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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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References

Abramowitz, J. S., & Jacoby, R. J. (2015). Obsessive-compulsive and related disorders: A critical review of the new diagnostic class. Annual Review of Clinical Psychology, 11, 165–186. doi: 10.1146/annurev-clinpsy-032813-153713CrossRefGoogle ScholarPubMed
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author.Google Scholar
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.Google Scholar
Arbabi, M., Farnia, V., Balighi, K., Mohammadi, M., Nejati-Safa, A., Golestan, B., & Darvish, F. (2008). Efficacy of citalopram in treatment of pathological skin picking, a randomized double blind placebo controlled trial. Acta Medica Iranica, 46, 367–372.Google Scholar
Beard, C., & Björgvinsson, T. (2014). Beyond generalized anxiety disorder: Psychometric properties of the GAD-7 in a heterogeneous psychiatric sample. Journal of Anxiety Disorders, 28, 547–552. doi: 10.1016/j.janxdis.2014.06.002CrossRefGoogle Scholar
Beard, C., Hsu, K. J., Rifkin, L. S., Busch, A. B., & Björgvinsson, T. (2016). Validation of the PHQ-9 in a psychiatric sample. Journal of Affective Disorders, 193, 267–273. doi: 10.1016/j.jad.2015.12.075CrossRefGoogle Scholar
Bergin, J., Verhulst, B., Aggen, S. H., Neale, M. C., Kendler, K. S., Bienvenu, O. J., & Hettema, J. M. (2014). Obsessive compulsive symptom dimension and neuroticism: An examination of shared genetic and environmental risk. American Journal of Medical Genetics, Part B: Neuropsychiatric Genetics, 165B, 647–653. doi: 10.1002/ajmg.b.32269CrossRefGoogle Scholar
Berlin, G. S., & Hollander, E. (2014). Compulsivity, impulsivity, and the DSM-5 process. CNS Spectrums, 19, 62–68. doi: 10.1017/S1092852913000722CrossRefGoogle ScholarPubMed
Bienvenu, O. J., Samuels, J. F., Wuyek, L. A., Liang, K. Y., Wang, Y., Grados, M. A., … Nestadt, G. (2012). Is obsessive-compulsive disorder an anxiety disorder, and what, if any, are spectrum conditions? A family study perspective. Psychological Medicine, 42, 1–13. doi: 10.1017/S0033291711000742CrossRefGoogle ScholarPubMed
Bienvenu, O. J., Wang, Y., Shugart, Y. Y., Welch, J. M., Grados, M. A., Fyer, A. J., … Nestadt, G. (2009). Sapap3 and pathological grooming in humans: Results from the OCD collaborative genetics study. American Journal of Medical Genetics, Part B: Neuropsychiatric Genetics, 150B, 710–720. doi: 10.1002/ajmg.b.30897CrossRefGoogle ScholarPubMed
Bloch, M. H., Landeros-Weisenberger, A., Dombrowski, P., Kelmendi, B., Wegner, R., Nudel, J., … Coric, V. (2007). Systematic review: Pharmacological and behavioral treatment for trichotillomania. Biological Psychiatry, 62, 839–846. doi: 10.1016/j.biopsych.2007.05.019CrossRefGoogle ScholarPubMed
Bloch, M. H., McGuire, J., Landeros-Weisenberger, A., Leckman, J. F., & Pittenger, C. (2010). Meta-analysis of the dose-response relationship of SSRI in obsessive-compulsive disorder. Molecular Psychiatry, 15, 850–855. doi: 10.1038/mp.2009.50CrossRefGoogle ScholarPubMed
Boardman, L., van der Mewre, L., Lochner, C., Kinnear, C. J., Seedat, S., Stein, D. J., … Hemmings, S. M. J. (2011). Investigating SAPAP3 variants in the etiology of obsessive-compulsive disorder and trichotillomania in the South African white population. Comprehensive Psychiatry, 52, 181–187. doi: 10.1016/j.comppsych.2010.05.007CrossRefGoogle ScholarPubMed
