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JAMA Psychiatry. 2019 Oct 9:1-10. doi: 10.1001/jamapsychiatry.2019.2998. [Epub ahead of print]

Comparison of the Association Between Goal-Directed Planning and Self-reported Compulsivity vs Obsessive-Compulsive Disorder Diagnosis.

Author information

School of Psychology, Trinity College Institute of Neuroscience and Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.
Department of Psychology, The Hebrew University of Jerusalem, Mount Scopus, Israel.
Department of Psychology, New York University, New York.
Department of Psychiatry, Massachusetts General Hospital, Boston.
Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
Department of Psychiatry, Columbia Irving University Medical Center, New York, New York.
New York State Psychiatric Institute, New York.
Department of Psychiatry, Harvard Medical School, McLean Hospital, Belmont, Massachusetts.
Department of Psychiatry, Stony Brook University, Stony Brook, New York.
VISN 2 Mental Illness Research Education and Clinical Centers, New York, New York.
James J. Peters Veterans Affairs Medical Center, Bronx, New York.
Icahn School of Medicine at Mount Sinai, New York, New York.
Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Butler Hospital, Providence, Rhode Island.
Department of Psychology, Harvard University, Cambridge, Massachusetts.
Department of Psychiatry, Hofstra Northwell School of Medicine, Hempstead, New York.
Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Princeton Neuroscience Institute, Department of Psychology, Princeton University, Princeton, New Jersey.



Dimensional definitions of transdiagnostic mental health problems have been suggested as an alternative to categorical diagnoses, having the advantage of capturing heterogeneity within diagnostic categories and similarity across them and bridging more naturally psychological and neural substrates.


To examine whether a self-reported compulsivity dimension has a stronger association with goal-directed and related higher-order cognitive deficits compared with a diagnosis of obsessive-compulsive disorder (OCD).

Design, Setting, and Participants:

In this cross-sectional study, patients with OCD and/or generalized anxiety disorder (GAD) from across the United States completed a telephone-based diagnostic interview by a trained rater, internet-based cognitive testing, and self-reported clinical assessments from October 8, 2015, to October 1, 2017. Follow-up data were collected to test for replicability.

Main Outcomes and Measures:

Performance was measured on a test of goal-directed planning and cognitive flexibility (Wisconsin Card Sorting Test [WCST]) and a test of abstract reasoning. Clinical variables included DSM-5 diagnosis of OCD and GAD and 3 psychiatric symptom dimensions (general distress, compulsivity, and obsessionality) derived from a factor analysis.


Of 285 individuals in the analysis (mean [SD] age, 32 [12] years; age range, 18-77 years; 219 [76.8%] female), 111 had OCD; 82, GAD; and 92, OCD and GAD. A diagnosis of OCD was not associated with goal-directed performance compared with GAD at baseline (β [SE], -0.02 [0.02]; P = .18). In contrast, a compulsivity dimension was negatively associated with goal-directed performance (β [SE], -0.05 [0.02]; P = .003). Results for abstract reasoning task and WCST mirrored this pattern; the compulsivity dimension was associated with abstract reasoning (β [SE], 2.99 [0.63]; P < .001) and several indicators of WCST performance (eg, categories completed: β [SE], -0.57 [0.09]; P < .001), whereas OCD diagnosis was not (abstract reasoning: β [SE], 0.39 [0.66]; P = .56; categories completed: β [SE], -0.09 [0.10]; P = .38). Other symptom dimensions relevant to OCD, obsessionality, and general distress had no reliable association with goal-directed performance, WCST, or abstract reasoning. Obsessionality had a positive association with requiring more trials to reach the first category on the WCST at baseline (β [SE], 2.92 [1.39]; P = .04), and general distress was associated with impaired goal-directed performance at baseline (β [SE],-0.04 [0.02]; P = .01). However, unlike the key results of this study, neither survived correction for multiple comparisons or was replicated at follow-up testing.

Conclusions and Relevance:

Deficits in goal-directed planning in OCD may be more strongly associated with a compulsivity dimension than with OCD diagnosis. This result may have implications for research assessing the association between brain mechanisms and clinical manifestations and for understanding the structure of mental illness.

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