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Cited by 158Obsessive-Compulsive Spectrum DisordersAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychoanalysis and Psychopathology Research

A trans-diagnostic perspective on obsessive-compulsive disorder

Open access
Gillan, C. M., Fineberg, N. A., Robbins, T. W.·2017·Psychological Medicine
DOI 10.1017/s0033291716002786PMC PMC5964477
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Abstract

Progress in understanding the underlying neurobiology of obsessive-compulsive disorder (OCD) has stalled in part because of the considerable problem of heterogeneity within this diagnostic category, and homogeneity across other putatively discrete, diagnostic categories. As psychiatry begins to recognize the shortcomings of a purely symptom-based psychiatric nosology, new data-driven approaches have begun to be utilized with the goal of solving these problems: specifically, identifying trans-diagnostic aspects of clinical phenomenology based on their association with neurobiological processes. In this review, we describe key methodological approaches to understanding OCD from this perspective and highlight the candidate traits that have already been identified as a result of these early endeavours. We discuss how important inferences can be made from pre-existing case-control studies as well as showcasing newer methods that rely on large general population datasets to refine and validate psychiatric phenotypes. As exemplars, we take ‘compulsivity’ and ‘anxiety’, putatively trans-diagnostic symptom dimensions that are linked to well-defined neurobiological mechanisms, goal-directed learning and error-related negativity, respectively. We argue that the identification of biologically valid, more homogeneous, dimensions such as these provides renewed optimism for identifying reliable genetic contributions to OCD and other disorders, improving animal models and critically, provides a path towards a future of more targeted psychiatric treatments.

AI snapshot

Written from the paper’s full text.

TL;DR

This review argues that obsessive-compulsive disorder (OCD) is better understood through trans-diagnostic dimensions such as anxiety and compulsivity rather than DSM categories alone. It highlights enhanced error-related negativity (ERN) as an anxiety-linked marker and impaired goal-directed control as a compulsivity-linked marker, while noting mixed specificity and the need for longitudinal, trans-diagnostic validation.

Key findings

  • OCD is highly comorbid and heterogeneous: in 706 OCD patients, 87.3% met criteria for another DSM diagnosis; approximately 30% of schizophrenia cases report obsessive-compulsive symptomatology and 14% have OCD; about three quarters of an epidemiological OCD sample experienced an anxiety or affective disorder.
  • Enhanced ERN is associated with anxiety-related disorders including OCD, generalized anxiety disorder, and social anxiety disorder, and less consistently with depression; decreased ERN is seen in schizophrenia, bipolar disorder, autism spectrum disorders, and addiction, while ADHD results are mixed. ERN remains enhanced after successful treatment and in unaffected first-degree relatives, suggesting a possible endophenotype.
  • Goal-directed control deficits are found in OCD and other compulsive/impulsive conditions such as addiction, eating disorders, and Tourette syndrome, but also in schizophrenia, autism spectrum disorder, and social anxiety disorder. In a general population sample of just under 2000 subjects, a data-driven “Compulsive Behaviour and Intrusive Thought” factor predicted goal-directed deficits better than any DSM-inspired questionnaire and was dissociable from “Anxious-Depression” and “Social Withdrawal.”
  • Treatment prediction data include OFC grey-matter volume predicting SRI response in OCD with 77% sensitivity and 81% specificity, and a meta-analytic number needed to treat of 6–12 for SSRIs versus placebo. The review states that the trans-diagnostic approach has not yet facilitated gene discovery or development of new, better treatments.

Methods

  • Narrative review synthesizing existing case-control and general population studies within an RDoC-style trans-diagnostic framework; no new primary data are reported.
  • Evidence includes tables summarizing ERN studies across psychiatric disorders and goal-directed learning studies; one cited general population study recruited just under 2000 online subjects and used self-report questionnaires plus a web-based model-based learning task.
  • Main analysis is qualitative synthesis and discussion of specificity and generalizability; no meta-analysis or formal pooled effect sizes are reported.