Brainstorm Consortium (2018). Analysis of shared heritability in common disorders of the brain. Science (New York, N.Y.), 360(6395), eaap8757. doi: 10.1126/science.aap8757CrossRefGoogle Scholar
Carey, E. A., del Pozo de Bolger, A., & Wootton, B. M. (2019). Psychometric properties of the hoarding disorder-dimensional scale. Journal of Obsessive-Compulsive and Related Disorders, 21, 91–96. doi: 10.1016/j.jocrd.2019.01.001CrossRefGoogle Scholar
Cheyne, J. E., del Pozo de Bolger, A., & Wootton, B. M. (2018). Reliability and validity of the Trichotillomania Dimensional Scale (TTM-D). Journal of Obsessive-Compulsive and Related Disorders, 19, 61–65. doi: 10.1016/j.jocrd.2018.08.004CrossRefGoogle Scholar
Christenson, G. A., Chernoff-Clementz, E., & Clementz, B. A. (1992). Personality and clinical characteristics in patients with trichotillomania. Journal of Clinical Psychiatry, 53, 407–413.Google ScholarPubMed
Conway, C. C., Forbes, M. K., Forbush, K. T., Fried, E. I., Hallquist, M. N., Kotov, R., … Eaton, N. R. (2019). A hierarchical taxonomy of psychopathology can transform mental health research. Perspectives on Psychological Science, 14, 419–436. doi: 10.1177/1745691618810696CrossRefGoogle ScholarPubMed
Costa, P. T. Jr., & McCrae, R. R. (1992) Revised NEO personality inventory (NEO-PI-R) and NEO five-factor inventory (NEO-FFI) professional manual. Odessa: Psychological Assessment Resources.Google Scholar
Duailibi, M. S., Cordeiro, Q., Brietzke, E., Ribeiro, M., LaRowe, S., Berk, M., & Trevizol, A. P. (2017). N-acetylcysteine in the treatment of craving in substance use disorders: Systematic review and meta-analysis. American Journal on Addictions, 26, 660–666. doi: 10.1111/ajad.12620CrossRefGoogle ScholarPubMed
Gerstenblith, T. A., Jaramillo-Huff, A., Ruutiainen, T., Nestadt, P. S., Samuels, J. F., Grados, M. A., … Rasmussen, S. A. (2019). Trichotillomania comorbidity in a sample enriched for familial obsessive-compulsive disorder. Comprehensive Psychiatry, 94, 152123. doi: 10.1016/j.comppsych.2019CrossRefGoogle Scholar
Gillan, C. M., Kalanthroff, E., Evans, M., Weingarden, H. M., Jacoby, R. J., Gershkovich, M., … Simpson, H. B. (2020). Comparison of the association between goal-directed planning and self-reported compulsivity vs obsessive-compulsive disorder diagnosis. JAMA Psychiatry, 77, 77–85. doi: 10.1001/jamapsychiatry.2019.2998CrossRefGoogle ScholarPubMed
Grant, J. E., Menard, W., & Phillips, K. A. (2006). Pathological skin picking in individuals with body dysmorphic disorder. General Hospital Psychiatry, 28, 487–493. doi: 10.1016/j.genhosppsych.2006.08.009CrossRefGoogle ScholarPubMed
Grant, J. E., Odlaug, B. L., Chamberlain, S. R., Redden, S. A., Leppink, E. W., Odlaug, B. L., & Kim, S. W. (2016). N-Acetylcysteine in the treatment of excoriation disorder: A randomized clinical trial. JAMA Psychiatry, 73, 490–496. doi: 10.1001/jamapsychiatry.2016.0060CrossRefGoogle ScholarPubMed
Grant, J. E., Odlaug, B. L., & Kim, S. W. (2009). N-acetylcysteine, a glutamate modulator, in the treatment of trichotillomania: A double-blind, placebo-controlled study. Archives of General Psychiatry, 66, 756–763. doi: 10.1001/archgenpsychiatry.2009.60CrossRefGoogle ScholarPubMed
Grant, J. E., Odlaug, B. L., & Kim, S. W. (2010). A clinical comparison of pathologic skin picking and obsessive-compulsive disorder. Comprehensive Psychiatry, 51, 347–352. doi: 10.1016/j.comppsych.2009.10.006CrossRefGoogle ScholarPubMed
