Matti Cervin1, Sean Perrin2, Elin Olsson3, Kristina Aspvall4, Daniel A Geller5, Sabine Wilhelm5, Joseph McGuire6, Luisa Lázaro7, Agustin E Martínez-González8, Barbara Barcaccia9, Andrea Pozza10, Wayne K Goodman11, Tanya K Murphy12, İsmail Seçer13, José A Piqueras14, Tiscar Rodríguez-Jiménez15, Antonio Godoy16, Ana I Rosa-Alcázar17, Ángel Rosa-Alcázar18, Beatriz M Ruiz-García17, Eric A Storch11, David Mataix-Cols4. 1. Lund University, Lund, Sweden; Skåne Child and Adolescent Psychiatry, Lund, Sweden. Electronic address: matti.cervin@med.lu.se. 2. Lund University, Lund, Sweden. 3. Skåne Child and Adolescent Psychiatry, Lund, Sweden. 4. Karolinska Institutet and Stockholm Health Care Services, Stockholm, Sweden. 5. Massachusetts General Hospital and Harvard Medical School, Boston Massachusetts. 6. Johns Hopkins University School of Medicine, Baltimore Maryland. 7. Hospital Clínic, IDIBAPS, CIBERSAM, University of Barcelona, Spain. 8. University of Alicante, Alicante, Spain. 9. Sapienza University of Rome, Italy. 10. University of Florence, Italy. 11. Baylor College of Medicine, Houston, Texas. 12. University of South Florida, Tampa. 13. Atatürk University, Erzurum, Turkey. 14. University Miguel Hernandez de Elche, Alicante, Spain. 15. The Catholic University of San Antonio, Murcia, Spain. 16. University of Malaga, Malaga, Spain. 17. University of Murcia, Murcia, Spain. 18. Catholic University of Murcia, Murcia, Spain.
Abstract
OBJECTIVE: Obsessive-compulsive disorder (OCD) is a heterogeneous condition with well-established symptom dimensions across the lifespan. The objective of the present study was to use network analysis to investigate the internal structure of these dimensions in unselected schoolchildren and in children with OCD. METHOD: We estimated the network structure of OCD symptom dimensions in 6,991 schoolchildren and 704 children diagnosed with OCD from 18 sites across 6 countries. All participants completed the Obsessive-Compulsive Inventory-Child Version. RESULTS: In both the school-based and clinic-based samples, the OCD dimensions formed an interconnected network with doubting/checking emerging as a highly central node, that is, having strong connections to other symptom dimensions in the network. The centrality of the doubting/checking dimension was consistent across countries, sexes, age groups, clinical status, and tic disorder comorbidity. Network differences were observed for age and sex in the school-based but not the clinic-based samples. CONCLUSION: The centrality of doubting/checking in the network structure of childhood OCD adds to classic and recent conceptualizations of the disorder in which the important role of doubt in disorder severity and maintenance is highlighted. The present results suggest that doubting/checking is a potentially important target for further research into the etiology and treatment of childhood OCD.
OBJECTIVE:Obsessive-compulsive disorder (OCD) is a heterogeneous condition with well-established symptom dimensions across the lifespan. The objective of the present study was to use network analysis to investigate the internal structure of these dimensions in unselected schoolchildren and in children with OCD. METHOD: We estimated the network structure of OCD symptom dimensions in 6,991 schoolchildren and 704 children diagnosed with OCD from 18 sites across 6 countries. All participants completed the Obsessive-Compulsive Inventory-Child Version. RESULTS: In both the school-based and clinic-based samples, the OCD dimensions formed an interconnected network with doubting/checking emerging as a highly central node, that is, having strong connections to other symptom dimensions in the network. The centrality of the doubting/checking dimension was consistent across countries, sexes, age groups, clinical status, and tic disorder comorbidity. Network differences were observed for age and sex in the school-based but not the clinic-based samples. CONCLUSION: The centrality of doubting/checking in the network structure of childhood OCD adds to classic and recent conceptualizations of the disorder in which the important role of doubt in disorder severity and maintenance is highlighted. The present results suggest that doubting/checking is a potentially important target for further research into the etiology and treatment of childhood OCD.
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