Limitations

  • Stated in the paper: the trans-diagnostic approach has yet to facilitate gene discovery or better treatments; dismissing symptom-based approaches entirely is premature; longitudinal designs are needed; case-control designs cannot easily disentangle genuine lack of mechanistic specificity from DSM measurement error or comorbidity; publication bias and small samples/power are obstacles.
  • Stated in the paper: “anxiety” is intended as a placeholder until direct comparisons across disorders and discrete symptom dimensions are complete; many candidate dimensions await empirical validation or rejection.
  • Evident from the text: many cited findings are mixed or unreplicated (e.g., ERN in depression and ADHD; goal-directed deficits in social anxiety, schizophrenia, and autism), and some treatment-prediction evidence comes from very small samples, such as only 10 patients returning at post-treatment assessment.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1017/s0033291716002786

Cites

206 of 206 references verified0 citation errors · 0 not checkable

Statistics

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Claims the paper makes

0 of 125 cited sources checked · 0 supported · 0 flagged

  • Premisecitation

    Co-morbidity is present in the majority of OCD cases even after careful attempts at differential diagnosis.

    “Even after careful attempts at differential diagnosis of OCD, co-morbidity is present in the majority of cases (Ruscio et al. 2010).”
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    • cites Ruscio et al. 2010

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  • Premisecitation

    Approximately three quarters of individuals with OCD in an epidemiological sample experienced either an anxiety disorder or an affective disorder.

    “Approximately three quarters of individuals with OCD in an epidemiological sample experienced either an anxiety disorder or an affective disorder (Fineberg et al. 2013a).”
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    • cites Fineberg et al. 2013a

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  • Premisecitation

    Progress in understanding the neurobiology of OCD has stalled in part because of heterogeneity within the OCD diagnostic category and homogeneity across other putatively discrete diagnostic categories.

    “Progress in understanding the underlying neurobiology of obsessive-compulsive disorder (OCD) has stalled in part because of the considerable problem of heterogeneity within this diagnostic category, and homogeneity across other putatively discrete, diagnostic categories.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Hyman, 2007

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    • cites Sanislow et al. 2010

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  • Premisecitation

    In OCD, there is a mosaic of diverse phenomenological manifestations.

    “In the case of OCD, there is a mosaic of diverse phenomenological manifestations (Torres, 2016).”
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    • cites Torres, 2016

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  • Interpretationnone given

    The noisy response to treatment in OCD is likely due to mechanistic heterogeneity within the OCD population that cannot easily be identified by analysing symptoms alone.

    “The noisy response to treatment that remains to be bridged is likely to be a result of mechanistic heterogeneity within the OCD population that we cannot easily identify by analysing symptoms alone.”
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  • May combine two claims. 26
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    Premisecitation

    Symptoms of OCD are not unique to OCD; DSM-5 outlines 14 other disorders or disorder classes whose symptoms broadly fit the criteria.

    “DSM-5 acknowledges that these symptoms are not unique to OCD; outlining 14 other disorders (or disorder classes) whose symptoms also broadly fit these criteria, which the clinician must consider in the context of differential diagnosis.”
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    • cites APA, 2013

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    Premisecitation

    OCD is a chronic, costly and disabling brain disorder for which existing treatments usually produce disappointing outcomes.

    “Obsessive-compulsive disorder (OCD), is a chronic, costly and disabling brain disorder for which existing treatments usually produce disappointing outcomes (Fineberg et al. 2014).”
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    • cites Fineberg et al. 2014

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    Premisecitation

    Shortcomings in the use of DSM categories for basic research are at least partly responsible for the lack of specific and robust associations between psychopathology and underlying neurobiological processes.

    “it has been suggested that shortcomings in the use of these categories for basic research are at least partly responsible for the lack of specific and robust associations between psychopathology and underlying neurobiological processes (Hyman, 2007; Sanislow et al. 2010).”
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    Interpretationreasoning

    Improved nosology based on more objective tests and criteria would lead to more homogeneous patient populations for clinical trials, more accurate phenotypes for psychiatric genetics, and potential for detection of early vulnerability allowing early therapeutic interventions.

    “In a wider context, improved nosology based on more objective tests and criteria would lead to more homogeneous populations of patients for clinical trials, more accurate phenotypes for psychiatric genetics, and the potential for detection of early vulnerability, allowing for early therapeutic interventions that prevent progression to chronic illness.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given

    The problem of homogeneity across diagnostic categories is coupled with a related problem of heterogeneity within diagnostic categories.

    “The issue of homogeneity across diagnostic categories is coupled with a related problem, heterogeneity within diagnostic categories.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The ERN is typically measured using EEG, and functional imaging has confirmed its source in the anterior cingulate cortex.

