title: Myth of the pure obsessional type in obsessive--compulsive disorder.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Department of Psychiatry, Center for Treatment and Study of Anxiety, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA. monnica@mail.med.upenn.edu
authors.forename: Monnica T
authors.initials: MT
authors.lastname: Williams
authors.forename: Samantha G
authors.initials: SG
authors.lastname: Farris
authors.forename: Eric
authors.initials: E
authors.lastname: Turkheimer
authors.forename: Anthony
authors.initials: A
authors.lastname: Pinto
authors.forename: Krystal
authors.initials: K
authors.lastname: Ozanick
authors.forename: Martin E
authors.initials: ME
authors.lastname: Franklin
authors.forename: Michael
authors.initials: M
authors.lastname: Liebowitz
authors.forename: H Blair
authors.initials: HB
authors.lastname: Simpson
authors.forename: Edna B
authors.initials: EB
authors.lastname: Foa
mesh_terms: D000328:Adult; D002562:Ceremonial Behavior; D002997:Clomipramine / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000145:classification / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy; D010552:Personality Assessment; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D013609:Taboo; D013850:Thinking
chemical_list: D002997:Clomipramine; D017367:Selective Serotonin Reuptake Inhibitors