Transdiagnostic dimensions in obsessive-compulsive and related disorders: associations with internalizing and externalizing symptoms

Abstract

Background Hierarchical structural models of psychopathology rarely extend to obsessive-compulsive spectrum disorders. The current study sought to examine the higher-order structure of the obsessive-compulsive and related disorders (OCRDs) in DSM-5: obsessive-compulsive disorder (OCD), hoarding disorder (HD), body dysmorphic disorder (BDD), trichotillomania (hair-pulling disorder; HPD) and excoriation (skin-picking) disorder (SPD). Methods Adult patients in a partial hospital program (N = 532) completed a dimensional measure of the five OCRDs. We used confirmatory factor analysis to identify the optimal model of the comorbidity structure. We then examined the associations between the transdiagnostic factors and internalizing and externalizing symptoms (i.e. depression, generalized anxiety, neuroticism, and drug/alcohol cravings). Results The best fitting model included two correlated higher-order factors: an obsessions-compulsions (OC) factor (OCD, BDD, and HD), and a body-focused repetitive behavior (BFRB) factor (HPD and SPD). The OC factor, not the BFRB factor, had unique associations with internalizing symptoms (standardized effects = 0.42–0.66) and the BFRB factor, not the OC factor, had small marginally significant unique association with drug/alcohol cravings (standardized effect = 0.22, p = 0.088). Conclusions The results mirror findings from twin research and indicate that OCD, BDD, and HD share liability that is significantly associated with internalizing symptoms, but this liability may be relatively less important for BFRBs. Further research is needed to better examine the associations between BFRBs and addictive disorders.

Personality traits and their clinical associations in trichotillomania and skin picking disorder

“…Having shown the large effect size association with neuroticism, the question remain as to what exactly is the relationship between neuroticism and these disorders? Research meta-analysis has shown that neuroticism seems to be a trait associated with multiple psychiatric disorders (albeit stronger in some than others, see [27,28]), with the effect size seen here on par with that reported in mood and anxiety disorders and higher than that reported in substance use disorders [29]. The lack of specificity of neuroticism to BFRBs suggest that perhaps this personality trait is a vulnerability marker to many disorders, to varying degrees, including BFRBs.…”

Higher order compulsivity versus grooming dimensions as treatment targets for the DSM‐5 obsessive–compulsive and related disorders

“…We used a maximum likelihood estimator with robust standard errors. We first determined the higher order structure of the pretreatment symptom scores by comparing CFA models based on prior research (see preregistration document and Snorrason et al, 2020). Five models were tested: a single‐factor model, a two‐factor model (compulsivity/distress and grooming), a three‐factor model (compulsivity, distress, and grooming), and versions of the two‐ and three‐factor models where BDD was allowed to cross‐load on distress and compulsivity (these latter models were tested because appearance‐related skin picking is common among BDD patients).…”

“…Existing structural research also indicates that HPD and SPD separate from the other OCRDs. A recent study among psychiatric patients (Snorrason et al, 2020) identified two correlated factors underlying OCRD symptoms: a compulsivity factor that included OCD, BDD, and HD, and a grooming factor that included HPD and SPD (see also Maraz et al, 2017). Similarly, a community twin study (Monzani et al, 2014) found two heritable factors underlying the OCRDs, one factor associated with all five disorders and another factor associated only with HPD and SPD.…”

“…The sample was comprised of adult patients receiving intensive/residential treatment in a specialty clinic for OCRDs. We first determined the optimal comorbidity structure of OCRDs by comparing several confirmatory factor analysis (CFA) models based on prior research (Snorrason et al, 2020). We expected that the best‐fitting model would include correlated compulsivity (OCD, BDD, HD) and grooming (HPD, SPD) factors, which would both be separable from a distress (depression and worry) factor.…”

The Five-Factor Model of Personality and the Structure of Psychopathology in Adolescence

“…In this regard, some studies have shown that eating disorder symptoms appear to be best grouped under the internalizing factor (Forbush et al, 2017), specifically under the distress subfactor (Mitchell, et al, 2014); and posttraumatic stress disorder is loaded on an anxious/misery subfactor (Cox, et al, 2002;Miller et al, 2008). Obsession-compulsion symptoms are usually included less in these factor models, but have shown significant associations with internalizing problems (Snorrason et al, 2020). Psychotic experiences appear to be aligned with a separate distinct factor according to various studies (de Jonge et al, 2018;Kotov et al, 2011;Wright, et al, 2013), whereas manic episodes and bipolar disorders have displayed comorbidity across both distress and thought disorder domains under the internalizing factor (Keyes et al, 2013).…”