    “It is typically measured using electroencephalogram, but functional imaging has been coupled with this technique to confirm that the ERN has its source in the anterior cingulate cortex (ACC) (Debener et al. 2005).”
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    • cites Debener et al. 2005

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    Interpretationreasoning

    OCD and other disorders are not discrete entities, and the lines between different DSM diagnoses are often blurred.

    “These findings indicate quite clearly that these and other disorders are not discrete entities, and that the lines between different DSM diagnoses are often blurred (Fig. 1).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationreasoning

    The specificity of any neurocognitive model of a psychiatric diagnosis is fundamentally limited by the extent to which that diagnosis is biologically valid.

    “What we will consider in the following sections is an admittedly well-trodden alternative: that it is our psychiatric taxonomy, not our neurocognitive models, that presents a problem for research and that the specificity of any neurocognitive model of a psychiatric diagnosis is fundamentally limited by the extent to which that diagnosis is biologically valid.”
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    Premisecitation

    Some researchers have called for a shift away from DSM categories in favour of establishing new biologically relevant trans-diagnostic traits that may play an important role in multiple disorders.

    “In response, some researchers have called for a shift away from the use of DSM categories, in favour of establishing new and biologically relevant trans-diagnostic traits that may play an important role in multiple disorders, as we currently define them (Robbins et al. 2012; Cuthbert & Kozak, 2013).”
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    • cites Cuthbert & Kozak, 2013

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    Premisecitation

    Agoraphobia and GAD are associated with increased OCD severity; bipolar disorder is associated with suicidal acts; panic disorder increases treatment-seeking behaviour.

    “For example, agoraphobia and GAD were associated with increased OCD severity; bipolar disorder was associated with suicidal acts and panic disorder increased treatment-seeking behaviour (Fineberg et al. 2013a).”
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    • cites Fineberg et al. 2013a

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The ERN is a negative deflection of the event-related potential when subjects make an error, listed as the RDoC sub-construct 'Performance Monitoring'.

    “The ERN is a negative deflection of the event-related potential (ERP) when subjects make an error (Falkenstein et al. 1991), listed as the RDoC sub-construct ‘Performance Monitoring’.”
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    • cites Falkenstein et al. 1991

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    Premisecitation

    NIMH launched the RDoC initiative, a framework based on the premise that clinical constructs should be defined and investigated on the basis of their neurobiological validity.

    “The National Institute of Mental Health (NIMH) has been an important leader in this regard, launching its Research Domain Criteria (RDoC) initiative (Insel et al. 2010), a framework based on the premise that clinical constructs should be defined (and therefore investigated) on the basis of their neurobiological validity.”
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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    In DSM-5, hoarding symptoms no longer exclusively contribute to a diagnosis of OCD and are additionally captured by a separate category, hoarding disorder.

    “This particularly impactful finding has provoked a change in DSM-5, such that hoarding symptoms no longer exclusively contribute to a diagnosis of OCD, and are additionally captured by a separate category, ‘hoarding disorder’.”
    Quote in the paperNot a substantial claim

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    Premisecitation

    The ERN primes defensive responses, for example by potentiating startle responses and encouraging avoidance behaviour.

    “studies have shown that the ERN primes defensive responses, for example by potentiating startle responses (Hajcak & Foti, 2008) and encouraging avoidance behaviour (Frank et al. 2005).”
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    • cites Hajcak & Foti, 2008

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    Premisecitation

    Enhanced ERN is also found in GAD, social anxiety disorder, and depression, although less consistently than in GAD or OCD.

    “GAD (Ladouceur et al. 2006; Weinberg et al. 2012, 2015, 2010) (but see Xiao et al. 2011), social anxiety disorder (Endrass et al. 2014) and depression (Chiu & Deldin, 2007; Holmes & Pizzagalli, 2008, 2010; Georgiadi et al. 2011; Aarts et al. 2013; Tang et al. 2013; Mueller et al. 2015) (although less consistently than in generalized anxiety or OCD, see Ruchsow et al. 2004, 2006; Olvet et al. 2010;”
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    Premisecitation

    The ERN effect appears trait rather than state dependent; it remains enhanced after successful treatment in adult and paediatric OCD, does not differ with chronic medication, and is enhanced in unaffected first-degree relatives of OCD sufferers.

