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Published in: European Child & Adolescent Psychiatry 3/2017

01-03-2017 | Original Contribution

Structure and clinical correlates of obsessive–compulsive symptoms in a large sample of children and adolescents: a factor analytic study across five nations

Authors: D. R. M. A. Højgaard, E. L. Mortensen, T. Ivarsson, K. Hybel, G. Skarphedinsson, J. B. Nissen, R. Valderhaug, K. Dahl, B. Weidle, N. C. Torp, M. Grados, A. B. Lewin, K. H. Melin, E. A. Storch, L. H. Wolters, T. K. Murphy, E. J. S. Sonuga-Barke, P. H. Thomsen

Published in: European Child & Adolescent Psychiatry | Issue 3/2017

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Abstract

The underlying structure of obsessive–compulsive disorder (OCD) remains to be confirmed in child and adolescent populations. In this paper we report the first factor analytic study of individual OCD items from Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS). OCD symptoms were assessed using the CY-BOCS symptom checklist in a sample of 854 patients with OCD (7–18 years of age) recruited from clinics in five countries. Pooled data were subjected to exploratory and confirmatory factor analysis (CFA) to identify the optimal factor structure. Various models were tested for age and gender subgroups. Also, the invariance of the solution across age and gender was tested and associations with demographic and clinical factors were explored. A three-factor model provided the best-fit solution. It consisted of the following factors: (1) harm/sexual, (2) symmetry/hoarding, (3) contamination/cleaning. The factor structure was invariant for age and gender across subgroups. Factor one was significantly correlated with anxiety, and factor two with depression and anxiety. Factor three was negatively correlated with tic disorder and attention-deficit/hyperactivity disorder (ADHD). Females had higher scores on factor two than males. The OCD symptom structure in children and adolescents is consistent across age and gender and similar to results from recent child and adolescents although hoarding may not be a separate factor. Our three-factor structure is almost identical to that seen in early studies on adults. Common mental disorders had specific patterns of associations with the different factors.
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Literature
1.
go back to reference American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Publishing, ArlingtonCrossRef American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Publishing, ArlingtonCrossRef
6.
go back to reference Torp NC, Dahl K, Skarphedinsson G et al (2015) Effectiveness of cognitive behavior treatment for pediatric obsessive–compulsive disorder: acute outcomes from the Nordic long-term OCD Treatment Study (NordLOTS). Behav Res Ther 64:15–23. doi:10.1016/j.brat.2014.11.005 CrossRefPubMed Torp NC, Dahl K, Skarphedinsson G et al (2015) Effectiveness of cognitive behavior treatment for pediatric obsessive–compulsive disorder: acute outcomes from the Nordic long-term OCD Treatment Study (NordLOTS). Behav Res Ther 64:15–23. doi:10.​1016/​j.​brat.​2014.​11.​005 CrossRefPubMed
10.
go back to reference Leckman JF, Grice DE, Boardman J et al (1997) Symptoms of obsessive–compulsive disorder. Am J Psychiatry 154:911–917CrossRefPubMed Leckman JF, Grice DE, Boardman J et al (1997) Symptoms of obsessive–compulsive disorder. Am J Psychiatry 154:911–917CrossRefPubMed
13.
14.
go back to reference Geller DA, Biederman J, Faraone S et al (2001) Developmental aspects of obsessive compulsive disorder: findings in children, adolescents, and adults. J Nerv Ment Dis 189:471–477CrossRefPubMed Geller DA, Biederman J, Faraone S et al (2001) Developmental aspects of obsessive compulsive disorder: findings in children, adolescents, and adults. J Nerv Ment Dis 189:471–477CrossRefPubMed
25.
