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Symptom Dimensions in OCD: Item-Level Factor Analysis and Heritability Estimates

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Symptom Dimensions in OCD: Item-Level Factor Analysis and Heritability Estimates Symptom Dimensions in OCD: Item-Level Factor Analysis and Heritability Estimates The MIT Faculty has made this article openly available. Please share how this access benefits you. Your story matters. Citation Katerberg, Hilga et al. “Symptom Dimensions in OCD: Item-Level Factor Analysis and Heritability Estimates.” Behavior Genetics 40 (2010): 505-517. As Published http://dx.doi.org/10.1007/s10519-010-9339-z Publisher Springer Science + Business Media B.V. Version Final published version Citable link http://hdl.handle.net/1721.1/65885 Terms of Use Creative Commons Attribution Noncommercial License Detailed Terms http://creativecommons.org/licenses/by-nc/2.5 Behav Genet (2010) 40:505–517 DOI 10.1007/s10519-010-9339-z ORIGINAL RESEARCH Symptom Dimensions in OCD: Item-Level Factor Analysis and Heritability Estimates Hilga Katerberg • Kevin L. Delucchi • S. Evelyn Stewart • Christine Lochner • Damiaan A. J. P. Denys • Denise E. Stack • J. Michael Andresen • J. E. Grant • Suck W. Kim • Kyle A. Williams • Johan A. den Boer • Anton J. L. M. van Balkom • Johannes H. Smit • Patricia van Oppen • Annemiek Polman • Michael A. Jenike • Dan J. Stein • Carol A. Mathews • Danielle C. Cath Received: 28 May 2009 / Accepted: 19 January 2010 / Published online: 2 April 2010 Ó The Author(s) 2010. This article is published with open access at Springerlink.com Abstract To reduce the phenotypic heterogeneity of and translational studies, numerous factor analyses of obsessive-compulsive disorder (OCD) for genetic, clinical the Yale-Brown Obsessive Compulsive Scale checklist (YBOCS-CL) have been conducted. Results of these analyses have been inconsistent, likely as a consequence of Edited by Michael Lyons. Hilga Katerberg and Kevin L. Delucchi contributed equally to this work. H. Katerberg Á J. A. den Boer Á A. Polman J. M. Andresen Department of Psychiatry, University Medical Center Massachusetts Institute of Technology, Cambridge, Groningen, University of Groningen, Groningen, MA, USA The Netherlands J. E. Grant H. Katerberg Á A. J. L. M. van Balkom Á Department of Psychiatry, University of Minnesota J. H. Smit Á P. van Oppen Medical School, Minneapolis, USA GGZ Buitenamstel, Amsterdam, The Netherlands S. W. Kim K. L. Delucchi Á C. A. Mathews Department of Psychiatry, University of Minnesota, Department of Psychiatry, University of California, Minneapolis, MI, USA San Francisco, CA, USA K. A. Williams S. E. Stewart Á M. A. Jenike Department of Neurology, University of Minnesota, Pediatric Obsessive-Compulsive Disorder Clinic, Minneapolis, MI, USA Massachusetts General Hospital, Boston, MA, USA A. J. L. M. van Balkom Á J. H. Smit Á P. van Oppen S. E. Stewart Department of Psychiatry, VU University Medical Center, Psychiatric and Neurodevelopmental Genetics Unit, Amsterdam, The Netherlands Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA D. J. Stein Department of Psychiatry, University of Cape Town, S. E. Stewart Á D. E. Stack Á M. A. Jenike Cape Town, South Africa Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA D. C. Cath (&) Department of Clinical and Health Psychology, C. Lochner Á D. J. Stein Altrecht outpatient anxiety services, Utrecht University, MRC Unit on Anxiety & Stress Disorders, Department Mimosastraat 2-4, 3551 DC Utrecht, The Netherlands of Psychiatry, University of Stellenbosch, Stellenbosch, e-mail: [email protected] South Africa D. A. J. P. Denys Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands 123 506 Behav Genet (2010) 40:505–517 small sample sizes and variable methodologies. Further- disorder- or syndrome-based constructs, based on the belief more, data concerning the heritability of the factors are that underlying symptom dimensions may reflect more limited. Item and category-level factor analyses of etiological homogeneity than a global OCD diagnosis YBOCS-CL items from 1224 OCD subjects were followed (Mataix-Cols et al. 2005). by heritability analyses in 52 OCD-affected multigenera- Obsessive-compulsive (OC) symptomatology is pre- tional families. Item-level analyses indicated that a five dominantly measured with the Yale-Brown Obsessive factor model: (1) taboo, (2) contamination/cleaning, (3) Compulsive Scale (YBOCS), which includes an assessment doubts, (4) superstitions/rituals, and (5) symmetry/hoarding of OC symptom severity and a symptom checklist provided the best fit, followed by a one-factor solution. All (YBOCS-CL) containing 45 obsessions and 29 compul- 5 factors as well as the one-factor solution were found to sions within 15 predefined symptom categories (Goodman be heritable. Bivariate analyses indicated that the taboo et al. 1989a, b). To