found to report less intrusion-related distress. Two studies reported a correlation between dysfunctional beliefs, negative appraisal of intrusions, and pOCD symptoms. Common categories of obsessive thoughts and compulsions experienced by fathers were also identified. Fathers appear susceptible to pOCD, which is consistent with the Cognitive-Behavioral Theory of OCD. Future research is recommended, therefore, to investigate clinical prevalence and severity of pOCD in fathers, particularly relative to mothers, and further investigate the role of dysfunctional beliefs in the development of pOCD.

Brain Functional Connectivity Correlates of Subclinical Obsessive-Compulsive Symptoms in Healthy Children

Commonly observed subclinical obsessive-compulsive symptoms in healthy children may predispose to obsessive-compulsive disorder (OCD). Therefore, investigating the underlying neurobiology may be relevant to identify alterations in specific brain circuits potentially accounting for clinical heterogeneity in OCD without the confounding effects of clinical samples. We analyzed the brain correlates of different obsessive-compulsive symptoms in a large group of healthy children using functional connectivity measures. We evaluated 227 healthy children (52% girls; mean [SD] age 9.71 [0.86] years; range, 8-12.1 years). Participants underwent clinical assessment with the Obsessive-Compulsive Inventory-Child Version and a resting-state functional magnetic resonance imaging examination. Total and symptom-specific severity were correlated with voxelwise global functional connectivity degree values. Significant clusters were then used as seeds of interest in seed-to-voxel analyses. Modulating effects of age and sex were also assessed. Global functional connectivity of the left ventral putamen and medial dorsal thalamus correlated negatively with total obsessive-compulsive symptom severity. Seed-to-voxel analyses revealed specific negative correlations from these clusters with limbic, sensorimotor, and insular regions in association with obsessing, ordering, and doubt-checking symptoms, respectively. Hoarding symptoms were associated with negative correlations between the left medial dorsal thalamus and a widespread pattern of regions, with such associations modulated by sex and age. Our findings concur with prevailing neurobiological models of OCD on the importance of cortico-striato-thalamo-cortical dysfunction to account for symptom severity. Notably, we showed that changes in cortico-striato-thalamo-cortical connectivity are present at subclinical stages, which may result in an increased vulnerability for OCD. Moreover, we mapped different symptom dimensions onto specific cortico-striato-thalamo-cortical circuit attributes.

Social losses predict a faster onset and greater severity of obsessive-compulsive disorder

BackgroundWhile stressful life events increase the risk of developing a range of psychiatric disorders, including obsessive-compulsive disorder (OCD), their ability to precipitate specific obsessive-compulsive symptoms' dimensions is unknown. Here we aimed to evaluate the potential role of three different types of stressful life events, herein termed losses (death of a loved one, termination of a romantic relationship and severe illness) in predicting the speed of progression from subclinical to clinical OCD and the severity of specific OCD dimensions in a large multicentre OCD sample. MethodsNine hundred and fifty-four OCD outpatients from the Brazilian OCD Research Consortium were included in this study. Several semi-structured and structured instruments were used, including the Structured Clinical Interview for DSM-IV Axis I Disorders, the Yale-Brown Obsessive-Compulsive Scale, the Dimensional Yale-Brown Obsessive-Compulsive Scale, the Brown Assessment of Beliefs Scale, the Beck Depression Inventory, the Beck Anxiety Inventory and the Yale OCD Natural History Questionnaire. Regression models investigated the interaction between types of loss and gender to predict speed of progression from subclinical obsessive-compulsive symptoms to OCD, and the severity of five symptom dimensions. ResultsWhile termination of a relationship was associated with a faster speed of progression from subthreshold to clinical OCD, the death of a loved one was associated with increased severity of hoarding symptoms. There was also an interaction between gender and experiences of death, which predicted a faster speed of progression to OCD in males. ConclusionsStressful life events have the ability to accelerate the progression from subclinical to clinical OCD, as well as impact the severity of specific OCD dimensions. Gender also plays a role in both the progression and severity of symptoms. These findings suggest that stressful life events may represent a marker to identify individuals at risk of progressing to clinical OCD.

