A Multidimensional Model of Obsessive-Compulsive Disorder

David Mataix-Cols, Maria Conceição do Rosario-Campos, James F. Leckman
2005 American Journal of Psychiatry  
Objective: Obsessive-compulsive disorder (OCD) is a clinically heterogeneous condition. This heterogeneity can reduce the power and obscure the findings from natural history studies to genome scans, neuroimaging, and clinical trials. The authors review the evidence supporting a multidimensional model of OCD. Method: Computerized and manual literature searches were performed to identify factor-analytic studies of obsessivecompulsive symptoms before data from disciplines that bear on the
more » ... ear on the potential usefulness of these dimensions were considered. Selection criteria included the novelty and importance of studies and their relevance to outcomes of interest to wellinformed mental health professionals. Results: Twelve factor-analytic studies involving more than 2,000 patients were identified that consistently extracted at least four symptom dimensions: symmetry/ordering, hoarding, contamination/ cleaning, and obsessions/checking. These dimensions were associated with distinct patterns of comorbidity, genetic transmission, neural substrates, and treatment response. The evidence supporting the hoarding dimension is particularly robust. Conclusions: The complex clinical presentation of OCD can be summarized with a few consistent, temporally stable symptom dimensions. These can be understood as a spectrum of potentially overlapping syndromes that may 1) coexist in any patient, 2) be continuous with normal obsessive-compulsive phenomena, and 3) extend beyond the traditional nosological boundaries of OCD. Although the dimensional structure of obsessivecompulsive symptoms is imperfect, this quantitative approach to phenotypic traits has the potential to advance our understanding of OCD and may aid in the identification of more robust endophenotypes. The need for a dimensional rating scale and suggestions for future research aimed at reducing the burden of this disorder are discussed. (Am J Psychiatry 2005; 162:228-238)
doi:10.1176/appi.ajp.162.2.228 pmid:15677583 fatcat:kl4fwj5gurdizeonailyi2g3pu