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

Published online by Cambridge University Press:  06 March 2020

Ivar Snorrason ,
Courtney Beard ,
Andrew D. Peckham  and
Thröstur Björgvinsson
Ivar Snorrason*
Affiliation:
McLean Hospital, Belmont, Massachusetts, USA Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
Courtney Beard
Affiliation:
McLean Hospital, Belmont, Massachusetts, USA Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
Andrew D. Peckham
Affiliation:
McLean Hospital, Belmont, Massachusetts, USA Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
Thröstur Björgvinsson
Affiliation:
McLean Hospital, Belmont, Massachusetts, USA Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
*
Author for correspondence: Ivar Snorrason, E-mail: [email protected]
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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.

Keywords

AddictiongroomingHiTOPinternalizingobsessive-compulsive spectrumstructure
Type
Original Article
Information
Psychological Medicine , Volume 51 , Issue 10 , July 2021 , pp. 1657 - 1665
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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