Transdiagnostic phenotypes of compulsive behavior and associations with psychological, cognitive, and neurobiological affective processing

Abstract

Compulsivity is a poorly understood transdiagnostic construct thought to underlie multiple disorders, including obsessive-compulsive disorder, addictions, and binge eating. Our current understanding of the causes of compulsive behavior remains primarily based on investigations into specific diagnostic categories or findings relying on one or two laboratory measures to explain complex phenotypic variance. This proof-of-concept study drew on a heterogeneous sample of community-based individuals (N = 45; 18–45 years; 25 female) exhibiting compulsive behavioral patterns in alcohol use, eating, cleaning, checking, or symmetry. Data-driven statistical modeling of multidimensional markers was utilized to identify homogeneous subtypes that were independent of traditional clinical phenomenology. Markers were based on well-defined measures of affective processing and included psychological assessment of compulsivity, behavioral avoidance, and stress, neurocognitive assessment of reward vs. punishment learning, and biological assessment of the cortisol awakening response. The neurobiological validity of the subtypes was assessed using functional magnetic resonance imaging. Statistical modeling identified three stable, distinct subtypes of compulsivity and affective processing, which we labeled “Compulsive Non-Avoidant”, “Compulsive Reactive” and “Compulsive Stressed”. They differed meaningfully on validation measures of mood, intolerance of uncertainty, and urgency. Most importantly, subtypes captured neurobiological variance on amygdala-based resting-state functional connectivity, suggesting they were valid representations of underlying neurobiology and highlighting the relevance of emotion-related brain networks in compulsive behavior. Although independent larger samples are needed to confirm the stability of subtypes, these data offer an integrated understanding of how different systems may interact in compulsive behavior and provide new considerations for guiding tailored intervention decisions.

Transdiagnostic compulsivity is associated with reduced reminder setting, only partially attributable to overconfidence

“…Metacognitive impairments are also central to explanations of compulsive behaviours, notably in OCD patients. In such patients, compulsivity can manifest in the form of checking behaviours, for example, checking that doors are locked or that appliances are switched off (Den Ouden et al, 2022). Whilst checking behaviours are also present in other compulsive disorders (e.g., 'body checking' in eating disorders; Mountford, Haase, & Waller, 2006), in OCD, these checks are often repetitive and ritualised and are typically associated with obsessive thoughts.…”

Subjective assessments of research domain criteria constructs in addiction and compulsive disorders: a scoping review protocol

“…5 10 This transdiagnostic approach is more sensitive to detecting neural correlates in psychiatric patients than conventional case-control comparisons, 5 revealing new insights into psychopathology. [11][12][13] Two endophenotypes of relevance not just in clinical but also at a population level are the tendencies towards impulsive and compulsive behaviours, given their high prevalence in the general population. 14 15 Normal human behaviour relies on a flexible balance between initiation and inhibition, and abnormalities within these pathways contribute to various maladaptive acts.…”

“… 5 10 This transdiagnostic approach is more sensitive to detecting neural correlates in psychiatric patients than conventional case–control comparisons, 5 revealing new insights into psychopathology. 11–13 …”

“…Previous work has shown that intermediate phenotypes track variation in clinical symptoms across multiple disorders6 and can be mapped onto underlying brain structure and function 5 10. This transdiagnostic approach is more sensitive to detecting neural correlates in psychiatric patients than conventional case–control comparisons,5 revealing new insights into psychopathology 11–13…”

Affecting OCD

“…On the first view, both approaches seem to exclude each other: whether compulsions are performed to diminish affective distress, e.g., anxiety, or they are performed habitually. However, the findings of several neuroimaging studies integrate both points of view by demonstrating the involvement of multiple parallel cortico-striatal-thalamo-cortico (CSTC) circuits associated with parallel processes such as habitual behavior, executive functions (e.g., response inhibition), reward learning, and emotional processing, including emotion regulation (Den Ouden et al, 2022;Shephard et al, 2021;. Anxiety and habit may even interact or affect each other.…”