Grant, J. E., Odlaug, B. L., & Potenza, M. N. (2007). Addicted to hair pulling? How an alternate model of trichotillomania may improve treatment outcome. Harvard Review of Psychiatry, 15, 80–85. doi: 10.1080/10673220701298407CrossRefGoogle ScholarPubMed
Grisham, J. R., Williams, A. D., & Kadib, R. (2010). Hoarding as a behavioral addiction. In Johnson, B. A. (Ed.), Addiction medicine (pp. 687–701). New York, NY: Springer. doi: 10.1007/978-1-4419-0338-9_34.CrossRefGoogle Scholar
Hollander, E., Friedberg, J. P., Wasserman, S., Yeh, C.-C., & Iyengar, R. (2005). The case for the OCD spectrum. In Abramowitz, J. S. & Houts, A. C. (Eds.), Concepts and controversies in obsessive-compulsive disorders (pp. 95–118). New York: Springer. doi: 10.1007/0-387-23370-9_5CrossRefGoogle Scholar
Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6, 1–55. doi: 10.1080/10705519909540118CrossRefGoogle Scholar
Kotov, R., Gamez, W., Schmidt, F., & Watson, D. (2010). Linking ‘Big’ personality traits to anxiety, depressive, and substance use disorders: A meta-analysis. Psychological Bulletin, 136, 768–821. doi: 10.1037/a0020327CrossRefGoogle ScholarPubMed
Kotov, R., Krueger, R. F., Watson, D., Achenbach, T. M., Althoff, R. R., Bagby, R. M., … Zimmerman, M. (2017). The Hierarchical Taxonomy of Psychopathology (HiTOP): A dimensional alternative to traditional nosologies. Journal of Abnormal Psychology, 126, 454–477. doi: 10.1037/abn0000258CrossRefGoogle ScholarPubMed
Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613. doi: 10.1046/j.1525-1497.2001.016009606.xCrossRefGoogle ScholarPubMed
LeBeau, R. T., Mischel, E. R., Simpson, H. B., Mataix-Cols, D., Phillips, K. A., Stein, D. J., & Craske, M. G. (2013). Preliminary assessment of obsessive-compulsive spectrum disorder scales for DSM-5. Journal of Obsessive-Compulsive and Related Disorders, 2, 114–118. doi: 10.1016/j.jocrd.2013.01.0CrossRefGoogle Scholar
López-Solà, C., Fontenelle, L. F., Bui, M., Hopper, J. L., Pantelis, C., Yücel, M., … Harrison, B. J. (2016). Aetiological overlap between obsessive-compulsive related and anxiety disorder symptoms: Multivariate twin study. British Journal of Psychiatry, 208, 26–33. doi: 10.1192/bjp.bp.114.156281CrossRefGoogle ScholarPubMed
Maraz, A., Hende, B., Urbàn, R., & Demetrovics, Z. (2017). Pathological grooming: Evidence for a single factor behind trichotillomania, skin picking and nail biting. PLoS ONE, 12, e0183806. doi: 10.1192/bjp.bp.114.156281CrossRefGoogle ScholarPubMed
Marsh, H. W., Hau, K.-T., & Wen, Z. (2004). In search of golden rules: Comment on hypothesis-testing approaches to setting cutoff values for fit indexes and dangers in overgeneralizing Hu and Bentler's (1999) findings. Structural Equation Modeling, 11, 320–341. doi: 10.1207/s15328007sem1103_2CrossRefGoogle Scholar
Mataix-Cols, D., Frost, R. O., Pertusa, A., Clark, L. A., Saxena, S., Leckman, J. F., … Wilhelm, S. (2010). Hoarding disorder: A new diagnosis for DSM-V? Depression and Anxiety, 27, 556–572. doi: 10.1002/da.20693CrossRefGoogle ScholarPubMed
Monzani, B., Rijsdijk, F., Harris, J., & Mataix-Cols, D. (2014). The structure of genetic and environmental risk factors for dimensional representations of DSM-5 obsessive-compulsive spectrum disorders. JAMA Psychiatry, 71, 182–189. doi: 10.1001/jamapsychiatry.2013.3524CrossRefGoogle ScholarPubMed
