Obsessive-Compulsive Disorder Is Associated With Broad Impairments in Executive Function: A Meta-Analysis
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Obsessive-compulsive disorder (OCD) is a serious and often chronically disabling condition. The current dominant model of OCD focuses on abnormalities in prefrontal-striatal circuits that support executive function (EF). Although there is growing evidence for EF impairments associated with OCD, results have been inconsistent, which makes the nature and magnitude of these impairments controversial. The current meta-analysis uses random-effects models to synthesize 110 studies in which participants with OCD were compared with healthy control participants on at least one neuropsychological measure of EF. The results indicate that individuals with OCD are impaired on tasks measuring most aspects of EF, consistent with broad impairment in EF. EF deficits were not explained by general motor slowness or depression. Effect sizes were largely stable across variation in demographic and clinical characteristics of samples, although medication use, age, and gender moderated some effects.
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Patients with OCD show impairments in several cognitive domains, including executive functioning, inhibitory control, cognitive flexibility, planning, working memory, visuospatial memory, decision-making, and performance monitoring.
“Across clinical and experimental studies, patients with OCD have shown impairments in several cognitive domains, including executive functioning, inhibitory control, cognitive flexibility, planning, working memory, visuospatial memory, decision-making, and performance monitoring [1,2,3,4].”
From Electrophysiological Correlates of Cognitive Dysfunction in Obsessive-Compulsive Disorder (OCD): A Systematic and Mechanistic Review of EEG, ERP, and QEEG Evidence (2026) · cites this paper as [4]
The Results (page unavailable in our copy) report poorer performance in OCD groups on inhibition, shifting, planning, and working-memory tasks, including visuospatial working memory. The paper does not establish impairments in decision-making or performance monitoring, so it supports only part of the attributed list. (LLM, conf=0.88)
Experimental — accuracy not yet measuredMeta-analytic evidence suggests that OCD is associated with broad but generally small-to-moderate impairments across executive tasks, with especially consistent abnormalities in response inhibition, set-shifting, planning, and cognitive flexibility.
“Meta-analytic evidence suggests that OCD is associated with broad but generally small-to-moderate impairments across executive tasks, with especially consistent abnormalities in response inhibition, set-shifting, planning, and cognitive flexibility [1,3,4].”
From Electrophysiological Correlates of Cognitive Dysfunction in Obsessive-Compulsive Disorder (OCD): A Systematic and Mechanistic Review of EEG, ERP, and QEEG Evidence (2026) · cites this paper as [4]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredEF deficits across psychopathology cannot be easily explained by non-specific factors such as psychomotor slowing, differences in IQ or education, or medication use.
“First, these deficits cannot be easily explained by non-specific factors such as psychomotor slowing, differences in IQ or education, or medication use (e.g., Barch, 2005; Forbes et al., 2009; Snyder, 2013; Snyder et al., 2015).”
From Advancing understanding of executive function impairments and psychopathology: bridging the gap between clinical and cognitive approaches (2015) · cites this paper as Snyder et al., 2015
The Discussion (Evaluating Hypotheses; page unavailable) finds that general motor slowing cannot fully account for EF deficits in OCD. The Results (Sensitivity Analyses and Moderator Analyses; page unavailable) report that deficits largely persisted in IQ-matched samples and were not driven by medication use. The paper does not establish the education point, and its analyses concern OCD rather than psychopathology broadly. (LLM, conf=0.88)
Experimental — accuracy not yet measuredMeta-analyses suggest transdiagnostic associations of cognitive control deficits with psychiatric disorders, including major depressive disorder, post-traumatic stress disorder, obsessive-compulsive disorder, bipolar disorder, schizophrenia, ADHD, conduct disorder and antisocial personality disorder, and substance use disorders.
“Indeed, meta-analyses suggest transdiagnostic associations of CC deficits with psychiatric disorders, including major depressive disorder, post-traumatic stress disorder [187], obsessive-compulsive disorder [188], bipolar disorder [189], schizophrenia [190], ADHD [191, 192], conduct disorder and antisocial personality disorder [193], and substance use disorders [194].”
From The role of prefrontal cortex in cognitive control and executive function (2022) · cites this paper as [188]
Meta-analyses have found response inhibition impairments in OCD.
“meta‐analyses have found response inhibition impairments in OCD”
From Obsessive-compulsive disorder: Etiology, neuropathology, and cognitive dysfunction (2023) · cites this paper as Snyder et al., 2015
Executive functions are broadly impaired in patients suffering from OCD.
