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Myth of the pure obsessional type in obsessive–compulsive disorder


  • This research was previously presented at the International OCD Foundation Annual Conference, Washington DC, July 16–18, 2010.

  • Conflict of interest: Dr. Liebowitz has received research support from Allergan, Pfizer, GSK, Astra Zeneca, Forest, Tikvah, Avera, Eli Lilly, Novartis, Sepracor, Horizon, Johnson and Johnson, Pherin, PGX Health, Abbott, Jazz, MAP, Takeda, Wyeth, Cephalon, Indevus, Endo, Ortho-McNeil, and Gruenthal he has served as a consultant for Astra Zeneca, Wyeth, Pfizer, Takeda, Pherin, Lilly, Otsuka, and Eisai. In addition, Dr. Liebowitz has licensing agreements for rating scale and/or electronic data capture devices with GSK, Pfizer, Avera, Tikvah, Endo, Lilly, Indevus, Servier; he holds the copyright of the Liebowitz Social Anxiety Scale; and he holds equity ownership in ChiMatrix (a company specializing in electronic data capture). Dr. Simpson is an advisor to Anxiety Disorders Association of America and Jazz Pharmaceuticals and has received medication at no cost from Janssen Pharmaceutica for a study. Dr. Foa has received research support from Pfizer, Solvay, Eli Lilly, SmithKline Beecham, GlaxoSmithKline, Cephalon, Bristol-Myers Squibb, Forest, Ciba-Geigy, Kali-Duphar, and APA; she has been a speaker for Pfizer, GlaxoSmith-Kline, Forest, and APA; and she receives royalties from the sale of two books on obsessive–compulsive disorder from Bantam and Harcourt. All remaining authors report no competing interests.


Background: Several studies have identified discrete symptom dimensions in obsessive–compulsive disorder (OCD), derived from factor analyses of the individual items or symptom categories of the Yale–Brown Obsessive–Compulsive Scale Symptom Checklist (YBOCS-SC). This study aims to extend previous work on the relationship between obsessions and compulsions by specifically including mental compulsions and reassurance-seeking. Because these compulsions have traditionally been omitted from prior factor analytic studies, their association to what have been called “pure obsessions” may have been overlooked. Method: Participants (N=201) were recruited from two multi-site randomized clinical treatment trials for OCD. The YBOCS-SC was used to assess OCD symptoms, as it includes a comprehensive list of obsessions and compulsions, arranged by content category. Each category was given a score based on whether symptoms were present and if the symptom was a primary target of clinical concern, and a factor analysis was conducted. Mental compulsions and reassurance-seeking were considered separate categories for the analysis. Results: Using an orthogonal geomin rotation of 16 YBOCS-SC categories/items, we found a five-factor solution that explained 67% of the total variance. Inspection of items that composed each factor suggests five familiar constructs, with mental compulsions and reassurance-seeking included with sexual, aggressive, and religious obsessions (unacceptable/taboo thoughts). Conclusions: This study suggests that the concept of the “pure obsessional” (e.g., patients with unacceptable/taboo thoughts yet no compulsions) may be a misnomer, as these obsessions were factorially associated with mental compulsions and reassurance-seeking in these samples. These findings may have implications for DSM-5 diagnostic criteria. Depression and Anxiety, 2011. © 2011 Wiley-Liss, Inc.