Four-factor structure of obsessive-compulsive disorder symptoms in children, adolescents, and adults.
OBJECTIVE
To determine whether the four-factor category-based obsessive-compulsive disorder (OCD) symptom structure from a previous confirmatory factor analysis (CFA) may be appropriately used in child, adolescent, and adult groups. Symptom dimensions are increasingly used as quantitative traits in genetic, neuroimaging, and treatment studies of OCD across all ages. Identification of a category-based OCD symptom dimension structure that is validated for use across child, adolescent, and adult age groups is necessary to guide ongoing translational research.


METHODS
Four OCD samples comprising 356 individuals were divided into child, adolescent, and adult groups. The fit of the only CFA-defined four-factor model was compared across these independent age group samples. Multiple-group CFA using maximum likelihood estimation assessed adequacy of fit comparing unconstrained and measurement weight-constrained models. The fit of previous exploratory factor analysis-defined three- and five-factor models on adults was also examined using CFA.


RESULTS
A four-factor solution provided adequate but imperfect fit across age groups, with comparable indices to the only previous OCD CFA: factor 1 (aggressive/sexual/religious/somatic/checking); factor 2 (symmetry/ordering/counting/repeating); factor 3 (contamination/cleaning), and factor 4 (hoarding). Models in which factor loadings were constrained and unconstrained across the three age groups yielded comparable model fit. Factors were highly correlated and were not mutually exclusive. The four-factor solution provided an improved fit to both three- and five-factor solutions using CFA across the three age groups.


CONCLUSIONS
A four-factor, CFA-defined, category-based model of OCD symptom dimensions is adequate for use in children, adolescents, and adult age groups. The factor structure of this multiple age group sample has limitations and is imperfect, but current findings support the comparability of the defined latent OCD dimensions across age groups. Further work is needed to optimize a comprehensive symptom dimension model reflecting clinical heterogeneity for use in emergent translational studies.
Drs. Stewart, Baer, Scharf, Illmann, Geller, Jenike, and Pauls are with Massachusetts General Hospital-Harvard Medical School; Dr. Rosario is with the Federal University of São Paulo; Dr. Carter is with the University of Massachusetts; Dr. Brown is with Boston University; Drs. Leckman and Sukhodolsky and Ms. Katsovitch are with Yale University; Dr. Rasmussen is with Brown University; Dr. Goodman is with the National Institutes of Health; Drs. Chabane and Delorme are with Robert Debré Hospital; and Dr. Leboyer is with Mondor-Chenevier Hospital.
S Evelyn
SE
Stewart
Drs. Stewart, Baer, Scharf, Illmann, Geller, Jenike, and Pauls are with Massachusetts General Hospital-Harvard Medical School; Dr. Rosario is with the Federal University of São Paulo; Dr. Carter is with the University of Massachusetts; Dr. Brown is with Boston University; Drs. Leckman and Sukhodolsky and Ms. Katsovitch are with Yale University; Dr. Rasmussen is with Brown University; Dr. Goodman is with the National Institutes of Health; Drs. Chabane and Delorme are with Robert Debré Hospital; and Dr. Leboyer is with Mondor-Chenevier Hospital.
Maria C
MC
Rosario
Drs. Stewart, Baer, Scharf, Illmann, Geller, Jenike, and Pauls are with Massachusetts General Hospital-Harvard Medical School; Dr. Rosario is with the Federal University of São Paulo; Dr. Carter is with the University of Massachusetts; Dr. Brown is with Boston University; Drs. Leckman and Sukhodolsky and Ms. Katsovitch are with Yale University; Dr. Rasmussen is with Brown University; Dr. Goodman is with the National Institutes of Health; Drs. Chabane and Delorme are with Robert Debré Hospital; and Dr. Leboyer is with Mondor-Chenevier Hospital.
Lee
L
Baer
Drs. Stewart, Baer, Scharf, Illmann, Geller, Jenike, and Pauls are with Massachusetts General Hospital-Harvard Medical School; Dr. Rosario is with the Federal University of São Paulo; Dr. Carter is with the University of Massachusetts; Dr. Brown is with Boston University; Drs. Leckman and Sukhodolsky and Ms. Katsovitch are with Yale University; Dr. Rasmussen is with Brown University; Dr. Goodman is with the National Institutes of Health; Drs. Chabane and Delorme are with Robert Debré Hospital; and Dr. Leboyer is with Mondor-Chenevier Hospital.
