Subtypes of Pediatric Obsessive-Compulsive Disorder: Insights from Recent Collaborative Research

Aims<br/>To investigate key dimensions of pediatric obsessive-compulsive disorder (OCD). The first study explored commonalities among OCD-affected youth to better conceptualize disorder presentation and associated features. The second examined the p-factor’s ability to predict short- and long-term outcomes in youth with OCD. The third compared clinical features and cognitive-behavioral therapy (CBT) responses between participants with and without psychotic vulnerability.<br/>Methods<br/>The studies utilized the NordLOTS sample (N = 269) of children and adolescents with OCD. Study one combined this sample with others from the USA, Canada, Sweden, Australia, and Iceland (N = 830). Study three compared the NordLOTS sample with a North American sample (n = 125).<br/>Results<br/>In study one, a four-cluster model distinguished groups by symptom expression and comorbidities, with clusters remaining stable across solutions. Study two found the p-factor predicted short-term OCD severity and psychosocial functioning, but not depressive symptoms or quality of life. Over the long term, the p-factor predicted all outcomes except OCD severity and outperformed traditional comorbidity measures. Study three revealed psychotic vulnerability in 41.6% of the Scandinavian sample and 34.4% of the North American sample. Those with psychotic vulnerability had worse baseline depressive symptoms and psychosocial functioning. Post-CBT, Scandinavian youth exhibited poorer psychosocial functioning and more symmetry/hoarding symptoms, while North Americans had more contamination-cleaning symptoms. Psychotic vulnerability did not affect CBT outcomes.<br/>Conclusions<br/>Results highlight the value of dimensional and transdiagnostic approaches in conceptualizing pediatric OCD. The p-factor offers superior prognostic utility, and psychosis risk evaluation is critical in youth with OCD.