    “The effect appears to be trait (rather than state) dependent; the ERN remains enhanced following successful treatment in both adult and paediatric OCD (Hajcak et al. 2008; Riesel et al. 2015), does not differ as a result of chronic medication (Stern et al. 2010) and an enhanced ERN has been observed in unaffected first-degree relatives of both adult and paediatric OCD sufferers (Riesel et al. 2011”
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    • cites Hajcak et al. 2008

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    Premisecitation

    In non-clinical samples, ERN magnitude is associated with self-reported worry, high trait anxiety, and OC-symptoms.

    “This thesis is supported by work in non-clinical samples, wherein the magnitude of the ERN is associated with self-reported worry (Hajcak et al. 2003; Zambrano-Vazquez & Allen, 2014), high levels of trait anxiety (Paulus et al. 2004) and OC-symptoms (Hajcak & Simons, 2002; Zambrano-Vazquez & Allen, 2014).”
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    • cites Hajcak et al. 2003

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    • cites Hajcak & Simons, 2002

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    Premisecitation

    These disorders include addiction, eating disorders, and Tourette's syndrome.

    “These disorders include addiction (Everitt & Robbins, 2005), eating disorders (Godier & Park, 2014) and Tourette's syndrome (Groenewegen et al. 2003), and although this area of research is still in its infancy, the first empirical investigations have found evidence for goal-directed deficits in these disorders (Sjoerds et al. 2013; Voon et al. 2014; Delorme et al. 2015; Ersche et al. 2016) (Table”
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    Interpretationcitation

    Clinically, these habits might manifest as compulsive behaviours and/or higher-order habitual needs or goals.

    “Clinically, these habits might manifest as compulsive behaviours and/or higher-order habitual needs or goals (Cushman & Morris, 2015).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Cushman & Morris, 2015

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    Premisecitation

    ERN amplitude predicts treatment adherence for substance abuse, and decreases in ERN are associated with self-reported impulsivity.

    “Moreover, the amplitude of the ERN was found to predict treatment adherence for substance abuse (Steele et al. 2014) and decreases in the ERN are associated with self-reported impulsivity (Potts et al. 2006).”
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    • cites Steele et al. 2014

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    Premisecitation

    Goal-directed control has been suggested to play a role in a range of disorders clinically characterized by repetitive behaviours that persist despite negative events or are experienced as 'out of control'.

    “Addressing the trans-diagnostic potential of this neurocognitive mechanism, goal-directed control has been suggested to play a role in a range of disorders that are clinically characterized by repetitive behaviours that persist despite negative events, or are experienced as ‘out of control’ (Gillan et al. 2016a).”
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    • cites Gillan et al. 2016a

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    Premisecitation

    Results in ADHD are mixed, with some studies showing decreased ERN, most reporting no differences, and only one study reporting an increase.

    “Results in ADHD are mixed with some studies showing decreased ERN (Liotti et al. 2005; van Meel et al. 2007; Groen et al. 2008; Herrmann et al. 2010; Groom et al. 2013), but most reporting no differences (Wiersema et al. 2005, 2009; Groen et al. 2008; Wild-Wall et al. 2009; Zhang et al. 2009; Groom et al. 2010; Sokhadze et al. 2012) and only one study reporting an increase (Burgio-Murphy et al. 20”
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    • cites Liotti et al. 2005

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    • cites Burgio-Murphy et al. 2007

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    Premisecitation

    Compulsive behaviours in OCD are stimulus-evoked, goal-insensitive habits, not goal-directed responses to anxiety/perceived threat.

    “such that compulsive behaviours in OCD are not goal-directed responses to anxiety/perceived threat, but are in fact stimulus-evoked, goal-insensitive habits (Dickinson, 1985).”
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    Interpretationreasoning

    These data provide convergent evidence that enhancement of the ERN is not ubiquitous in psychiatry, but appears directionally specific to disorders characterized predominantly by anxiety.

    “Together, these data provide convergent evidence that an enhancement of the ERN is not ubiquitous in psychiatry, but rather appears to be directionally specific to disorders characterized predominantly by anxiety.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    OCD rates are higher in the social anxiety population.

    “Indeed, like most disorders, OCD rates are higher in the social anxiety population (Grant et al. 2005).”
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    • cites Grant et al. 2005

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    Premisecitation

    Studies have recently shown similar deficits in goal-directed control in schizophrenia, autism spectrum disorder, and social anxiety disorder, which is not considered clinically a 'compulsive' disorder.

