Subtyping obsessive-compulsive disorder: A taxometric analysis

doi:10.1016/S0005-7894(05)80120-0

Behavior Therapy

Volume 36, Issue 4, Autumn 2005, Pages 381-391

https://doi.org/10.1016/S0005-7894(05)80120-0 Get rights and content

Abstract

Obsessive-compulsive disorder (OCD) is a heterogeneous condition comprising multiple symptoms. Researchers have identified OCD subtypes using a range of symptom-based research methods, including factor and cluster analyses and examination of differential treatment response. These methods can be challenged on the grounds that they fail to demonstrate the existence of discrete taxonomic entities. Furthermore, no study has examined subtyping on the basis of cognitive characteristics. In the present study, the categorical vs. dimensional status of 6 possible subtypes of OCD was examined using taxometric methods. Three potential cognitive subtypes (based on high levels of responsibility/threat estimation, perfectionism/certainty, and importance/control of thoughts) and 3 potential symptomatic subtypes (based on elevated levels of contamination obsessions and cleaning compulsions, checking, and obsessionality) were examined using the MAXEIG and MAMBAC procedures in a sample of 404 diagnosed cases of OCD. Findings favored dimensional models of the potential responsibility, perfectionism, checking, and contamination subtypes, but offered qualified support for taxonic models of the importance/control of thoughts and obsessional subtypes. Implications for the subclassification of OCD are discussed.

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Efforts to understand the constellation of symptoms in obsessive-compulsive disorder (OCD) have typically relied on models where latent variable(s) are assumed to underlie all symptoms. In contrast, a network approach does not assume that there are underlying latent variables and allows for the possibility that clusters of symptoms may mutually reinforce each other. We aimed to determine whether obsessions and compulsions formed a coherent and mutually reinforcing network of symptoms.
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Despite emerging evidence linking obsessive-compulsive disorder and symptoms (OCS) and nicotine dependence (ND), this comorbidity has received little research. To address this, the current investigation highlights evidence of this comorbidity in two epidemiologic datasets: (1) US nationally-representative survey (i.e., National Comorbidity Study-Replication; NCS-R), and (2) a psychiatric clinical epidemiology dataset (i.e., the Methods to Improve Diagnostic Assessment and Services; MIDAS). For NCS-R (n = 2088), interviews were carried as part of extensive data collection, including OCS symptom count and ND diagnosis. For MIDAS (n = 1257), as part of receiving mental health services at a US hospital outpatient treatment program, participants received diagnostic interviews, including evaluation of ND and obsessive-compulsive disorder (OCD), with OCS being characterized by self-reported symptom count. Results from NCS-R indicate that rates of current ND increased from 3.1% to 10.8% as OCS symptom count increased. Results from the MIDAS clinical sample exhibited a similar trend, but with higher overall figures compared to the US-representative NCS-R sample, with rates of current ND increasing from 18.3% to 41.4% as OCS count increased. In both datasets, OCS was positively associated with current (but not prior) ND after adjusting for psychiatric and sociodemographic covariates. For MIDAS, after adjusting for covariates, OCD diagnostic status was not associated with ND. Findings from this study lend support for the OCS-ND comorbidity in clinical and non-clinical populations and suggests that the OCS-ND link may be obscured when obsessive-compulsive phenomena is modeled as a dichotomous diagnostic variable versus as a dimensional construct.
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Research demonstrates that autogenous (AO) and reactive obsessions (RO) differ in obsessional content; however, no experimental research has examined differences in emotion generation and regulation. Characterizing this taxonomy with respect to emotion generation and regulation could refine conceptualizations of obsessionality and optimize clinical interventions.
Seventy undergraduates were randomly assigned to imagine a personally-relevant AO or RO. Subsequently, emotional reactivity was assessed. Participants then rated their emotion regulation efforts and the degree to which the intrusion violated their values.
Broadly aligning with expectations, bootstrapped linear regression models indicated that AOs led to a significant increase in self-conscious emotions (guilt, shame, and embarrassment), and these effects were stronger for those whose values were more severely threatened by the intrusion. A conditional process analysis revealed that the relationship between the AO condition and emotion regulation difficulties was explained by an increase in negative emotional reactivity, and the strength of this effect depended upon the degree of conflict with participants’ values.
The use of an analogue sample, and minimal emotional reactivity in the RO condition, threaten the ecological and external validity of the study.
The current study employed a novel experimental design demonstrating a meaningful relationship between AOs and both emotional activation and regulation. Results highlight the relevance of self-conscious emotions to the conceptualization of AOs and the utility of addressing them in the context of exposure therapy.
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Olfactory reference disorder (ORD), a newly included disorder in the ICD-11, is characterized by ‘pathological’ concerns about emitting body odor. While research is emerging on the construct, no study has directly examined the boundary between ORD and normal body odor concerns. That is, should ORD be considered as categorical in nature versus a more dimensional construct? As such, the current study explored the extent to which ORD symptoms correspond to a distinct category or dimension in a mixed university student and community sample (n = 757). Three indicators, derived from the Yale-Brown Obsessive Compulsive Scale Modified for Olfactory Reference Syndrome, were submitted to three independent taxometric procedures: MAMBAC, MAXEIG, and L-Mode. Two of three procedures showed that the latent structure of ORD is dimensional rather than categorical. The comparison curve fit index profile method yielded dimensional structure. Results suggested that researchers and clinical practitioners would be well-advised to conceptualize, assess, and treat ORD symptoms in a dimensional way.
What is at the core of OCD? A network analysis of selected obsessive-compulsive symptoms and beliefs
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Obsessive-compulsive disorder (OCD) is a heterogeneous condition that consists of distinct subtypes, and identification of its core symptoms may inform how to best conceptualize the heterogeneity. Accordingly, we used network analysis to evaluate which symptoms (and associations between symptoms) are most central to OCD symptoms and beliefs.
Participants consisted of a combined sample of adults with a primary diagnosis of OCD (N = 150), those with other primary diagnoses (N = 114), and an unselected nonclinical sample (N = 310). Network analysis was used to identify the most central symptoms (nodes) and associations between symptoms (edges) assessed by the Obsessive-Compulsive Inventory-Revised and the Obsessional Beliefs Questionnaire-44.
The most central symptoms in the network were negative appraisals of intrusive thoughts (i.e., Having intrusive thoughts means I'm out of control). Some of the strongest associations between symptoms were also observed for those pertaining to intrusive thoughts and their negative appraisal. Furthermore, central symptoms in the network predicted depression and anxiety (over and above peripheral symptoms) among those with a primary diagnosis of OCD, but not the severity of OCD symptoms.
The approach was exploratory rather than experimental and relied solely on self-report measures of OCD symptoms and beliefs.
Negative appraisals of intrusive thoughts were the most central symptoms in the OCD network, and they uniquely predict co-occurring symptoms of anxiety and depression, suggesting that these symptoms should be prioritized in theoretical and treatment models of OCD.
Contamination-fear in subclinical obsessive-compulsive disorder: A further proof for no preferential processing of disorder-related stimuli
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Citation Excerpt :
They base their conclusion on findings that OCD is rather a dimensional than a categorical phenomenon (i.e., individuals with OCD experience merely experience more frequent and intense symptoms and, thus, report more distress and impairment) and argue that a few studies even demonstrated OC symptoms in subclinical individuals and some degree of impairment and treatment seeking among them (Abramowitz et al., 2010; García-Soriano, Belloch, Morillo, & Clark, 2011; Watson & Wu, 2005). Also, taxometric studies (Haslam, Williams, Kyrios, McKay, & Taylor, 2005; Olatunji, Williams, Haslam, Abramowitz, & Tolin, 2008) found strong support for a dimensional latent structure. Other studies suggest that the contents of obsessions in clinical and non-clinical samples are similar (Julien, O'Connor, & Aardema, 2009; Rachman & Silva, 1978), and that the same is true for the type of compulsions (Flament et al., 1988; Henderson & Pollard, 1988).
How do individuals with obsessive-compulsive disorder (OCD) process and respond to images of rotten food or dirty toilets? In contrast to other fear-related disorders, evidence for attentional biases and preferential processing of disorder-related stimuli in samples of OCD is mixed. To address methodological problems of previous studies and to increase validity, we used two independent samples of participants with contamination fear and two sets of standardized stimuli in an established experimental paradigm. In two experiments, we compared evaluation and visual processing of contamination-fear related (CFr) stimulus material in individuals with high (HCF) and low (LCF) contamination fear. In experiment 1, we selected CFr stimuli from a database with disgust-related images (DIRTI). Even though the HCF group rated CFr images as being more unpleasant, arousing, and disgusting, we found no indicators of preferential processing (larger priming effects or faster responses). In experiment 2, we selected CFr stimuli from a database with images specifically chosen to evoke symptom-related anxiety in OCD patients (BOCD-PS). Again, negative evaluations of stimuli did not transfer into enhanced information processing. We conclude that early information processing of CFr stimuli is fundamentally different to that of fear-related stimuli in anxiety disorders; probably because of the triggered disgust response.

