Elsevier

Journal of Affective Disorders

Volume 183, 1 September 2015, Pages 253-257
Journal of Affective Disorders

Preliminary communication
Examination of the relations between obsessive–compulsive symptom dimensions and fear and distress disorder symptoms

https://doi.org/10.1016/j.jad.2015.05.013Get rights and content

Highlights

  • Examined relations between OCD symptom dimensions and fear/distress symptoms.

  • Findings support overlap between OCD and other anxiety disorders.

  • Additionally, findings support are multidimensional nature of OCD.

Abstract

Background

Whereas prior work has established fear and distress clusters underlying unipolar mood and anxiety disorders, the optimal placement of obsessive–compulsive disorder (OCD) within this model is unclear. One likely contributor to this ambiguity is the heterogeneous nature of OCD. There is increasing evidence for distinct symptom dimensions that are more homogenous than the broad OCD phenotype. Using structural equation modeling, the current study examined the relations between various OCD symptom dimensions and symptoms associated with fear/distress disorders.

Methods

Participants included 526 individuals recruited from an online crowdsourcing marketplace.

Results

Results revealed that the symmetry obsessions/arranging compulsions, harm obsessions/checking compulsions, and unacceptable thoughts/neutralizing compulsions were related to both fear and distress disorder symptoms, whereas the contamination obsessions/washing compulsions dimension of OCD was specifically related to fear disorder symptoms.

Limitations

Limitations include the use of self-report questionnaires to measure all constructs of interest.

Conclusions

These findings add to a growing body of literature attesting to the multidimensional nature of OCD and progress our understanding of the etiological underpinnings of this severe and debilitating condition.

Introduction

Obsessive compulsive disorder (OCD) is characterized by the presence of recurrent thoughts and/or images (i.e., obsessions) that bring about significant distress, as well as repetitive behaviors (i.e., compulsions) aimed at reducing or neutralizing the associated anxiety (American Psychiatric Association, 2013). OCD is thought to affect around 2–3% of the population and due to the extensive time spent obsessing and engaging in compulsive behaviors can cause significant impairment in social and occupational domains (Kessler et al., 2005, Torres et al., 2006). While the onset of symptoms is typically gradual, if left untreated the course is often chronic with symptoms waxing and waning over time (American Psychiatric Association, 2013).

OCD has been found to be associated with a wide range of psychiatric disorders but is most commonly comorbid with mood and anxiety conditions (Brown et al., 2001). Indeed, OCD is often conceptualized with other mood and anxiety disorders within a hierarchical framework of emotional distress disorders. In this model, unipolar mood and anxiety disorders are clustered based on symptomatic presentation typical of distress (i.e., anxious apprehension) or fear (i.e., anxious arousal; e.g., Krueger, 1999, Watson, 2005). Disorders subsumed under distress (i.e., distress disorders) typically include depressive disorders (i.e., major depressive disorder [MDD], dysthymia), generalized anxiety disorder (GAD), and post-traumatic stress disorder (PTSD). Disorders subsumed under fear (i.e., fear disorders) typically include panic disorder (PD), specific phobia, social anxiety disorder (SAD), and OCD (Watson, 2005).

The fear/distress framework for conceptualizing mood and anxiety disorders is useful from both a nosological and research perspective. Indeed, this model may help to explain patterns of comorbidity between various mood and anxiety disorders. For example, a growing body of evidence has demonstrated significant similarities between depression and GAD including high rates of genetic overlap (Kendler, 1996, Mineka et al., 1998) as well as elevated levels of comorbidity (Krueger, 1999). As such, it has been argued that these disorders should be linked together hierarchically under a general category of distress disorders (Watson, 2005). In addition, the fear/distress framework overlaps with the National Institute of Mental Health׳s Research Domain Criteria (RDoC) initiative in which they call for a new way of classifying psychiatric disorders based on dimensions of observable behavior. Within this framework, psychiatric disorders are grouped into major domains of functioning reflected by aspects of motivation, cognition, and social behavior. For example, acute (i.e., fear) and potential threat (i.e., distress) are conceptualized as distinct lower order constructs under the negative valence systems domain (Cuthbert, 2014).

Whereas there is evidence for fear and distress clusters underlying unipolar mood and anxiety disorders (Allan et al., 2015, Krueger and Markon, 2006, Sellbom et al., 2008, Slade and Watson, 2006), the evidence for OCD׳s placement within this model is equivocal. Some work suggests that OCD is associated with both fear and distress disorder clusters. For example, in an exploratory factor analysis on psychopathology symptoms in an epidemiological sample (the 2007 Australian National Survey of Mental Health and Wellbeing; N=8841), OCD symptoms loaded on a factor separate from fear and distress symptoms but with fear and distress symptom factors under an internalizing factor (Wright et al., 2013). On the other hand, several studies have reported that OCD clusters with only the fear disorders (Prenoveau et al., 2010, Slade and Watson, 2006). However, others have found that OCD does not cluster with fear or distress disorders (Markon, 2010, Wright et al., 2013).

