IntroductionStudying the brain anatomic structure offers a promising approach to improve our understanding of neural functional alter ations often encountered in individuals with psychiatric disorders. In those with obsessive-compulsive disorder (OCD), a psychiatric disorder with a 2%-3% lifetime prevalence 1 that causes strong impairment of daily life, findings up to now show disruptions on a functional and a structural neural level, mainly in a network including cortico-striatothalamo-cortical (CSTC) areas. Overall, these findings are rather inconsistent and limited by confounding factors, such as differences in clinical characteristics of the study sample or varying methodological approaches.Meta-analytic reviews showed that cortical areas, mainly the anterior cingulate cortex (ACC), orbitofrontal cortex (OFC) and parietofrontal regions, seem to be predominantly affected by grey matter volume deficits in patients with OCD, whereas the lenticular nuclei and thalamus were found to be characterized by increases in grey matter volume.2-4 A recent review article 5 confirmed these results and concluded that structural alterations in patients with OCD are widespread and occur most probably at a network level, with cortical tissue reductions and a tendency toward increases in grey matter volume of subcortical limbic areas. These subcortical tissue increases were also corroborated by a recent meta/mega-analysis of the ENIGMA OCD imaging consortium. 6 Additionally, this meta/mega-analysis showed that the neuroplasticity of specific areas depends on the age of the studied sample (i.e., smaller hippocampal but larger pallidum volumes were prominent in adults with OCD, whereas only larger thalamic volumes were specific for pediatric patients). Besides grey matter volume alterations in patients with OCD, significantly decreased grey matter thickness in partly overlapping areas (i.e., limbic, parietal and temporal areas) was also found in another recent mega-analysis. 7 It is Background: Mounting evidence indicates the presence of structural brain alterations in individuals with obsessive-compulsive disorder (OCD). Findings are, however, rather heterogeneous, which may be partly because of differences in methodological approaches or clinical sample characteristics. The aim of the present study was to analyze the whole brain cortical volume, surface area and thickness in a large sample of patients with OCD compared with age-and sex-matched healthy controls. Methods: We conducted whole brain surfacebased analyses of grey matter measures using the automated FreeSurfer software in patients with OCD and matched controls. Group analyses were performed and corrected for multiple testing using Monte Carlo simulations (p < 0.05). Altered brain regions and their average morphological values were associated to symptom severity and type (Yale-Brown Obsessive Compulsive Scale scores). Results:We included 75 patients and 75 controls in our analyses. Patients with OCD showed decreases in both volume and surface area compared with healthy ...