Neuropsychological performance across symptom dimensions of obsessive-compulsive disorder: a comment on the state and critical review of the literature

ABSTRACT

Introduction: Obsessive-compulsive disorder (OCD) is a heterogeneous disorder, with multiple symptom presentations. Delineating the neuropsychological characteristics associated with previously identified symptom clusters may therefore be useful in assisting to better define symptom subtypes of OCD.

Areas covered: This review summarizes the existing literature on the assessment of neuropsychological performance in symptom-based dimensions of OCD. Results of 23 studies are described and the methodological issues and challenges present in this body of literature are discussed.

Expert opinion: The current state of the literature precludes a meaningful meta-analysis of cognitive dysfunction across the breadth of symptom dimensions of OCD. This is due primarily to significant methodological differences observed between studies, both in terms of neuropsychological measures and symptom subtyping methods employed, and any resulting meta-analytic results would be biased by varying quality of evidence. Future studies addressing these limitations should include more consistent neuropsychology measures and methods of classifying OCD symptoms with the aim of reproducing the results of previous research to identify more concrete patterns of neuropsychological performance across dimensions; best practices and alternative approaches are discussed.

KEYWORDS:

• Obsessive-compulsive disorder
• neuropsychological performance
• subtypes
• dimensions
• symptom theme

Article highlights

• A total of 23 studies assessing neuropsychological task performance across symptom dimensions of OCD were retrieved.

• Negative associations with performance or group differences were observed primarily for Washing, Checking and Symmetry symptoms.

• Numerous possible limitations include sample size, heterogeneous symptom presentations within subgroups, methods for defining symptom dimensions, Type I error, and inconsistent neuropsychological task implementation.

• Difficulty exists in determining whether neuropsychological performance underlies or is moderated by OCD symptoms.

• Future work should assess OCD beliefs as moderators of task performance.

• Recent work appears to trend towards core motivations underlying symptom presentation as driving cognitive performance.

Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.