“Executive functions are broadly impaired in patients suffering from OCD [1, 2]”
From Error-Related Brain Potentials as Biomarkers of Pathology Severity and Treatment Resistance in Patients With Obsessive-Compulsive Disorder (2026) · cites this paper as [2]
Effect sizes 3 SD above or below the mean effect size (d = .50) were considered outliers and excluded, based on Snyder et al. (2015).
“Based on Snyder et al. (2015), effect sizes 3 SD above or below the mean effect size ( d = .50) were considered outliers and thus excluded.”
From Therapeutic games to reduce anxiety and depression in young people: A systematic review and exploratory meta‐analysis of their use and effectiveness. (2024) · cites this paper as Snyder et al. (2015)
EF deficits in obsessive compulsive disorder are not driven by co-occurring depression, as even those with low levels of depressive symptoms show the same level of EF deficits.
“Importantly, while depression frequently co-occurs with OCD, EF deficits in OCD are not driven by co-occurring depression, as even those with low levels of depressive symptoms show the same level of EF deficits (Snyder et al., 2015).”
From Advancing understanding of executive function impairments and psychopathology: bridging the gap between clinical and cognitive approaches (2015) · cites this paper as Snyder et al., 2015
Neuropsychological test results in OCD remain significantly heterogeneous and inconsistent across studies.
“results remain inconsistent and heterogeneous”
From Neuropsychological Research in Obsessive-Compulsive Disorder: Current Status and Future Directions (2021) · cites this paper as [4]
Across multiple cognitive domains, individuals with OCD show deficient test performance compared with non-clinical controls, with small to medium effect sizes.
“Despite some common findings across studies indicating deficient test performance across cognitive domains with small to medium effect sizes”
From Neuropsychological Research in Obsessive-Compulsive Disorder: Current Status and Future Directions (2021) · cites this paper as [4]
Moderator analyses examining demographic and clinical variables such as sex, age, education, age of onset, OCD symptom severity, medication, and comorbidities found no meaningful moderation effects on neuropsychological performance in OCD.
“moderator analyses examining multiple potential variables, including demographic (e.g., sex, age, education) and clinical variables (e.g., age of onset, OCD symptom-severity, medication, comorbidities) found no meaningful moderation effects (2, 4, 5)”
From Neuropsychological Research in Obsessive-Compulsive Disorder: Current Status and Future Directions (2021) · cites this paper as [4]
Despite previous research suggesting that neuropsychological performance may be related to symptom severity, severity has not emerged as a significant moderator of performance on meta-analyses.
“Despite previous research suggesting that neuropsychological performance may be related to symptom severity, severity has not emerged as a significant moderator of performance on meta-analyses (4, 5, 10)”
From Neuropsychological Research in Obsessive-Compulsive Disorder: Current Status and Future Directions (2021) · cites this paper as [4]
Working memory and planning appear impaired in OCD.
“working memory and planning appear to be impaired in OCD [121, 164]”
From Toward a neurocircuit-based taxonomy to guide treatment of obsessive-compulsive disorder (2021) · cites this paper as [164]
There is evidence for genuine motor slowing in tests of executive function in OCD patients.
“Although debated [41], there is evidence for genuine motor slowing in tests of executive function [42,43].”
From Projection-specific deficits in synaptic transmission in adult Sapap3-knockout mice (2020) · cites this paper as [42]
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- Authors
- Snyder, H. R., Kaiser, R. H., Warren, S. L., & Heller, W.
- Affiliations
- University of Denver (US)
- Harvard University (US)
- St. Louis VA Medical Center (US)
- University of Illinois Urbana-Champaign (US)
- Venue
- Clinical Psychological Science
- Publisher
- SAGE Publications
- Published
- 2014-07-18
- Volume
- 3
- Issue
- 2
- Pages
- 301-330
- ISSN
- 2167-7026 (ISSN-L)
- 2167-7034
- PMC
- PMC4351670
- OpenAlex
- W2141193081
- Semantic Scholar
- e18cda6c1faa197570b9d0ee4c1f40c027e4e1ca
- Cited by
- 325
- References
- 200
- Citations by year
- 2026: 23 · 2025: 29 · 2024: 23 · 2023: 30 · 2022: 29 · 2021: 45 · 2020: 34 · 2019: 28 · 2018: 31 · 2017: 24 · 2016: 16 · 2015: 13
- FWCI
- 20.85
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Psychological Science (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (P50MH079485, F32MH098481, R01MH061358, T32MH015442)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Keywords
- obsessive-compulsive disorder, executive function, neuropsychological deficits, depression, medication effects
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.
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.
What counts as a claim ›How we measure confidence ›How we check this ›
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