go back to reference Mataix-Cols D, Rauch SL, Manzo PA et al (1999) Use of factor-analyzed symptom dimensions to predict outcome with serotonin reuptake inhibitors and placebo in the treatment of obsessive–compulsive disorder. Am J Psychiatry 156:1409–1416PubMed Mataix-Cols D, Rauch SL, Manzo PA et al (1999) Use of factor-analyzed symptom dimensions to predict outcome with serotonin reuptake inhibitors and placebo in the treatment of obsessive–compulsive disorder. Am J Psychiatry 156:1409–1416PubMed
30.
go back to reference De Mathis MA, De Alvarenga P, Funaro G et al (2011) Gender differences in OCD: a literature review. Rev Bras Psiquiatr 33:390–399CrossRef De Mathis MA, De Alvarenga P, Funaro G et al (2011) Gender differences in OCD: a literature review. Rev Bras Psiquiatr 33:390–399CrossRef
31.
go back to reference Williams MT, Farris SG, Turkheimer EN et al (2014) The impact of symptom dimensions on outcome for exposure and ritual prevention therapy in obsessive–compulsive disorder. J Anxiety Disord 28:553–558CrossRefPubMedPubMedCentral Williams MT, Farris SG, Turkheimer EN et al (2014) The impact of symptom dimensions on outcome for exposure and ritual prevention therapy in obsessive–compulsive disorder. J Anxiety Disord 28:553–558CrossRefPubMedPubMedCentral
32.
go back to reference American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edn (text revision), American Psychiatric Association, Washington, DC. doi:10.1002/jps.3080051129 American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edn (text revision), American Psychiatric Association, Washington, DC. doi:10.​1002/​jps.​3080051129
38.
go back to reference Holmgren Melin K, Skärsäter I, Mowatt Haugland BS, Ivarsson T (2015) Treatment and 12-month outcome of children and adolescents with obsessive–compulsive disorder: a naturalistic study. J Obsessive Compuls Relat Disord 6:1–6. doi:10.1016/j.jocrd.2015.04.002 CrossRef Holmgren Melin K, Skärsäter I, Mowatt Haugland BS, Ivarsson T (2015) Treatment and 12-month outcome of children and adolescents with obsessive–compulsive disorder: a naturalistic study. J Obsessive Compuls Relat Disord 6:1–6. doi:10.​1016/​j.​jocrd.​2015.​04.​002 CrossRef
39.
go back to reference Wolters LH (2013) Towards improving treatment for childhood OCD: analyzing mediating mechanisms and non-response. University of Amsterdam, Amsterdam Wolters LH (2013) Towards improving treatment for childhood OCD: analyzing mediating mechanisms and non-response. University of Amsterdam, Amsterdam
41.
go back to reference Kaufman J, Birmaher B, Brent D et al (1997) Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 36:980–988. doi:10.1097/00004583-199707000-00021 CrossRefPubMed Kaufman J, Birmaher B, Brent D et al (1997) Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 36:980–988. doi:10.​1097/​00004583-199707000-00021 CrossRefPubMed
42.
go back to reference Silverman WK, Saavedra LM, Pina AA (2001) Test-retest reliability of anxiety symptoms and diagnoses with the Anxiety Disorders Interview Schedule for DSM-IV: child and parent versions. J Am Acad Child Adolesc Psychiatry 40:937–944. doi:10.1097/00004583-200108000-00016 CrossRefPubMed Silverman WK, Saavedra LM, Pina AA (2001) Test-retest reliability of anxiety symptoms and diagnoses with the Anxiety Disorders Interview Schedule for DSM-IV: child and parent versions. J Am Acad Child Adolesc Psychiatry 40:937–944. doi:10.​1097/​00004583-200108000-00016 CrossRefPubMed
43.
go back to reference Cronbach LJ (1951) Coefficient alpha and the internal structure of tests. Psychometrika 16:297–334CrossRef Cronbach LJ (1951) Coefficient alpha and the internal structure of tests. Psychometrika 16:297–334CrossRef
46.
go back to reference Kubinger KD (2003) On artificial results due to using factor analysis for dichotomous variables. Psychology 45:106–110 Kubinger KD (2003) On artificial results due to using factor analysis for dichotomous variables. Psychology 45:106–110
47.