Moreno-Amador, B., Piqueras, J. A., Rodriguez-Jimenez, T., Marzo, J. C., & Mataix-Cols, D. (2018). Adaptation and validation of the dimensional DSM-5 obsessive-compulsive related disorder scales in adolescents: Preliminary data. Journal of Obsessive-Compulsive and Related Disorders, 19, 99–104. doi: 10.1016/j.jocrd.2018.10.002CrossRefGoogle Scholar
Odlaug, B. L., & Grant, J. E. (2010). Pathologic skin picking. American Journal of Drug and Alcohol Abuse, 36, 296–303. doi: 10.3109/00952991003747543CrossRefGoogle ScholarPubMed
Pertusa, A., Frost, R. O., & Mataix-Cols, D. (2010). When hoarding is a symptom of OCD: A case series and implications for DSM-V. Behaviour Research and Therapy, 48, 1012–1020. doi: 10.1016/j.brat.2010.07.003CrossRefGoogle ScholarPubMed
Phillips, K. A., Stein, D. J., Rauch, S. L., Hollander, E., Fallon, B. A., Barsky, A., … Leckman, J. (2010). Should an obsessive-compulsive spectrum grouping of disorders be included in DSM-V? Depression and Anxiety, 27, 528–555. doi: 10.1002/da.20705CrossRefGoogle ScholarPubMed
R Core Team. (2013). R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing. http://www.R-project.org/.Google Scholar
Robbins, T. W., Gillan, C. M., Smith, D. G., de Wit, S., & Ersche, K. D. (2012). Neurocognitive endophenotypes of impulsivity and compulsivity: Towards dimensional psychiatry. Trends in Cognitive Sciences, 16, 81–91. doi: 10.1016/j.tics.2011.11.009CrossRefGoogle ScholarPubMed
Rosseel, Y. (2012). Lavaan: An R package for structural equation modeling and more. Version 0.5-12 (BETA). Ghent, Belgium: Ghent University.Google Scholar
Schlosser, S., Black, D. W., Blum, N., & Goldstein, R. B. (1995). The demography, phenomenology and family history of 22 persons with compulsive hair pulling. Annals of Clinical Psychiatry, 6, 147–151. doi: 10.3109/10401239409148996CrossRefGoogle Scholar
Snorrason, I., Beard, C., Christensen, K., Bjornsson, A. S., & Björgvinsson, T. (2019). Body dysmorphic disorder and major depressive episode have comorbidity-independent associations with suicidality in an acute psychiatric setting. Journal of Affective Disorders, 259, 266–270. doi: 10.1016/j.jad.2019.08.059CrossRefGoogle Scholar
Snorrason, I., Belleau, E. L., & Woods, D. W. (2012). How related are hair pulling disorder (trichotillomania) and skin picking disorder? A review of evidence for comorbidity, similarities and shared etiology. Clinical Psychology Review, 32, 618–629. doi: 10.1016/j.cpr.2012.05.008CrossRefGoogle ScholarPubMed
Snorrason, I., Olafsson, R. P., Houghton, D. C., Woods, D. W., & Lee, H.-J. (2015). ‘Wanting’ and ‘liking’ skin picking: A validation of the Skin Picking Reward Scale. Journal of Behavioral Addictions, 4, 250–262. doi: 10.1556/2006.4.2015.033CrossRefGoogle Scholar
Snorrason, I., Ricketts, E. J., Olafsson, R. P., Rozenman, M., Colwell, C., & Piacentini, J. (2018). Disentangling reward processing in trichotillomania: ‘Wanting’ and ‘liking’ hair pulling have distinct clinical correlates. Journal of Psychopathology and Behavioral Assessment, 41, 271–279. doi: 10.1007/s10862-018-9712-4CrossRefGoogle Scholar
Snorrason, I., Stein, D. J., & Woods, D. W. (2013). Classification of excoriation (skin picking) disorder: Current status and future directions. Acta Psychiatrica Scandinavica, 128, 406–407. doi: 10.1111/acps.12153CrossRefGoogle ScholarPubMed
Spitzer, R. L., Kroenke, K., Williams, J. B., & Lowe, B. (2006). A brief measure for assessing Generalized Anxiety Disorder: The GAD-7. Archives of Internal Medicine, 166, 1092–1097. doi: 10.1001/archinte.166.10.1092CrossRefGoogle ScholarPubMed
