Comparison of the Association Between Goal-Directed Planning and Self-reported Compulsivity vs Obsessive-Compulsive Disorder Diagnosis (vol 57, pg, 254, 2019)

Question Are deficits in goal-directed planning better identified by self-reported compulsivity or a diagnosis of obsessive-compulsive disorder? Findings In this cross-sectional study of 285 patients diagnosed with obsessive-compulsive disorder, generalized anxiety disorder, or both, self-reported compulsivity was more strongly associated with goal-directed deficits than a diagnosis of obsessive-compulsive disorder compared with generalized anxiety disorder. Meaning This study suggests that transdiagnostic compulsivity symptoms may have greater biological validity than a diagnosis of obsessive-compulsive disorder. Importance Dimensional definitions of transdiagnostic mental health problems have been suggested as an alternative to categorical diagnoses, having the advantage of capturing heterogeneity within diagnostic categories and similarity across them and bridging more naturally psychological and neural substrates. Objective To examine whether a self-reported compulsivity dimension has a stronger association with goal-directed and related higher-order cognitive deficits compared with a diagnosis of obsessive-compulsive disorder (OCD). Design, Setting, and Participants In this cross-sectional study, patients with OCD and/or generalized anxiety disorder (GAD) from across the United States completed a telephone-based diagnostic interview by a trained rater, internet-based cognitive testing, and self-reported clinical assessments from October 8, 2015, to October 1, 2017. Follow-up data were collected to test for replicability. Main Outcomes and Measures Performance was measured on a test of goal-directed planning and cognitive flexibility (Wisconsin Card Sorting Test [WCST]) and a test of abstract reasoning. Clinical variables included DSM-5 diagnosis of OCD and GAD and 3 psychiatric symptom dimensions (general distress, compulsivity, and obsessionality) derived from a factor analysis. Results Of 285 individuals in the analysis (mean [SD] age, 32 [12] years; age range, 18-77 years; 219 [76.8%] female), 111 had OCD; 82, GAD; and 92, OCD and GAD. A diagnosis of OCD was not associated with goal-directed performance compared with GAD at baseline (beta [SE], -0.02 [0.02]; P = .18). In contrast, a compulsivity dimension was negatively associated with goal-directed performance (beta [SE], -0.05 [0.02]; P = .003). Results for abstract reasoning task and WCST mirrored this pattern; the compulsivity dimension was associated with abstract reasoning (beta [SE], 2.99 [0.63]; P < .001) and several indicators of WCST performance (eg, categories completed: beta [SE], -0.57 [0.09]; P < .001), whereas OCD diagnosis was not (abstract reasoning: beta [SE], 0.39 [0.66]; P = .56; categories completed: beta [SE], -0.09 [0.10]; P = .38). Other symptom dimensions relevant to OCD, obsessionality, and general distress had no reliable association with goal-directed performance, WCST, or abstract reasoning. Obsessionality had a positive association with requiring more trials to reach the first category on the WCST at baseline (beta [SE], 2.92 [1.39]; P = .04), and general distress was associated with impaired goal-directed performance at baseline (beta [SE],-0.04 [0.02]; P = .01). However, unlike the key results of this study, neither survived correction for multiple comparisons or was replicated at follow-up testing. Conclusions and Relevance Deficits in goal-directed planning in OCD may be more strongly associated with a compulsivity dimension than with OCD diagnosis. This result may have implications for research assessing the association between brain mechanisms and clinical manifestations and for understanding the structure of mental illness. This cross-sectional study assesses whether deficits in goal-directed planning are better identified by self-reported compulsivity or a diagnosis of obsessive-compulsive disorder.