What Are the Different Symptom Dimensions of Obsessive-Compulsive Disorder?

What you need to know

• Researchers identified 8 distinct symptom dimensions of obsessive-compulsive disorder (OCD)
• Incompleteness and disturbing thoughts emerged as core features that were most interconnected with other symptoms
• This expanded model of OCD symptoms may help improve understanding and treatment of the disorder

Uncovering the Complex Structure of OCD Symptoms

Obsessive-compulsive disorder (OCD) is a mental health condition characterized by unwanted, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions). While OCD is often portrayed in the media as simply excessive hand-washing or checking locks repeatedly, the reality is that the disorder can manifest in many different ways.

A team of international researchers set out to get a more comprehensive picture of the symptom structure of OCD. They analyzed data from 1,366 children, adolescents, and adults diagnosed with OCD across four countries. The participants completed an extensive checklist of 87 distinct OCD symptoms.

Using advanced statistical techniques, the researchers identified 8 broad symptom dimensions of OCD:

1. Disturbing Thoughts
2. Incompleteness
3. Contamination
4. Hoarding
5. Body Focus
6. Superstition
7. Transformation
8. Loss/Separation

This expanded model provides a more nuanced view of OCD symptoms compared to previous research that typically identified 3-5 dimensions. Let’s take a closer look at what each of these symptom dimensions entails.

The 8 Symptom Dimensions of OCD

1. Disturbing Thoughts

This dimension includes intrusive, unwanted thoughts related to harm, violence, sex, or religion. For example, someone might have recurring thoughts about harming a loved one (even though they would never actually want to do this) or blasphemous thoughts that go against their religious beliefs. This dimension also includes checking behaviors to prevent harm.

2. Incompleteness

Incompleteness refers to feelings that things are not “just right.” This can manifest as a need for symmetry, ordering items in a certain way, or repeating actions until they feel complete. It also includes mental compulsions like counting or reviewing memories to achieve a sense of completeness.

3. Contamination

This familiar dimension of OCD involves fears of germs, dirt, or illness. It includes both obsessive thoughts about contamination and compulsive cleaning or avoidance behaviors.

4. Hoarding

While hoarding is now recognized as a separate disorder, some individuals with OCD experience hoarding symptoms like difficulty discarding items or obsessions about losing things.

5. Body Focus

This dimension involves excessive focus on or concerns about one’s body or appearance. It can include symptoms that overlap with body dysmorphic disorder or eating disorders.

6. Superstition

Superstitious fears and behaviors emerged as a distinct dimension. This includes assigning special significance to certain numbers or colors.

7. Transformation

This less common dimension involves fears of turning into someone or something else, or acquiring unwanted characteristics. For example, someone might fear that they will spontaneously start behaving like someone they saw on TV.

8. Loss/Separation

This dimension includes obsessive fears about being separated from loved ones and compulsive behaviors to prevent loss or separation.

Core Features: Incompleteness and Disturbing Thoughts

When the researchers examined how these 8 dimensions were related to each other, two emerged as particularly central: incompleteness and disturbing thoughts. These dimensions had the most connections to other symptom types, suggesting they may represent core features of OCD.

This finding aligns with theories that propose two key motivational processes underlying OCD symptoms:

1. A sense of incompleteness or things not feeling “just right”
2. Harm avoidance - attempting to prevent feared outcomes

The researchers suggest that targeting these core dimensions in treatment may have ripple effects, potentially improving other types of symptoms as well. However, this idea needs to be tested in future treatment studies.

Implications for Understanding and Treating OCD

This expanded model of OCD symptoms has several potential implications:

• It provides a more comprehensive framework for assessing OCD symptoms across the lifespan. The symptom structure was largely similar in children and adults.

• It highlights symptom types that may have been underappreciated previously, like superstitious behaviors and transformation fears. Being aware of these less common manifestations could aid in diagnosis.

• Understanding how different symptom types are interconnected may help in developing more targeted treatments. For example, focusing on incompleteness might improve multiple symptom areas.

• The model could guide future research into the genetic and neurobiological underpinnings of different OCD symptom dimensions.

Conclusions

• OCD symptoms can be grouped into 8 broad dimensions, providing a more nuanced picture of the disorder
• Incompleteness and disturbing thoughts appear to be core features of OCD
• This expanded model may help improve assessment, understanding, and treatment of OCD across the lifespan

While this research provides valuable insights into the structure of OCD symptoms, it’s important to remember that each person’s experience with OCD is unique. If you’re concerned about OCD symptoms, speak with a mental health professional for proper assessment and treatment options tailored to your individual needs.