Alice S
AS
Carter
Drs. Stewart, Baer, Scharf, Illmann, Geller, Jenike, and Pauls are with Massachusetts General Hospital-Harvard Medical School; Dr. Rosario is with the Federal University of São Paulo; Dr. Carter is with the University of Massachusetts; Dr. Brown is with Boston University; Drs. Leckman and Sukhodolsky and Ms. Katsovitch are with Yale University; Dr. Rasmussen is with Brown University; Dr. Goodman is with the National Institutes of Health; Drs. Chabane and Delorme are with Robert Debré Hospital; and Dr. Leboyer is with Mondor-Chenevier Hospital.
Timothy A
TA
Brown
Drs. Stewart, Baer, Scharf, Illmann, Geller, Jenike, and Pauls are with Massachusetts General Hospital-Harvard Medical School; Dr. Rosario is with the Federal University of São Paulo; Dr. Carter is with the University of Massachusetts; Dr. Brown is with Boston University; Drs. Leckman and Sukhodolsky and Ms. Katsovitch are with Yale University; Dr. Rasmussen is with Brown University; Dr. Goodman is with the National Institutes of Health; Drs. Chabane and Delorme are with Robert Debré Hospital; and Dr. Leboyer is with Mondor-Chenevier Hospital.
Jeremiah M
JM
Scharf
Drs. Stewart, Baer, Scharf, Illmann, Geller, Jenike, and Pauls are with Massachusetts General Hospital-Harvard Medical School; Dr. Rosario is with the Federal University of São Paulo; Dr. Carter is with the University of Massachusetts; Dr. Brown is with Boston University; Drs. Leckman and Sukhodolsky and Ms. Katsovitch are with Yale University; Dr. Rasmussen is with Brown University; Dr. Goodman is with the National Institutes of Health; Drs. Chabane and Delorme are with Robert Debré Hospital; and Dr. Leboyer is with Mondor-Chenevier Hospital.
Cornelia
C
Illmann
Drs. Stewart, Baer, Scharf, Illmann, Geller, Jenike, and Pauls are with Massachusetts General Hospital-Harvard Medical School; Dr. Rosario is with the Federal University of São Paulo; Dr. Carter is with the University of Massachusetts; Dr. Brown is with Boston University; Drs. Leckman and Sukhodolsky and Ms. Katsovitch are with Yale University; Dr. Rasmussen is with Brown University; Dr. Goodman is with the National Institutes of Health; Drs. Chabane and Delorme are with Robert Debré Hospital; and Dr. Leboyer is with Mondor-Chenevier Hospital.
James F
JF
Leckman
Drs. Stewart, Baer, Scharf, Illmann, Geller, Jenike, and Pauls are with Massachusetts General Hospital-Harvard Medical School; Dr. Rosario is with the Federal University of São Paulo; Dr. Carter is with the University of Massachusetts; Dr. Brown is with Boston University; Drs. Leckman and Sukhodolsky and Ms. Katsovitch are with Yale University; Dr. Rasmussen is with Brown University; Dr. Goodman is with the National Institutes of Health; Drs. Chabane and Delorme are with Robert Debré Hospital; and Dr. Leboyer is with Mondor-Chenevier Hospital.
Denis
D
Sukhodolsky
Drs. Stewart, Baer, Scharf, Illmann, Geller, Jenike, and Pauls are with Massachusetts General Hospital-Harvard Medical School; Dr. Rosario is with the Federal University of São Paulo; Dr. Carter is with the University of Massachusetts; Dr. Brown is with Boston University; Drs. Leckman and Sukhodolsky and Ms. Katsovitch are with Yale University; Dr. Rasmussen is with Brown University; Dr. Goodman is with the National Institutes of Health; Drs. Chabane and Delorme are with Robert Debré Hospital; and Dr. Leboyer is with Mondor-Chenevier Hospital.
Lilya
L
Katsovich
Drs. Stewart, Baer, Scharf, Illmann, Geller, Jenike, and Pauls are with Massachusetts General Hospital-Harvard Medical School; Dr. Rosario is with the Federal University of São Paulo; Dr. Carter is with the University of Massachusetts; Dr. Brown is with Boston University; Drs. Leckman and Sukhodolsky and Ms. Katsovitch are with Yale University; Dr. Rasmussen is with Brown University; Dr. Goodman is with the National Institutes of Health; Drs. Chabane and Delorme are with Robert Debré Hospital; and Dr. Leboyer is with Mondor-Chenevier Hospital.
