Meta-analysis of the symptom structure of obsessive–compulsive disorder
Open accessAbstract
OBJECTIVE: OCD is a clinically heterogeneous condition. This heterogeneity has the potential to reduce power in genetic, neuroimaging, and clinical trials. Despite a mounting number of studies, there remains debate regarding the exact factor structure of OCD symptoms. The authors conducted a meta-analysis to determine the factor structure of the Yale-Brown Obsessive Compulsive Scale Symptom Checklist. METHOD: Studies were included if they involved subjects with OCD and included an exploratory factor analysis of the 13 Yale-Brown Obsessive Compulsive Scale Symptom Checklist categories or the items therein. A varimax-rotation was conducted in SAS 9.1 using the PROC FACTOR CORR to extract factors from sample-size weighted co-occurrence matrices. Stratified meta-analysis was conducted to determine the factor structure of OCD in studies involving children and adults separately. RESULTS: Twenty-one studies involving 5,124 participants were included. The four factors generated were 1) symmetry: symmetry obsessions and repeating, ordering, and counting compulsions; 2) forbidden thoughts: aggression, sexual, religious, and somatic obsessions and checking compulsions, 3) cleaning: cleaning and contamination, and 4) hoarding: hoarding obsessions and compulsions. Factor analysis of studies including adults yielded an identical factor structure compared to the overall meta-analysis. Factor analysis of child-only studies differed in that checking loaded highest on the symmetry factor and somatic obsessions, on the cleaning factor. CONCLUSIONS: A four-factor structure explained a large proportion of the heterogeneity in the clinical symptoms of OCD. Further item-level factor analyses are needed to determine the appropriate placement of miscellaneous somatic and checking OCD symptoms.
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OCD is best conceptualized as a dimensional disorder with at least five consistently identified symptom dimensions.
“Given the wide variation in the presentation of OCD, there is increasing evidence that it may be best conceptualized as a dimensional disorder and the following symptom dimensions have been most consistently identified: (a) contamination obsessions with cleaning/washing rituals, (b) doubts about harm with checking/reassurance seeking rituals, (c) obsessions relating to a need for symmetry, exactn”
From An update on the efficacy of psychological treatments for obsessive-compulsive disorder in adults (2013) · cites this paper as Bloch et al., 2008
The Discussion supports a dimensional approach, but identifies a fairly robust four-factor structure—not at least five consistently identified dimensions. It recommends specifying those four dimensions: symmetry, forbidden thoughts, cleaning, and hoarding. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredHoarding consistently appears as a separate factor in many factor analytic studies.
“Hoarding consistently appears as a separate factor in many factor analytic studies and represents a possible source of variability in results.”
From The profile of executive function in OCD hoarders and hoarding disorder (2014) · cites this paper as Bloch et al., 2008
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- Authors
- Bloch, M. H., Landeros-Weisenberger, A., Rosario, M. C., Pittenger, C., & Leckman, J. F.
- Affiliations
- Yale University (US)
- Venue
- American Journal of Psychiatry
- Published
- 2008-12
- Volume
- 165
- Issue
- 12
- Pages
- 1532-1542
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- PMC
- PMC3972003
- OpenAlex
- W2113728266
- Cited by
- 681
- References
- 42
- Citations by year
- 2026: 32 · 2025: 35 · 2024: 27 · 2023: 38 · 2022: 47 · 2021: 37 · 2020: 34 · 2019: 37 · 2018: 44 · 2017: 50 · 2016: 30 · 2015: 41 · 2014: 36 · 2013: 48 · 2012: 40
- FWCI
- 6.02
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, other-oa)
- Funders
- National Institute of Mental Health (K05MH076273, K23MH091240, T32MH018268)
- 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, symptom structure, factor structure, hoarding, checking compulsions
- MeSH terms
- Factor Analysis, Statistical, Humans, Obsessive-Compulsive Disorder, Surveys and Questionnaires, Severity of Illness Index, International Classification of Diseases, Diagnostic and Statistical Manual of Mental Disorders
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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.
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