Stein, D. J., Grant, J. E., Franklin, M. E., Keuthen, N., Lochner, C., Singer, H. S., & Woods, D. W. (2010). Trichotillomania (hair pulling disorder), skin picking disorder, and stereotypic movement disorder: Toward DSM-V. Depression and Anxiety, 27, 611–626. doi: 10.1002/da.20700CrossRefGoogle ScholarPubMed
Storch, E. A., Bagner, D., Merlo, L. J., Shapira, N. A., Geffken, G. R., Murphy, T. K., & Goodman, W. K. (2007). Florida obsessive-compulsive inventory: Development, reliability, and validity. Journal of Clinical Psychology, 63, 851–859. doi: 10.1002/jclp.20382CrossRefGoogle Scholar
Timpano, K. R., Broman-Fulks, J. J., Glaesmer, H., Exner, C., Rief, W., Olatunji, B. O., … Schmidt, N. B. (2012). A taxometric exploration of the latent structure of hoarding. Psychological Assessment, 25, 194–203. doi: 10.1037/a0029966CrossRefGoogle ScholarPubMed
van Ameringen, M., Mancini, C., Patterson, B., Bennett, M., & Oakman, J. (2010). A randomized, double-blind, placebo-controlled trial of olanzapine in the treatment of trichotillomania. Journal of Clinical Psychiatry, 71, 1336–1343. doi: 10.4088/JCP.09m05114greCrossRefGoogle ScholarPubMed
Waszczuk, M. A., Eaton, N. R., Krueger, R. F., Shackman, A. J., Waldman, I. D., Zald, D. H., … Kotov, R. (2020). Redefining phenotypes to advance psychiatric genetics: Implications from hierarchical taxonomy of psychopathology. Journal of Abnormal Psychology, 129, 143–161. doi: 10.1037/abn0000486CrossRefGoogle ScholarPubMed
Watson, D. (2005). Rethinking the mood and anxiety disorders: A quantitative hierarchical model for DSM-V. Journal of Abnormal Psychology, 114, 522–536. doi: 10.1037/0021-843X.114.4.522CrossRefGoogle ScholarPubMed
Watson, D., Stasik-O'Brien, S. M., Ellickson-Larew, S., & Stanton, K. (2018). Explicating the dispositional basis of the OCRDs: A hierarchical perspective. Journal of Psychopathology and Behavioral Assessment, 40, 497–513. doi: 10.1007/s10862-018-9667-5CrossRefGoogle Scholar
Weiss, R. D., Griffin, M. L., Mazurick, C., Berkman, B., Gastfriend, D. R., Frank, A., Barber, J. P., … Moras, K. (2003). The relationship between cocaine craving, psychosocial treatment, and subsequent cocaine use. American Journal of Psychiatry, 160, 1320–1325. doi: 10.1176/appi.ajp.160.7.1320CrossRefGoogle ScholarPubMed
Welch, J. M., Lu, J., Rodriguiz, R. M., Trotta, N. C., Peca, J., Ding, J. D., Feliciano, C., … Dudek, S. M. (2007). Cortico-striatal synaptic defects and OCD-like behaviours in Sapap3-mutant mice. Nature, 448, 894–900. doi: 10.1038/nature06104CrossRefGoogle ScholarPubMed
Wolf, E. J., Harrington, K. M., Clark, S. L., & Miller, M. W. (2013). Sample size requirements for structural equation models: An evaluation of power, bias and solution propriety. Educational and Psychological Measurement, 76, 913–934. doi: 10.1177/0013164413495237CrossRefGoogle ScholarPubMed
Zald, D. H., & Lahey, B. B. (2017). Implication of the hierarchical structure of psychopathology for psychiatric neuroimaging. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 2, 310–317. doi: 10.1016/j.bpsc.2017.02.003Google Scholar
Züchner, S., Wendland, J. R., Ashley-Koch, A. E., Collins, A. L., Tran-Viet, K. N., Quinn, K., … Krishnan, K. R. (2009). Multiple rare SAPAP3 missense variants in trichotillomania and OCD. Molecular Psychiatry, 14, 6–9. doi: 10.1038/mp.2008.83CrossRefGoogle ScholarPubMed