P.191 Subclinical obsessive-compulsive symptoms are associated with disrupted functional integrity of brain networks in healthy children

P.191 Subclinical obsessive-compulsive symptoms are associated with disrupted functional integrity of brain networks in healthy children

Personality disorder traits in young adults with subclinical obsessive-compulsive symptoms: Not just traits related to obsessive- compulsive personality.

Research is scarce regarding personality disorder traits of individuals with subclinical obsessive-compulsive symptoms. Cluster analysis based on obsessional, schizotypal, and borderline personality and autism-spectrum features was conducted on the results for 118 students scoring above cutoff on the Obsessive Compulsive Inventory-Revised. This identified four groups: O, L, S, and A. One third of the sample was represented by individuals with obsessional traits (O), while another third was composed of individuals with low traits (L); the last two profiles corresponded to a cluster with autistic traits (A) and a group with schizotypal and borderline features (S), both clusters together comprising the remaining third. Significant differences were observed between groups, both on personality traits and on psychopathological symptoms. The S cluster displayed the highest scores of suicidality, depression, and obsessive-compulsive symptoms. This study identified meaningful profiles of personality disorder traits, distinct from obsessive-compulsive personality, in individuals with subclinical obsessive-compulsive symptoms.

Brain functional connectivity is associated with subclinical obsessive-compulsive symptoms in healthy children

Brain functional connectivity is associated with subclinical obsessive-compulsive symptoms in healthy children

Thoughts as Unexpected Intruders: Context, Obsessive-Compulsive Symptoms, and the Sense of Agency Over Thoughts

Obsessions are commonly described as intrusive, ego-dystonic, and coming out of nowhere. This might reflect an experience of a low sense of agency (SoA; i.e., the experience of being the source of one’s own thoughts). In this study, we investigated the relationship between obsessive-compulsive (OC) symptoms and the SoA over thoughts. Participants were told that subliminal auditory primes (actually sham) can insert thoughts into their minds, and their experiences of inserted thoughts were collected online. The results of three experiments showed reduced SoA over thoughts in individuals with subclinical OC symptoms, regardless of the valence of the thoughts. Several potential confounding factors (e.g., suppression, vigilance, general anxiety) were ruled out. The experience of inserted thoughts was related to experiencing thoughts as “out of context,” which partially explained reduced SoA in participants with high levels of OC symptoms. These experiments highlight the importance of focusing on the low-level, contextual, and phenomenological characteristics of intrusive thoughts in addition to their content and appraisals.

Brain Structural Correlates of Subclinical Obsessive-Compulsive Symptoms in Healthy Children

Subclinical obsessive-compulsive (OC) symptoms are frequently observed in children and have been reported to predict a subsequent diagnosis of OC disorder (OCD). Therefore, identifying the putative neurobiological signatures of such risk is crucial, because it would allow for the characterization of the underpinnings of OCD without the interfering effects of chronicity, medication, or comorbidities, especially when interpreted within the context of OCD clinical heterogeneity and taking into account normal neurodevelopmental changes. The present study aimed to identify the brain volumetric features associated with subclinical OC symptoms and the potential modulatory effects of sex and age in a large sample of healthy children. Two hundred fifty-five healthy children were assessed using the Obsessive-Compulsive Inventory-Child Version and underwent a brain structural magnetic resonance examination. The relation between total and symptom-specific scores and regional gray and white matter (GM and WM) volumes was evaluated. Participants were grouped according to sex and age (younger versus older) to assess the effect of these factors on symptom-brain morphometry associations. Ordering symptoms were negatively related to GM volumes in the ventral caudate. Hoarding symptoms were positively associated with GM and WM volumes in the left inferior frontal gyrus, and obsessing symptoms correlated negatively with GM and WM volumes in the right temporal pole. Doubt-checking symptoms correlated positively with WM volumes in the right inferior fronto-occipital fasciculus and the corpus callosum. Sex and age modulated some of these associations. Subclinical OC symptoms are associated with specific brain volumetric features, which could be considered potential neural signatures of increased risk for OCD.