Steven
S
Rasmussen
Drs. Stewart, Baer, Scharf, Illmann, Geller, Jenike, and Pauls are with Massachusetts General Hospital-Harvard Medical School; Dr. Rosario is with the Federal University of São Paulo; Dr. Carter is with the University of Massachusetts; Dr. Brown is with Boston University; Drs. Leckman and Sukhodolsky and Ms. Katsovitch are with Yale University; Dr. Rasmussen is with Brown University; Dr. Goodman is with the National Institutes of Health; Drs. Chabane and Delorme are with Robert Debré Hospital; and Dr. Leboyer is with Mondor-Chenevier Hospital.
Wayne
W
Goodman
Drs. Stewart, Baer, Scharf, Illmann, Geller, Jenike, and Pauls are with Massachusetts General Hospital-Harvard Medical School; Dr. Rosario is with the Federal University of São Paulo; Dr. Carter is with the University of Massachusetts; Dr. Brown is with Boston University; Drs. Leckman and Sukhodolsky and Ms. Katsovitch are with Yale University; Dr. Rasmussen is with Brown University; Dr. Goodman is with the National Institutes of Health; Drs. Chabane and Delorme are with Robert Debré Hospital; and Dr. Leboyer is with Mondor-Chenevier Hospital.
Richard
R
Delorme
Drs. Stewart, Baer, Scharf, Illmann, Geller, Jenike, and Pauls are with Massachusetts General Hospital-Harvard Medical School; Dr. Rosario is with the Federal University of São Paulo; Dr. Carter is with the University of Massachusetts; Dr. Brown is with Boston University; Drs. Leckman and Sukhodolsky and Ms. Katsovitch are with Yale University; Dr. Rasmussen is with Brown University; Dr. Goodman is with the National Institutes of Health; Drs. Chabane and Delorme are with Robert Debré Hospital; and Dr. Leboyer is with Mondor-Chenevier Hospital.
Marion
M
Leboyer
Drs. Stewart, Baer, Scharf, Illmann, Geller, Jenike, and Pauls are with Massachusetts General Hospital-Harvard Medical School; Dr. Rosario is with the Federal University of São Paulo; Dr. Carter is with the University of Massachusetts; Dr. Brown is with Boston University; Drs. Leckman and Sukhodolsky and Ms. Katsovitch are with Yale University; Dr. Rasmussen is with Brown University; Dr. Goodman is with the National Institutes of Health; Drs. Chabane and Delorme are with Robert Debré Hospital; and Dr. Leboyer is with Mondor-Chenevier Hospital.
Nadia
N
Chabane
Drs. Stewart, Baer, Scharf, Illmann, Geller, Jenike, and Pauls are with Massachusetts General Hospital-Harvard Medical School; Dr. Rosario is with the Federal University of São Paulo; Dr. Carter is with the University of Massachusetts; Dr. Brown is with Boston University; Drs. Leckman and Sukhodolsky and Ms. Katsovitch are with Yale University; Dr. Rasmussen is with Brown University; Dr. Goodman is with the National Institutes of Health; Drs. Chabane and Delorme are with Robert Debré Hospital; and Dr. Leboyer is with Mondor-Chenevier Hospital.
Michael A
MA
Jenike
Drs. Stewart, Baer, Scharf, Illmann, Geller, Jenike, and Pauls are with Massachusetts General Hospital-Harvard Medical School; Dr. Rosario is with the Federal University of São Paulo; Dr. Carter is with the University of Massachusetts; Dr. Brown is with Boston University; Drs. Leckman and Sukhodolsky and Ms. Katsovitch are with Yale University; Dr. Rasmussen is with Brown University; Dr. Goodman is with the National Institutes of Health; Drs. Chabane and Delorme are with Robert Debré Hospital; and Dr. Leboyer is with Mondor-Chenevier Hospital.
Daniel A
DA
Geller
Drs. Stewart, Baer, Scharf, Illmann, Geller, Jenike, and Pauls are with Massachusetts General Hospital-Harvard Medical School; Dr. Rosario is with the Federal University of São Paulo; Dr. Carter is with the University of Massachusetts; Dr. Brown is with Boston University; Drs. Leckman and Sukhodolsky and Ms. Katsovitch are with Yale University; Dr. Rasmussen is with Brown University; Dr. Goodman is with the National Institutes of Health; Drs. Chabane and Delorme are with Robert Debré Hospital; and Dr. Leboyer is with Mondor-Chenevier Hospital. Electronic address: pauls@pngu.mgh.harvard.edu.
David L
DL
Pauls
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D015233:Models, Statistical; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis* / Q000523:psychology; D010552:Personality Assessment / Q000706:statistics & numerical data*; D011594:Psychometrics / Q000706:statistics & numerical data; D015203:Reproducibility of Results