    “However, studies have recently been published showing similar deficits in goal-directed control in schizophrenia (Morris et al. 2015), autism spectrum disorder (Alvares et al. 2016), and most problematically, social anxiety disorder (Alvares et al. 2014, 2016), which is not considered clinically to be a ‘compulsive’ disorder (Table 2).”
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    Interpretationcitation

    In an appropriately powered general population sample, a neurocognitive model can be tested for both generalizability and specificity, leading to a data-driven definition of a neurobiologically validated clinical phenotype.

    “This approach showcases how in an appropriately powered general population sample, a neurocognitive model can be tested for both generalizability and specificity, leading to a data-driven definition of a neurobiologically validated clinical phenotype.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Gillan et al. 2016b

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    Premisecitation

    In Gillan et al. 2016b, the relationship between 'Compulsive Behaviour and Intrusive Thought' and goal-directed deficits was specific and dissociable from non-compulsive trans-diagnostic phenotypes ('Anxious-Depression' and 'Social Withdrawal'), which showed no relation to goal-directed deficits.

    “the relationship exhibits excellent specificity with respect to ‘non-compulsive’ aspects of psychopathology, i.e. Factor 1 (‘Anxious Depression’) and Factor 3 (‘Social Withdrawal’).”
    • Also stated in: § Validating a trans-diagnostic mechanism: goal-directed learning and compulsivity · plain
      “this relationship was dissociable from other trans-diagnostic phenotypes identified in this study, ‘Anxious-Depression’ and ‘Social Withdrawal’ (which showed no relation to goal-directed deficits)”
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    Interpretationnone given

    To date, the trans-diagnostic approach has yet to facilitate gene discovery or the development of new, better treatments.

    “to date this approach has yet to facilitate gene discovery or the development of new, better treatments.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    It is unclear how an ERN measurement can help inform treatment response across disorders.

    “Thus, the question of how an ERN measurement can help inform treatment response across disorders is far from clear.”
    Quote in the paperSubstantial claim

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    Interpretationcitation

    If the 77% sensitivity and 81% specificity figures hold up to replication, using this marker to determine SRI prescription would mean two out of every 10 people assigned to SSRI would not respond, while another two of the 10 not assigned treatment would have missed out on benefits.

    “If these figures hold up to replication using the same analysis pipeline, the interpretation is that if this marker were used to determine whether or not an SRI is prescribed to a drug-naive individual, just two out of every 10 people assigned to SSRI would not respond, while another two of the 10 not assigned the treatment would have missed out on the benefits of the SSRI (Hoexter et al. 2015).”
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    Premisecitation

    GAD does not respond to antipsychotics.

    “GAD does not respond to antipsychotics (Ravindran & Stein, 2010).”
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    Premisenone given

    Antipsychotics can be useful for OCD in particularly treatment resistant cases.

    “Although antipsychotics can be useful for OCD in particularly treatment resistant cases”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Antipsychotics can be useful for OCD in particularly treatment resistant cases.

  • May combine two claims.

    Interpretationcitation

    The same drug (paroxetine) is effective in treating distinct psychiatric problems, and its efficacy at treating depression and OCD symptoms is predicted by dissociable patterns of abnormal baseline neural activity.

    “This means that not only is the same drug effective in treating distinct psychiatric problems, its efficacy at treating depression and OCD symptoms (sometimes in the same individual) is predicted by dissociable patterns of abnormal baseline neural activity.”
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    • cites Saxena et al. 2003

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    Interpretationreasoning

    Breaking OCD down into orthogonal trans-diagnostic mechanisms may be of benefit for developing translational models, particularly for animal models.

    “breaking OCD down into orthogonal trans-diagnostic mechanisms may be of benefit for developing translational models – particularly for animal models that are crucial for causal mechanistic investigations.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

    Interpretationnone given

    This research initiative has just begun for OCD, and many candidate dimensions await empirical validation or rejection.

    “This research initiative has just begun for OCD, and many candidate dimensions await empirical validation or rejection.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Avoidance compulsions, obsessions and anxiety are the defining clinical features of OCD according to DSM-5.

