Comparison of the Association Between Goal-Directed Planning and Self-reported Compulsivity vs Obsessive-Compulsive Disorder Diagnosis

Abstract

IMPORTANCE Dimensional definitions of transdiagnostic mental health problems have been suggested as an alternative to categorical diagnoses, having the advantage of capturing heterogeneity within diagnostic categories and similarity across them and bridging more naturally psychological and neural substrates. OBJECTIVE To examine whether a self-reported compulsivity dimension has a stronger association with goal-directed and related higher-order cognitive deficits compared with a diagnosis of obsessive-compulsive disorder (OCD). DESIGN, SETTING, AND PARTICIPANTSIn this cross-sectional study, patients with OCD and/or generalized anxiety disorder (GAD) from across the United States completed a telephone-based diagnostic interview by a trained rater, internet-based cognitive testing, and self-reported clinical assessments from October 8, 2015, to October 1, 2017. Follow-up data were collected to test for replicability. MAIN OUTCOMES AND MEASURESPerformance was measured on a test of goal-directed planning and cognitive flexibility (Wisconsin Card Sorting Test [WCST]) and a test of abstract reasoning. Clinical variables included DSM-5 diagnosis of OCD and GAD and 3 psychiatric symptom dimensions (general distress, compulsivity, and obsessionality) derived from a factor analysis. RESULTS Of 285 individuals in the analysis (mean [SD] age, 32 [12] years; age range, 18-77 years; 219 [76.8%] female), 111 had OCD; 82, GAD; and 92, OCD and GAD. A diagnosis of OCD was not associated with goal-directed performance compared with GAD at baseline (β [SE], −0.02 [0.02]; P = .18). In contrast, a compulsivity dimension was negatively associated with goal-directed performance (β [SE], −0.05 [0.02]; P = .003). Results for abstract reasoning task and WCST mirrored this pattern; the compulsivity dimension was associated with abstract reasoning (β [SE], 2.99 [0.63]; P < .001) and several indicators of WCST performance (eg, categories completed: β [SE], −0.57 [0.09]; P < .001), whereas OCD diagnosis was not (abstract reasoning: β [SE], 0.39 [0.66]; P = .56; categories completed: β [SE], −0.09 [0.10]; P = .38). Other symptom dimensions relevant to OCD, obsessionality, and general distress had no reliable association with goal-directed performance, WCST, or abstract reasoning. Obsessionality had a positive association with requiring more trials to reach the first category on the WCST at baseline (β [SE], 2.92 [1.39]; P = .04), and general distress was associated with impaired goal-directed performance at baseline (β [SE],−0.04 [0.02]; P = .01). However, unlike the key results of this study, neither survived correction for multiple comparisons or was replicated at follow-up testing.CONCLUSIONS AND RELEVANCE Deficits in goal-directed planning in OCD may be more strongly associated with a compulsivity dimension than with OCD diagnosis. This result may have implications for research assessing the association between brain mechanisms and clinical manifestations and for understanding the structure of mental illness.

Habitual Routines and Automatic Tendencies Differential Roles in Alcohol Misuse Among Undergraduates

“…In addition, the expected associations between the COHS subscales and clinical scores indicate good external consistency. Indeed, as in previous studies (Ersche et al, 2017 , 2019 ), we found an association between a compulsivity score (Zermatten et al, 2006 ) and the two COHS subscales, thus confirming the past empirical results showing individuals with a compulsive tendency relied strongly on a habitual mode of action (Voon et al, 2015 ; Gillan et al, 2016 , 2019 ). Additionally, we found that the impulsivity was inversely proportional to routine tendencies, which is consistent with the proposition that goal-striving individuals managing their behaviors with consideration for the consequences of their actions in mind are less inclined to allow environmental stimuli to take over control, a phenomenon related to impulsivity (Lanza and Drabick, 2011 ; Ersche et al, 2019 ).…”

Transdiagnostic Phenotyping Reveals a Host of Metacognitive Deficits Implicated in Compulsivity

“…The same applies to goal-directed planning, which is both deficient in patients tested in-person 9 and correlated with OCD symptoms in the general population tested online 17,26 . Notably, recent work in a patient sample even found that goal-directed deficits were more strongly associated with the compulsivity dimension than OCD diagnosis status 27 . As such, there is no reason to suspect these findings are not applicable to patients.…”

Using language in social media posts to study the network dynamics of depression longitudinally

“…Whether these findings generalise to other aspects of mental health is not yet known. Prior work suggests that transdiagnostic approached might be ultimately more powerful in the context of linking cognitive changes to mental health phenomena, and so it may also prove true here [60,61]. We may find…”