A network analysis of obsessive-compulsive symptoms and their comorbidity with other disorders

Objectives: To improve our understanding of the heterogeneity of obsessive-compulsive disorder (OCD) and its comorbidity with other disorders by using network analysis. Methods: An existing data base of 257 participants with a primary diagnosis of OCD and whose symptoms were evaluated using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was subjected to network analysis. Results: The analysis revealed eight clusters of characteristics. Two clusters were too small in numbers to reach any meaningful conclusion. The other six clusters included patients with: 1) contamination and cleaning symptoms with little comorbidity; 2) high prevalence checking symptoms with comorbid depression and anxiety disorders; 3) high prevalence contamination and cleaning symptoms with aggressive obsessions and checking compulsions; 4) high prevalence hoarding symptoms with comorbid depression and anxiety; 5) high prevalence impulsive aggressive, sexual and checking symptoms, hair-pulling and comorbid body dysmorphic disorder; and 6) high prevalence hoarding with impulsive aggressive and checking symptoms with comorbid alcohol use disorder and psychosis. Conclusions: This study highlights the potential role of comorbidity. Contamination/cleaning symptoms were observed to have less psychiatric comorbidity. Symmetry/ordering symptoms did not feature prominently in the symptom clusters, whilst checking compulsions were common to multiple clusters.