Obsessive-compulsive disorder: Subclassification based on co-morbidity

G. Nestadt, C. Z. Di, M. A. Riddle, M. A. Grados, B. D. Greenberg, A. J. Fyer, J. T. McCracken, S. L. Rauch, D. L. Murphy, S. A. Rasmussen, B. Cullen, A. Pinto, J. A. Knowles, J. Piacentini, D. L. Pauls, O. J. Bienvenu, Y. Wang, K. Y. Liang, J. F. Samuels, K. Bandeen Roche

Research output: Contribution to journalArticlepeer-review


Background. Obsessive-compulsive disorder (OCD) is probably an etiologically heterogeneous condition. Many patients manifest other psychiatric syndromes. This study investigated the relationship between OCD and co-morbid conditions to identify subtypes. Method. Seven hundred and six individuals with OCD were assessed in the OCD Collaborative Genetics Study (OCGS). Multi-level latent class analysis was conducted based on the presence of eight co-morbid psychiatric conditions [generalized anxiety disorder (GAD), major depression, panic disorder (PD), separation anxiety disorder (SAD), tics, mania, somatization disorders (Som) and grooming disorders (GrD)]. The relationship of the derived classes to specific clinical characteristics was investigated. Results. Two and three classes of OCD syndromes emerge from the analyses. The two-class solution describes lesser and greater co-morbidity classes and the more descriptive three-class solution is characterized by: (1) an OCD simplex class, in which major depressive disorder (MDD) is the most frequent additional disorder; (2) an OCD co-morbid tic-related class, in which tics are prominent and affective syndromes are considerably rarer; and (3) an OCD co-morbid affective-related class in which PD and affective syndromes are highly represented. The OCD co-morbid tic-related class is predominantly male and characterized by high conscientiousness. The OCD co-morbid affective-related class is predominantly female, has a young age at onset, obsessive-compulsive personality disorder (OCPD) features, high scores on the 'taboo' factor of OCD symptoms, and low conscientiousness. Conclusions. OCD can be classified into three classes based on co-morbidity. Membership within a class is differentially associated with other clinical characteristics. These classes, if replicated, should have important implications for research and clinical endeavors.

Original languageEnglish (US)
Pages (from-to)1491-1501
Number of pages11
JournalPsychological medicine
Issue number9
StatePublished - Sep 2009


  • Latent class
  • OCD
  • Subtypes

ASJC Scopus subject areas

  • Applied Psychology
  • Psychiatry and Mental health

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