Comparison of the Association Between Goal-Directed Planning and Self-reported Compulsivity vs Obsessive-Compulsive Disorder Diagnosis

Claire M. Gillan, Eyal Kalanthroff, Michael Evans, Hilary M. Weingarden, Ryan J. Jacoby, Marina Gershkovich, Ivar Snorrason, Raphael Campeas, Cynthia Cervoni, Nicholas Charles Crimarco, Yosef Sokol, Sarah L. Garnaat, Nicole C.R. Mclaughlin, Elizabeth A. Phelps, Anthony Pinto, Christina L. Boisseau, Sabine Wilhelm, Nathaniel D. Daw, H. B. Simpson

Research output: Contribution to journalArticle

Abstract

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 (β [SE],-0.02 [0.02]; P =.18). In contrast, a compulsivity dimension was negatively associated with goal-directed performance (β [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 (β [SE], 2.99 [0.63]; P <.001) and several indicators of WCST performance (eg, categories completed: β [SE],-0.57 [0.09]; P <.001), whereas OCD diagnosis was not (abstract reasoning: β [SE], 0.39 [0.66]; P =.56; categories completed: β [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 (β [SE], 2.92 [1.39]; P =.04), and general distress was associated with impaired goal-directed performance at baseline (β [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.

Original languageEnglish (US)
Pages (from-to)E1-E9
JournalJAMA Psychiatry
DOIs
StateAccepted/In press - Jan 1 2019

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Obsessive-Compulsive Disorder
Anxiety Disorders
Telephone
Internet
Statistical Factor Analysis
Psychiatry
Mental Health
Cross-Sectional Studies
Outcome Assessment (Health Care)
Interviews
Psychology

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Gillan, C. M., Kalanthroff, E., Evans, M., Weingarden, H. M., Jacoby, R. J., Gershkovich, M., ... Simpson, H. B. (Accepted/In press). Comparison of the Association Between Goal-Directed Planning and Self-reported Compulsivity vs Obsessive-Compulsive Disorder Diagnosis. JAMA Psychiatry, E1-E9. https://doi.org/10.1001/jamapsychiatry.2019.2998

Comparison of the Association Between Goal-Directed Planning and Self-reported Compulsivity vs Obsessive-Compulsive Disorder Diagnosis. / Gillan, Claire M.; Kalanthroff, Eyal; Evans, Michael; Weingarden, Hilary M.; Jacoby, Ryan J.; Gershkovich, Marina; Snorrason, Ivar; Campeas, Raphael; Cervoni, Cynthia; Crimarco, Nicholas Charles; Sokol, Yosef; Garnaat, Sarah L.; Mclaughlin, Nicole C.R.; Phelps, Elizabeth A.; Pinto, Anthony; Boisseau, Christina L.; Wilhelm, Sabine; Daw, Nathaniel D.; Simpson, H. B.

In: JAMA Psychiatry, 01.01.2019, p. E1-E9.

Research output: Contribution to journalArticle

Gillan, CM, Kalanthroff, E, Evans, M, Weingarden, HM, Jacoby, RJ, Gershkovich, M, Snorrason, I, Campeas, R, Cervoni, C, Crimarco, NC, Sokol, Y, Garnaat, SL, Mclaughlin, NCR, Phelps, EA, Pinto, A, Boisseau, CL, Wilhelm, S, Daw, ND & Simpson, HB 2019, 'Comparison of the Association Between Goal-Directed Planning and Self-reported Compulsivity vs Obsessive-Compulsive Disorder Diagnosis', JAMA Psychiatry, pp. E1-E9. https://doi.org/10.1001/jamapsychiatry.2019.2998
Gillan, Claire M. ; Kalanthroff, Eyal ; Evans, Michael ; Weingarden, Hilary M. ; Jacoby, Ryan J. ; Gershkovich, Marina ; Snorrason, Ivar ; Campeas, Raphael ; Cervoni, Cynthia ; Crimarco, Nicholas Charles ; Sokol, Yosef ; Garnaat, Sarah L. ; Mclaughlin, Nicole C.R. ; Phelps, Elizabeth A. ; Pinto, Anthony ; Boisseau, Christina L. ; Wilhelm, Sabine ; Daw, Nathaniel D. ; Simpson, H. B. / Comparison of the Association Between Goal-Directed Planning and Self-reported Compulsivity vs Obsessive-Compulsive Disorder Diagnosis. In: JAMA Psychiatry. 2019 ; pp. E1-E9.
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abstract = "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 (β [SE],-0.02 [0.02]; P =.18). In contrast, a compulsivity dimension was negatively associated with goal-directed performance (β [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 (β [SE], 2.99 [0.63]; P <.001) and several indicators of WCST performance (eg, categories completed: β [SE],-0.57 [0.09]; P <.001), whereas OCD diagnosis was not (abstract reasoning: β [SE], 0.39 [0.66]; P =.56; categories completed: β [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 (β [SE], 2.92 [1.39]; P =.04), and general distress was associated with impaired goal-directed performance at baseline (β [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.",
author = "Gillan, {Claire M.} and Eyal Kalanthroff and Michael Evans and Weingarden, {Hilary M.} and Jacoby, {Ryan J.} and Marina Gershkovich and Ivar Snorrason and Raphael Campeas and Cynthia Cervoni and Crimarco, {Nicholas Charles} and Yosef Sokol and Garnaat, {Sarah L.} and Mclaughlin, {Nicole C.R.} and Phelps, {Elizabeth A.} and Anthony Pinto and Boisseau, {Christina L.} and Sabine Wilhelm and Daw, {Nathaniel D.} and Simpson, {H. B.}",
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doi = "10.1001/jamapsychiatry.2019.2998",
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T1 - Comparison of the Association Between Goal-Directed Planning and Self-reported Compulsivity vs Obsessive-Compulsive Disorder Diagnosis

AU - Gillan, Claire M.

AU - Kalanthroff, Eyal

AU - Evans, Michael

AU - Weingarden, Hilary M.

AU - Jacoby, Ryan J.

AU - Gershkovich, Marina

AU - Snorrason, Ivar

AU - Campeas, Raphael

AU - Cervoni, Cynthia

AU - Crimarco, Nicholas Charles

AU - Sokol, Yosef

AU - Garnaat, Sarah L.

AU - Mclaughlin, Nicole C.R.

AU - Phelps, Elizabeth A.

AU - Pinto, Anthony

AU - Boisseau, Christina L.

AU - Wilhelm, Sabine

AU - Daw, Nathaniel D.

AU - Simpson, H. B.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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 (β [SE],-0.02 [0.02]; P =.18). In contrast, a compulsivity dimension was negatively associated with goal-directed performance (β [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 (β [SE], 2.99 [0.63]; P <.001) and several indicators of WCST performance (eg, categories completed: β [SE],-0.57 [0.09]; P <.001), whereas OCD diagnosis was not (abstract reasoning: β [SE], 0.39 [0.66]; P =.56; categories completed: β [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 (β [SE], 2.92 [1.39]; P =.04), and general distress was associated with impaired goal-directed performance at baseline (β [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.

AB - 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 (β [SE],-0.02 [0.02]; P =.18). In contrast, a compulsivity dimension was negatively associated with goal-directed performance (β [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 (β [SE], 2.99 [0.63]; P <.001) and several indicators of WCST performance (eg, categories completed: β [SE],-0.57 [0.09]; P <.001), whereas OCD diagnosis was not (abstract reasoning: β [SE], 0.39 [0.66]; P =.56; categories completed: β [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 (β [SE], 2.92 [1.39]; P =.04), and general distress was associated with impaired goal-directed performance at baseline (β [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.

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