One potential explanation for these inconsistent findings could be due to the symptomatically heterogeneous nature of OCD. Indeed, two different patients diagnosed with OCD can exhibit entirely distinct, non-overlapping symptom patterns. For instance, one individual may have obsessional doubts that he/she left the stove on, leading to increased checking behaviors whereas another individual may have obsessional concerns of being contaminated, leading to increased hand washing. Research on the dimensional structure of OCD has identified several typical symptom dimensions that incorporate these heterogeneous obsessions and compulsions (Stewart et al., 2008). These include: 1) contamination obsessions and washing compulsions, 2) responsibility for harm obsessions and checking compulsions, 3) symmetry obsessions and ordering compulsions, and 4) unacceptable thoughts (e.g., sexual, religious, or aggressive in nature) and neutralizing compulsions (e.g., thought suppression; Abramowitz et al., 2010).

Prior research indicates that these various symptom clusters are associated with distinct patterns of comorbidity, neurological correlates and treatment response (Mataix-Cols et al., 2005). For example, Leckman et al. (1997) found that individuals with obsessions/checking and symmetry/ordering symptoms were more likely to have co-occurring tics than individuals with other OCD symptom dimensions. When examining underlying neural mechanisms of OCD, Rauch et al. (1998) found that checking symptoms correlated with increased regional cerebral blood flow in the striatum whereas symmetry ordering symptoms correlated with reduced blood flow in this area. Finally, whereas the effectiveness of cognitive behavioral therapy (CBT) for OCD has been well documented in numerous controlled trials, research examining treatment outcomes by symptom dimensions have suggested that individuals with primary sexual and/or religious obsessions may respond less favorably to CBT than individuals with other primary OCD symptom domains (Alonso et al., 2001).

There are several advantages of conceptualizing OCD symptom dimensions within a fear/distress framework. From an etiological perspective, understanding whether specific OCD symptom dimensions cluster together distinctly with fear and/or distress facets will allow for a more structured exploration of common underlying risk factors. From a treatment perspective, fear disorders are characterized by anxious arousal and avoidance whereas distress disorders are characterized by anxious apprehension. Therefore, individuals with OCD symptom dimensions clustering with fear disorders may respond more favorably to behavioral based interventions (e.g., exposure and response prevention) whereas individuals with OCD symptom dimensions clustering with distress disorders may respond more favorably to cognitive based interventions (e.g., cognitive therapy). Despite the potential utility in identifying distinct patterns of overlapping variance across the various OCD symptom domains, to our knowledge only one study to date has examined the relations between OCD symptom dimensions and associated disorders that can be conceptualized within the fear/distress framework. Using exploratory factor analysis, Hasler et al. (2005) examined the relations between OCD symptom dimensions and comorbid mood and anxiety pathology. The authors found a 4 factor solution comprising three OCD symptom dimensions and a hoarding factor. The OC symptom domains included unacceptable thoughts and checking symptoms, symmetry obsessions and ordering compulsions and contamination obsessions and washing compulsions. Unacceptable thoughts/checking symptoms were broadly related to mood and anxiety disorders whereas symmetry obsessions/ordering compulsions were related only to fear based disorders (i.e., panic disorder and agoraphobia). Finally, no significant relations emerged between contamination/washing concerns and the various mood and anxiety related conditions. Although it is important to note, factor three only captured two symptoms of contamination.

The current study was designed to examine the relations between OCD symptom dimensions and symptoms associated with fear distress disorders. Based on the limited empirical work available examining discrete patterns of comorbidity by symptom dimensions (Hasler et al., 2005, Leckman et al., 1997), it was hypothesized that the symmetry obsessions/ordering compulsions would be related to fear symptoms whereas the harm obsessions/checking compulsions and unacceptable thoughts/neutralizing compulsions would be related to both fear and distress symptoms. Finally, because few studies have examined contamination in relation to mood and anxiety disorders no specific hypotheses were made for this dimension.

Section snippets

Participants and procedure

We recruited 526 participants using Amazon׳s Mechanical Turk (Mturk), an online crowdsourcing marketplace. Previous research has indicated that data collected through Mturk is diverse and high quality (Buhrmester et al., 2011, Paolacci and Chandler, 2014), typically consisting of individuals that are educated, underemployed, middle class, Caucasian, and approximately 30 years old (Berinsky et al., 2012, Shapiro et al., 2013). For the current study, we recruited participants who were living in

Descriptive statistics and correlations

Descriptive statistics and correlations were calculated for the scale scores for the obsessive–compulsive symptom clusters and distress and fear symptoms as well as for gender and age, which were used as control variables (see Table 1). All correlations were in expected directions, as significant correlations were found across and between the obsessive–compulsive scales and the fear and distress scales.

Structural equation model examining the unique relations distress and fear symptoms share with obsessive–compulsive symptom factors

The SEM examining the unique relations the Distress factor and the Fear factor shared with

Discussion

In the current study, the harm obsessions/checking compulsions, unacceptable thoughts/neutralizing compulsions, and symmetry obsessions/arranging compulsions dimensions of OCD were associated with both fear and distress symptoms although stronger relations with fear symptoms were found for the harm obsessions/checking compulsions and symmetry obsessions/arranging compulsions dimensions. Additionally, the contamination obsessions/washing compulsions dimension of OCD was specifically related to

Role of funding source

There are no sources of funding to disclose.

Conflict of interest

There are no conflicts of interest to disclose.

Acknowledgments

We have no acknowledgments.

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