Is it time to change the gold standard of obsessive-compulsive disorder severity assessment? Factor structure of the Yale-Brown Obsessive-Compulsive Scale

Abstract

Objectives: The Yale-Brown Obsessive-Compulsive Scale has been considered the gold standard scale to assess obsessive-compulsive disorder severity. Previous studies using exploratory factor analysis and confirmatory factor analysis with this scale showed mixed findings in terms of factor structure and fit of models. Therefore, we used confirmatory factor analysis to compare different Yale-Brown Obsessive-Compulsive Scale models in a large sample aiming to identify the best model fit. Methods: We assessed adult obsessive-compulsive disorder patients ( n = 955) using three measures: Yale-Brown Obsessive-Compulsive Scale severity ratings, the Dimensional Yale-Brown Obsessive-Compulsive Scale and the clinical global impression scale. We tested all factor structures reported by previous studies to investigate which model best fitted the data: one-factor, two-factor, three-factor and their equivalent high-order solutions. We also investigated Yale-Brown Obsessive-Compulsive Scale items correlations with scores from the other measures of obsessive-compulsive disorder severity. Results: Confirmatory factor analysis models presented mediocre to fair goodness-of-fit indexes. Severity items related to resistance to obsessions and compulsions presented low factor loadings. The model with the best fit indexes was a high-order model without obsessive-compulsive disorder resistance items. These items also presented small correlations with other obsessive-compulsive disorder severity measures. Conclusion: The obsessive-compulsive disorder field needs to discuss further improvements in the Yale-Brown Obsessive-Compulsive Scale and/or continue to search for better measures of obsessive-compulsive disorder severity.

Factor structure of the Dimensional Yale-Brown Obsessive-Compulsive Scale in a large sample of adults with obsessive-compulsive disorder

“…More importantly, it was superior to the Y-BOCS in terms of goodness-of-fit. 12 This could be explained by the fact that the DY-BOCS does not have items that investigate resistance to OCD symptoms, since a previous study on the Y-BOCS found that these items presented the lowest factor loading and that removing them led to better goodness-of-fit indexes. 12 This interesting finding indicates that the DY-BOCS could be a useful alternative for adequate OCD severity measurement in research and clinical settings.…”

Knowledge and competency standards for specialized cognitive behavior therapy for adult obsessive-compulsive disorder

“…Further studies are needed to examine updated OCD measures (e.g., Fatori, et al 2020) as well as the specificity of standardized measures used to assess OCD (Huppert et al 2007;Huppert and Fradkin, 2016).…”

Measurement fidelity of clinical assessment methods in a global study on identifying reproducible brain signatures of obsessive–compulsive disorder.

“…The factor structure with a clear dichotomy of the obsessions and compulsions subscales fit well with the removal of two resistance items. The resistance and control items of the Y-BOCS are multidimensional (Anholt et al, 2010; Fatori et al, 2020; McKay et al, 1995; Kim et al, 2005) and some have recommended removal of resistance items to improve model fit because they do not correlate with overall severity or are better correlated with insight (Fatori et al, 2020). These basic conceptual issues regarding the dichotomy between obsessions and compulsions and the nature of control/resistance and how they contribute to the overall severity of OCD still need to be addressed.…”