go back to reference StataCorp (2013) Stata statistical software: release 13. StataCorp LP, College Station, TX StataCorp (2013) Stata statistical software: release 13. StataCorp LP, College Station, TX
48.
go back to reference Muthén LK, Muthén BO (1998-2015) Mplus user’s guide, 7th edn. Muthén and Muthén, Los Angeles, CA Muthén LK, Muthén BO (1998-2015) Mplus user’s guide, 7th edn. Muthén and Muthén, Los Angeles, CA
51.
go back to reference Yu C (2002) Evaluating cutoff criteria of model fit indices for latent variable models with binary and continuous outcomes. University of California, Oakland Yu C (2002) Evaluating cutoff criteria of model fit indices for latent variable models with binary and continuous outcomes. University of California, Oakland
52.
go back to reference Geller DA, Hoog SL, Heiligenstein JH et al (2001) Fluoxetine treatment for obsessive–compulsive disorder in children and adolescents: a placebo-controlled clinical trial. J Am Acad Child Adolesc Psychiatry 40:773–779CrossRefPubMed Geller DA, Hoog SL, Heiligenstein JH et al (2001) Fluoxetine treatment for obsessive–compulsive disorder in children and adolescents: a placebo-controlled clinical trial. J Am Acad Child Adolesc Psychiatry 40:773–779CrossRefPubMed
55.
go back to reference Baer L (1994) Factor analysis of symptom subtypes of obsessive compulsive disorder and their relation to personality and tic disorders. J Clin Psychiatry 55(Suppl):18–23PubMed Baer L (1994) Factor analysis of symptom subtypes of obsessive compulsive disorder and their relation to personality and tic disorders. J Clin Psychiatry 55(Suppl):18–23PubMed
56.
go back to reference Hantouche EG, Lancrenon S (1996) Modern typology of symptoms and obsessive–compulsive syndromes: results of a large French study of 615 patients. Encephale 22(Spec No):9–21PubMed Hantouche EG, Lancrenon S (1996) Modern typology of symptoms and obsessive–compulsive syndromes: results of a large French study of 615 patients. Encephale 22(Spec No):9–21PubMed
57.
go back to reference Stein DJ, Carey PD, Lochner C et al (2008) Escitalopram in obsessive–compulsive disorder: response of symptom dimensions to pharmacotherapy. CNS Spectr 13:492–498CrossRefPubMed Stein DJ, Carey PD, Lochner C et al (2008) Escitalopram in obsessive–compulsive disorder: response of symptom dimensions to pharmacotherapy. CNS Spectr 13:492–498CrossRefPubMed
58.
go back to reference Girishchandra BG, Khanna S (2001) Phenomenology of obsessive compulsive disorder: a factor analytic approach. Indian J Psychiatry 43:306–316PubMedPubMedCentral Girishchandra BG, Khanna S (2001) Phenomenology of obsessive compulsive disorder: a factor analytic approach. Indian J Psychiatry 43:306–316PubMedPubMedCentral
59.
go back to reference Denys D, De Geus F, Van Megen HJGM, Westenberg HGM (2004) Symptom dimensions in obsessive–compulsive disorder: factor analysis on a clinician-rated scale and a self-report measure. Psychopathology 37:181–189. doi:10.1159/000079509 CrossRefPubMed Denys D, De Geus F, Van Megen HJGM, Westenberg HGM (2004) Symptom dimensions in obsessive–compulsive disorder: factor analysis on a clinician-rated scale and a self-report measure. Psychopathology 37:181–189. doi:10.​1159/​000079509 CrossRefPubMed
60.
Metadata
Title
Structure and clinical correlates of obsessive–compulsive symptoms in a large sample of children and adolescents: a factor analytic study across five nations
Authors
D. R. M. A. Højgaard
E. L. Mortensen
T. Ivarsson
K. Hybel
G. Skarphedinsson
J. B. Nissen
R. Valderhaug
K. Dahl
B. Weidle
N. C. Torp
M. Grados
A. B. Lewin
K. H. Melin
E. A. Storch
L. H. Wolters
T. K. Murphy
E. J. S. Sonuga-Barke
P. H. Thomsen
Publication date
01-03-2017
Publisher
Springer Berlin Heidelberg
Published in
European Child & Adolescent Psychiatry / Issue 3/2017
Print ISSN: 1018-8827
Electronic ISSN: 1435-165X
DOI
https://doi.org/10.1007/s00787-016-0887-5

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