Clarifying the Placement of Obsessive-Compulsive Disorder in the Empirical Structure of Psychopathology

Abstract

Recent work on the empirical structure of psychopathology has aimed to address some limitations that can arise from traditional categorical classification approaches. This research has focused on modeling patterns of co-occurrence among traditional diagnoses, uncovering a variety of well-validated dimensions (or spectra) of psychopathology, spanning common and uncommon mental disorders. A model integrating these empirically derived spectra (the Hierarchical Taxonomy of Psychopathology; HiTOP) has been proposed. However, the placement of obsessive-compulsive disorder (OCD) within this model remains unclear, as studies have variably found OCD to fit best as part of the Fear, Distress or Thought Disorder spectra. One reason for this may be the heterogeneity of symptoms experienced by individuals with OCD, which is lost when analysing categorical diagnoses. For example, different symptom clusters within OCD—such as washing and contamination versus obsessions and checking—may be differentially associated with different spectra in the HiTOP model. The aim of this study was to test this hypothesis. Data were collected in an anonymous online survey from community participants (n = 609), largely with elevated symptoms of mental illness, and analyzed in a factor analytic framework treating OCD as a unitary construct and as four separate symptom clusters. The results indicated that OCD and its constituent symptom clusters had significant loadings of varying strength on the Fear and Thought Disorder spectra. These findings suggest that OCD may be best characterized as cross-loading on both the Fear and Thought Disorder spectra, and highlight the importance of accounting for diagnostic heterogeneity in future research.

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Fig. 1
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Data Availability

Data are available upon request.

Notes

  1. 1.

    In total, 207 individuals were excluded from analysis. These participants did not differ in terms of sex (32.9% male, 65.7% female, 1.4% self-identified as other; χ2(2) = 2.21, p = .332) or age (mean 29.5 years, standard deviation = 15.14, range = 16–75; t(811) = −1.66, p = .097). Like the sample included for analysis, the most common education level was graduation from High School (n = 97, 47.1%), and the majority of excluded participants reported an Australian ethnic background (n = 152, 73.4%) and speaking English only at home (n = 176, 85.0%).

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Funding

This study did not receive direct funding. MKF’s work on the paper was supported by a Macquarie University Research Fellowship.

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Both authors contributed to the study conception and design. Data collection and analysis were performed by KF under the supervision of MKF. The first draft of the manuscript was written by KF, and MKF assisted in revising and preparing the manuscript for submission. Both authors read and approved the final manuscript.

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Correspondence to Miriam K. Forbes.

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MKF is a member of the Executive (Workgroup Chair) of the Hierarchical Taxonomy of Psychopathology Consortium.

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The questionnaire and methodology for this study was approved by the Macquarie University Human Research Ethics Committee (5201951338311), and was performed in accordance with the ethics standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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All participants provided written informed consent.

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Faure, K., Forbes, M.K. Clarifying the Placement of Obsessive-Compulsive Disorder in the Empirical Structure of Psychopathology. J Psychopathol Behav Assess (2021). https://doi.org/10.1007/s10862-021-09868-1

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Keywords

  • Obsessive-compulsive disorder
  • OCD symptom-clusters
  • Hierarchical taxonomy of psychopathology
  • HiTOP
  • Nosology
  • Mental illness