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Obsessive-Compulsive Disorder Is Associated With Broad Impairments in Executive Function: A Meta-Analysis
Open accessAbstract
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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“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“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]
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“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
The cited source says what the claim attributes to it.
In the citing paper
“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]
The cited source says what the claim attributes to it.
In the citing paper
“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)
The cited source says what the claim attributes to it.
In the citing paper
“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
In the citing paper
“results remain inconsistent and heterogeneous”
From Neuropsychological Research in Obsessive-Compulsive Disorder: Current Status and Future Directions (2021) · cites this paper as [4]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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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Citations
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Cited by
Sorted by citations
Friedman, N. P., & Miyake, A. (2017) · Cortex · doi:10.1016/j.cortex.2016.04.023 · Cited by 1,834
The role of prefrontal cortex in cognitive control and executive function
Friedman, N. P., & Robbins, T. W. (2022) · Neuropsychopharmacology · doi:10.1038/s41386-021-01132-0 · Cited by 1,737
“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…”
Snyder, H. R., Miyake, A., & Hankin, B. L. (2015) · Frontiers in Psychology · doi:10.3389/fpsyg.2015.00328 · Cited by 946
“We are thankful to Snyder et al. (2015) for recently engaging in a much-needed comprehensive narrative review about the EF impairments in psychopathology.”
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A systematic review of sleep disturbance in anxiety and related disorders
Cox, R. C., & Olatunji, B. O. (2016) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2015.12.001 · Cited by 395
Metadata
- 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
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