P.4.f.001 - Brain structural correlates of subclinical obsessive-compulsive symptoms in healthy children

In this paper we provide a new solution to the problem of adaptive stabilization of linear multivariable systems of relative degree one with reduced prior knowledge of the high frequency gain—imposing only a full-rank condition to this matrix. Instrumental for the establishment of our result is the use of the parameter estimation technique of dynamic regressor extension and mixing recently proposed in the literature. This estimator is used to update the parameters of the classical output-feedback controller, hence the controller is smooth and does not require any projections nor overparameterizations.

Children with Obsessive-Compulsive Symptomology in the General Population: Different Subtypes?

Obsessive-compulsive disorder (OCD) is a moderately prevalent neurodevelopmental disorder, and many children suffer from subclinical obsessive-compulsive (OC) symptoms. The disorder is heterogeneous and has high comorbidity rates. In early disease stages of psychiatric disorders, symptoms are typically hard to attribute exclusively to specific disorders. The authors investigated whether profiles of neuropsychiatric symptoms can be distinguished within a large population-based study of school-aged children (7-10 years) scoring high on OC symptoms. OC symptoms and comorbid symptoms common in pediatric OCD were assessed: symptoms of attention-deficit hyperactivity disorder, oppositional defiant disorder, autism, and anxiety. Latent profile analysis was performed on the subgroup of children scoring high on OC symptoms (high-OC sample, n = 209, i.e., 4.5% of total sample, n = 4632) using the z scores of the measures of comorbid symptoms as indicators. Three distinguishable profiles were found within the high-OC sample. The first subgroup ("OC-specific"; 81.3%, 3.7% of total sample) had only OC-specific problems, the second subgroup ("Comorbid OC"; 11.0%, 0.5% of total sample) had high scores on all measures of comorbid symptomology, and the third subgroup ("Autistic OC"; 7.7%, 0.3%, of total sample) scored especially high on autism. The findings show that profiles based on neuropsychiatric symptoms can be distinguished within a population-based sample of school-aged children scoring high on obsessive-compulsive symptoms. These profiles may be useful in establishing patterns of symptom course during development. Longitudinal follow-up is necessary to ascertain whether at a later age these subgroups still differ in their symptom profile and neuropsychiatric trajectory.

Epidemiology and comorbidity of obsessive–compulsive disorder in late adolescence: a cross-sectional study in senior high schools in Greece

Objective: The aim of this study was to examine the epidemiology, comorbidity and use of health services of obsessive–compulsive disorder (OCD) and subclinical obsessive–compulsive symptoms in late adolescence.Methods: A total of 2427 adolescents attending senior high schools in Greece were selected for a detailed psychiatric interview using the revised clinical interview schedule (CIS-R). Use of alcohol, nicotine and cannabis, and several socio-demographic and socio-economic variables were also assessed.Results: The prevalence of OCD was 1.39% (95% confidence interval [CI]: 1.05–1.84) while that of subclinical obsessive–compulsive symptoms was 2.77% (2.22–3.45). There was a female preponderance for subclinical symptoms. Financial difficulties of the family was the only socio-demographic variable that was significantly associated with OCD but not with subclinical symptoms. The pattern of comorbidity was similar for both conditions but milder in the subclinical form. About one in three reported use of general health services and one in ten use of psychiatric services.Conclusions: OCD and subclinical obsessive–compulsive symptoms were relatively common. Comorbidity with other psychiatric disorders and use of substances was considerable even in subclinical status, but use of specialised health services was small. Clinical and research implications are discussed.

P.3.010 - Brain structural correlates of subclinical obsessive-compulsive symptoms in healthy children

P.3.010 - Brain structural correlates of subclinical obsessive-compulsive symptoms in healthy children

Subclinical obsessive-compulsive symptoms, cognitive processes, school achievement, and intelligence-achievement relationship in adolescents

