Obsessive-compulsive disorder (OCD) is a heterogeneous mental health condition, with a lifetime prevalence of 2.3% (Kessler et al., 2012). Attempts have been made to subtype OCD to better understand and treat its heterogeneity with subtypes proposed based on features like symptoms, dysfunctional beliefs, and comorbidities (Radomsky & Taylor, 2005).
However, no dominant model fully explains OCD’s heterogeneity across all individuals (Taylor, McKay & Abramowitz, 2005).
An additional treatment response guideline was included to assess if subtypes had differential treatment outcomes. Understanding valid OCD subtypes could aid with classification, understanding, and specialized treatment of OCD.
The examined subtypes covered a breadth of approaches, dividing groups along dimensions like specific symptoms, comorbid conditions, beliefs, demographics and clinical features. The reviews found most of these did not show clear validity against the analysis guidelines used.
Key Points
Method
Literature searches were conducted using PsycInfo, PubMed, and Scopus using search terms combining “obsessive-compulsive disorder” and “subtype,” “subclass,” or “subgroup.”
The searches yielded 2181 total studies. Inclusion criteria limited studies to those examining proposed OCD subtypes in relation to at least one validity guideline in adults diagnosed using DSM-IV criteria. 165 unique studies covering 31 putative subtypes were identified.
Statistical Analysis
Guidelines were coded as “studied and met,” “studied and not met,” “not studied,” or “inconsistent” for each subtype.
Results
The researchers reviewed 21 potential subtypes of OCD to see if they could be considered valid. They tested whether each subtype was different from regular OCD in 6 key ways:
The researchers found:
This means:
The evidence does not clearly support the validity of most proposed OCD subtypes based on the thorough analysis criteria used in this review.
While the obsession type shows promise, better models for subclassifying OCD are still needed to improve treatment matching and outcomes.
Insight
The review indicates currently proposed OCD subtypes lack clearvaliditywhen assessed on multiple key criteria. This likely results from suboptimal categorical subtyping approaches rather than insufficient research into most subtypes.
The obsession type subtype shows the most promise as a valid subtype, possibly due its broader subtype classification compared to other symptom-based subtypes.
Obsession type
The obsession type subtype refers to categorizing obsessive-compulsive disorder (OCD) cases based on the predominant type of obsessions experienced. This subtype divides obsessions into two categories:
The obsession type subtype met 5 of the 6 validity guidelines assessed in the reviewed paper. Cases were assigned to categories based on the individual’s predominant obsession theme.
This subtype shows promise in explaining differences seen in OCD. The autogenous and reactive groups differed significantly in clinical presentation, treatment response, long-term course, laboratory study findings, and delimitation from other disorders.
This suggests tracking obsession themes could aid understanding and specialized treatment of OCD cases.
Strengths
Limitations
Implications
Dimensional Approaches
The lack of clear discrete subtypes supports the hypothesis that OCD heterogeneity is better captured dimensionally.
Rather than forcing categorical groups, we should measure multiple continuous factors like symptom dimensions, comorbidities, cognitions, etc. concurrently.
Thisdimensional approach, combined with data analytics, could better explain variance and guide personalized treatments.
Personalized Medicine
We have enough data to hypothesize personalized approaches may improve outcomes.
Promising Subtypes
The obsession-type subtype still shows the most empirical promise on validity criteria. Further research should continue to replicate and extend our understanding of autogenous vs reactive presentation.
Examining their cognitive-behavioral processes, neural correlates, genetics, and family history, could reveal meaningful differences to guide treatment.
Beyond obsession type, understudied criteria like family history, course, treatment response should be extended to other promising subtypes like impulsive or poor insight OCD. Broader study on the least established validity criteria for most subtypes is warranted.
Limit Symptom-Based Subtyping
Conversely, the bulk of research exists exploring symptom dimensions like contamination, hoarding, etc. But analyses indicated these fail validity despite extensive study.
The field should limit further efforts to validate these specific symptom presentations. Rather, shift focus to ideological dimensions like beliefs, internal phenomenon like ego-dystonia, and new data-driven approaches.
References
Primary reference
Rowsell, M., & Francis, S. E. (2015). OCD subtypes: Which, if any, are valid?.Clinical Psychology: Science and Practice,22(4), 414.
Other references
Calamari, J. E., Wiegartz, P. S., Riemann, B. C., Cohen, R. J., Greer, A., Jacobi, D. M., Jahn, S. C., & Carmin, C. (2004). Obsessive-compulsive disorder subtypes: An attempted replication and extension of a symptom-based taxonomy.Behaviour Research and Therapy, 42(6), 647–670.https://doi.org/10.1016/S0005-7967(03)00173-6
Haslam, N., Williams, B. J., Kyrios, M., McKay, D., & Taylor, S. (2005). Subtyping obsessive-compulsive disorder: A taxometric analysis. Behavior Therapy, 36(4), 381–391.https://doi.org/10.1016/s0005-7894(05)80120-0
Kessler, R. C., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Wittchen, H. (2012). Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States.International Journal of Methods in Psychiatric Research, 21(3), 169–184.https://doi.org/10.1002/mpr.1359
Olatunji, B. O., Williams, B. J., Haslam, N., Abramowitz, J. S., & Tolin, D. F. (2008). The latent structure of obsessive-compulsive symptoms: A taxometric study.Depression and Anxiety, 25(11), 956–968.https://doi.org/10.1002/da.20387
Radomsky, A. S., & Taylor, S. (2005). Subtyping OCD: Prospects and problems.Behavior Therapy, 36(4), 371–379.https://doi.org/10.1016/j.beth.2005.07.003
Robins, E., & Guze, S. B. (1970). Establishment of diagnostic validity in psychiatric illness: Its application to schizophrenia.The American Journal of Psychiatry, 126(7), 983–987.https://doi.org/10.1176/ajp.126.7.983
Taylor, S., McKay, D., & Abramowitz, J. S. (2005). Is obsessive–compulsive disorder a disturbance of security motivation?Psychological Review, 112(3), 658–656.https://doi.org/10.1037/0033-295x.112.3.650
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Some questions for further discussion:
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