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Original researchSubtyping obsessive-compulsive disorder: A taxometric analysis

Abstract

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Psychiatric Clinics of North America

Clinical Psychology Review

Behaviour Research and Therapy

Behaviour Research and Therapy

Clinical Psychology Review

Behaviour Research and Therapy

Psychiatric Clinics of North America

Behaviour Research and Therapy

Behaviour Research and Therapy

Symptom presentation and outcome of cognitive-behavior therapy for obsessive-compulsive disorder

Journal of Consulting and Clinical Psychology

Long-term follow-up and predictors of clinical outcome in obsessivecompulsive patients treated with serotonin reuptake inhibitors and behavioral therapy

Journal of Clinical Psychiatry

Is depression taxonic, dimensional, or both?

Journal of Abnormal Psychology

Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV)

The robustness of taxometric analysis with skewed indicators: I. A Monte Carlo study of the MAMBAC procedure

Psychological Reports

Detecting latent taxa: Monte Carlo comparison of taxometric, admixture and clustering procedures

Psychological Reports

Structured Clinical Interview for DSM-IV-Patient Edition (SCID-I/P)

DSM-IV field trial: Obsessive-compulsive disorder

American Journal of Psychiatry

Cognitive approaches to obsessions and compulsions: Theory, assessment and treatment

Disentangling chronological age from age of onset in children and adolescents with obsessive-compulsive disorder

International Journal of Neuropsychopharmacology

Subtyping major depression: A taxometric analysis

Journal of Abnormal Psychology

Original research
Subtyping obsessive-compulsive disorder: A taxometric analysis