The aim of the study was to determine whether the general intelligence, cognitive processes, school achievement, and intelligence-achievement relationship of adolescents with subclinical levels of obsessive-compulsive symptoms differed from those of their normal counterparts. From an initial large pool of 14-year-old Bengali students in eighth grade, 110 girls and 100 boys were finally selected. The Children's Yale-Brown Obsessive Compulsive Scale and the Children's Obsessional Compulsive Inventory were used to exclude those with clinical levels of obsessive-compulsive disorder, and to identify those with subclinical levels of obsessive-compulsive symptoms as differentiated from the typically developed adolescents. The participants were administered the Standard Progressive Matrices for assessing general intelligence and Sumon's Attention Memory Module to assess memory-related variables and span of attention. School achievement was assessed from school records from the last two years. Intelligence-achievement relationship was obtained by computing the correlation between intelligence scores and achievement. The analyses revealed that those with subclinical symptoms had poorer cognitive processes, lower achievement and lower intelligence-achievement correlation than their healthy counterparts. Findings imply the need for detection of subclinical obsessive-compulsive symptoms and early intervention of adolescent school students.

Performance monitoring in obsessive–compulsive undergraduates: Effects of task difficulty

Both obsessive–compulsive disorder and subclinical obsessive–compulsive (OC) symptoms seem to be associated with hyperactive error-related brain activity. The current study examined performance monitoring in subjects with subclinical OC symptoms using a new task with different levels of difficulty. Nineteen subjects with high and 18 subjects with low OC characteristics performed a random dot cinematogram (RDC) task with three levels of difficulty. The high and low OC groups did not differ in error-related negativity (ERN), correct-related negativity (CRN) and performance irrespective of task difficulty. The amplitude of the ERN decreased with increasing difficulty whereas the magnitude of CRN did not vary. ERN and CRN approached in size and topography with increasing difficulty, which suggests that errors and correct responses are processed more similarly. These results add to a growing number of studies that fail to replicate hyperactive performance monitoring in individuals with OC symptoms in task with higher difficulty or requiring learning. Together with these findings our results suggest that the relationship between OC symptoms and performance monitoring may be sensitive to type of task and task characteristics and cannot be observed in a RDC that differs from typically used tasks in difficulty and the amount of response-conflict.

Obsessive–compulsive symptoms in at‐risk mental states for psychosis: associations with clinical impairment and cognitive function

Obsessive-compulsive symptoms (OCS) constitute a major comorbidity in schizophrenia. Prevalence estimations of OCS for patients with at-risk mental states (ARMS) for psychosis vary largely. It is unclear how ARMS patients with or without comorbid OCS differ regarding general psychosocial functioning, psychotic and affective symptoms and neurocognitive abilities. At-risk mental states patients (n=233) from the interventional trial PREVENT (Secondary Prevention of Schizophrenia) were stratified according to the presence or absence of comorbid OCS and compared on several clinical variables. Patients, who fulfilled the criteria for obsessive-compulsive disorder (OCD) or presented with subclinical OCS (ARMSposOCS sample), did not significantly differ from patients without OCS (ARMSnegOCS) with regard to gender, age, premorbid verbal intelligence and levels of education. Furthermore, similar severity of depressive syndromes, basic cognitive, attenuated psychotic and brief limited intermittent psychotic symptoms were found. However, ARMSposOCS patients showed more impairment of psychosocial functioning and higher general psychopathology. In contrast, they scored higher in cognitive tasks measuring working memory and immediate verbal memory. Findings extend upon previous results due to the multidimensional assessment. Subsequent longitudinal studies might elucidate how comorbid OCS influence differential treatment response, especially to cognitive behavioural interventions and the transition rates to psychosis.

The relationship of self-reported subclinical obsessive-compulsive symptoms and impulsivity among adults with AD/HD

This study examined the degree to which subclinical obsessive-compulsive symptoms (SOCS) among individuals with Attention Deficit/Hyperactivity Disorder (AD/HD) were associated with response inhibition difficulties on a performance-based test. Participants consisted of 64 adults with AD/HD who completed the Conner׳s Continuous Performance Test, Second Edition (CPT-II), Symptom Checklist-90-Revised (SCL-90-R), and the Brown Attention Deficit Disorder Scale (ADD Scale). Individuals with higher scores on the Obsessive-Compulsive Scale from the SCL-90-R made significantly more commission errors on the CPT-II; whereas other SCL-90-R scores did not demonstrate such a relationship. We did not find that SOCS were related to severity of AD/HD. These results supported the hypothesis that individuals with AD/HD with response inhibition difficulties tend to report more subclinical obsessive symptoms.