reduce the phenomenological hetero- and doubts factor, and the contamination and symmetry/ geneity of OCD, several factor analyses have been per- hoarding factor share genetic influences. Contamination formed using the YBOCS-CL (Baer 1994; Cavallini et al. and symmetry/hoarding show shared genetic variance with 2002; Cullen et al. 2007; Delorme et al. 2006; Denys et al. symptom severity. Nearly all factors showed shared envi- 2004; Feinstein et al. 2003; Girishchandra and Khanna ronmental variance with each other and with symptom 2001; Hasler et al. 2005, 2007; Kim et al. 2005; Leckman severity. These results support the utility of both OCD et al. 1997; Mataix-Cols et al. 1999, 2005, 2008; McKay diagnosis and symptom dimensions in genetic research and et al. 2006; Pinto et al. 2008; Stein et al. 2007, 2008; clinical contexts. Both shared and unique genetic influ- Stewart et al. 2007, 2008; Wu et al. 2007). The majority of ences underlie susceptibility to OCD and its symptom these studies identified three or four main symptom dimensions. dimensions based on factor analyses of 13 symptom cate- gories, rather than using individual items within categories. Keywords OCD Á Factor analysis Á Heritability Á This is likely due to methodological constraints and con- Symptom dimensions Á Y-BOCS Á Genetic Á Severity Á cerns about small sample sizes. A recent meta-analysis of Onset twenty-one symptom category-based factor analyses iden- tified four OC symptom dimensions: (1) symmetry obses- sions; counting, ordering and arranging compulsions; (2) Introduction obsessions and checking (aggressive, sexual, religious and somatic obsessions; and related checking compulsions); (3) Obsessive-compulsive disorder (OCD) is a neuropsychiat- contamination/cleaning, and (4) hoarding (Bloch et al. ric condition that affects 1–2% of the population world- 2008). wide and is characterized by intrusive, recurrent thoughts, Although clinically useful, the category-based approach feelings, and ideas (obsessions) and/or repetitive actions, to factor analysis is limited by the fact that individual often aimed at reducing tension or anxiety accompanying symptoms have been grouped into predefined YBOCS-CL obsessions (compulsions) (American Psychiatric Associa- symptom categories (designed to fit a presupposed theo- tion 1994; Fontenelle and Hasler 2008). retical model), which may not actually cluster together if OCD is phenomenologically and etiologically hetero- assessed separately. In addition, the YBOCS-CL ‘‘miscel- geneous (Mataix-Cols et al. 2007). Phenomenologically, laneous’’ obsessions and compulsions categories are usu- OCD-affected individuals vary widely with respect to ally excluded from category-driven analyses, limiting symptom type (e.g., hoarding vs. cleaning), symptom complete data availability for analyses of the OCD phe- severity, age of symptom onset, and comorbidities (e.g., tic notype. Therefore, symptom dimensions resulting from disorders, depression, grooming disorders, etc.). Further, category-driven analyses may have biases that are not genetic epidemiology studies suggest that OCD is geneti- present in item-driven analyses (Denys et al. 2004; Fein- cally complex, with multiple genetic and environmental stein et al. 2003). factors contributing to its development (for an overview: To address this limitation, eight studies (Table 1) have see Pauls 2008). The heterogeneity of OCD symptoms may been published on exploratory factor analyses using indi- contribute to the difficulty in identifying susceptibility vidual items from the YBOCS-CL (Denys et al. 2004; genes that confer vulnerability to specific components of Feinstein et al. 2003; Girishchandra and Khanna 2001; the disorder. It may also dilute findings emergent from Hantouche and Lancrenon 1996; Pinto et al. 2008; Stein other etiological, clinical, and treatment studies. One of the et al. 2007; Stein et al. 2007, 2008; Wu et al. 2007). various approaches to minimize OCD heterogeneity that Although the factors identified in these studies partially has received support from neuroimaging, treatment, and overlap with category-based factors, a key difference is that genetic studies is the use of symptom-based rather than nearly all item-based analyses report 5 rather than 4 final 123 Behav Genet (2010) 40:505–517 Table 1 Exploratory item-level factor analytic studies in OCD Study Subjects # Contamination/ Aggressive/harm Superstitions Somatic Hoarding Sexual/religious Symmetry Others n Factors cleaning Hantouche and 615 17 X X X X X X X X Lancrenon 1996 Girishchandra and 202 5 X X (including X X (including symmetry) X Khanna 2001 checking) Feinstein et al. 2003 160 4 X X (including X (including symmetry) X checking) Denys et al. 2004 335 5 X X (including X X (including symmetry) X (including checking) aggressive obsessions) Wu et al. 2007 149 gen
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