    “avoidance compulsions, obsessions and anxiety are the defining clinical features of OCD according to DSM-5 (APA, 2013).”
    Quote in the paperSubstantial claim0 of 1 sources checked
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  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    The symptom complex produced by avoidance compulsions, obsessions and anxiety is unlikely to be underpinned by one specific cognitive/neural mechanism.

    “As the symptom complex that this triad produces is unlikely to be underpinned by one specific cognitive/neural mechanism”
    Quote in the paperNot a substantial claim
38 of 38

  • The paper relies on this without support.

    Most patient studies do not have sufficient statistical power to control for confounding variables.

    “While these confounding variables could be controlled for statistically, most patient studies simply do not have the necessary power to do so.”

  • The paper relies on this without support.

    Difficulty in recruiting sufficient sample sizes for patient research is compounded by the increasing number of possibly confounding disorders defined by DSM in every new edition.

    “Indeed, the difficulty in recruiting sufficient sample sizes for research studies with patients is compounded by the increasing number of (possibly confounding) disorders defined by the DSM in every new edition.”

  • The paper relies on this without support.

    In psychiatry, symptoms cause the suffering.

    “In psychiatry, the symptoms cause the suffering and our focus should remain on understanding and reducing these symptoms, as the patient experiences them.”

  • The paper relies on this without support.

    Antidepressants paroxetine and mirtazapine have good efficacy for treating both OCD and GAD.

    “have good efficacy for treating both OCD and GAD.”

  • The paper relies on this without support.

    Antipsychotics can be useful for OCD in particularly treatment resistant cases.

    “Although antipsychotics can be useful for OCD in particularly treatment resistant cases”

  • The paper relies on this without support.

    GABA directly inhibits ACC functioning.

    “GABA (which is thought to directly inhibit ACC functioning)”

  • The paper relies on this without support.

    Individuals with a diagnosis of OCD are aetiologically and phenotypically heterogeneous.

    “Given that individuals with a diagnosis of OCD are aetiologically and phenotypically heterogeneous”
7 of 7

Claims other papers make about this one

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Cites

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Research works printed but not linked: 4

  1. Delorme, 2015, Goal-directed and habitual behaviour systems in Gilles de la Tourette syndrome, Movement Disorders, 30, S490
  2. Spielberger, 1983, Manual for the State-Trait Anxiety Inventory
  3. Logan, 1994, Inhibitory Processes in Attention, Memory and Language, 189
  4. 2013, Diagnostic and Statistical Manual of Mental Disorders

Cited by

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Authors
Gillan, C. M., Fineberg, N. A., & Robbins, T. W.
Affiliations
  • University of Cambridge (GB)
  • University of Hertfordshire (GB)
Corresponding author
Gillan, C. M.
ORCID
Venue
Psychological Medicine
Publisher
Cambridge University Press (CUP)
Published
2017-03-27
Volume
47
Issue
9
Pages
1528-1548
ISSN
  • 0033-2917 (ISSN-L)
  • 1469-8978
DOI
10.1017/s0033291716002786
PMC
PMC5964477
OpenAlex
W2599804294
Semantic Scholar
dfa24d0ad37e36c1be754ed502b8876afa4c7425
Cited by
158
References
206
Citations by year
2026: 11 · 2025: 12 · 2024: 12 · 2023: 20 · 2022: 17 · 2021: 37 · 2020: 16 · 2019: 22 · 2018: 10 · 2017: 1
FWCI
2.05
Type
journal article
Language
en
Open access
Licence
Locations
  • Psychological Medicine (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • University of Hertfordshire Research Archive (University of Hertfordshire) (submittedVersion)
Funders
  • Bristol-Myers Squibb
  • Eli Lilly and Company
  • AstraZeneca
  • Teva Pharmaceutical Industries
  • Wellcome Trust (106431/Z/14/Z, 101521, 104631/Z/14/Z, 101521/Z/12/Z)
  • National Institute for Health and Care Research
  • Shire
  • European College of Neuropsychopharmacology
  • Servier
  • H. Lundbeck A/S
  • National Institutes of Health
  • Medical Research Council
  • National Institute of Mental Health
Topics
  • Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
Keywords
obsessive-compulsive disorder, psychiatric classification, compulsivity, anxiety, goal-directed learning, error-related negativity, psychiatric phenotypes, clinical heterogeneity
MeSH terms
Humans, Obsessive-Compulsive Disorder

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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