Multimodal network localization of brain abnormalities and neuromodulation target identification in obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is associated with heterogeneous structural and functional brain abnormalities, yet their organization at the network level remains unclear. Here, we applied coordinate-based network mapping to integrate peak coordinates from voxel-based morphometry, executive function, and emotion processing studies, and linked them to a large-scale normative resting-state connectome. Three distributed networks were identified, corresponding to gray matter abnormalities, executive dysfunction, and emotion processing dysfunction. These networks converged on the basal ganglia system, while showing dissociable involvement of the salience and default mode networks. Permutation testing (1000 iterations) confirmed that the observed network configurations were unlikely to arise by chance. Comparative analyses revealed partial overlap with anxiety and major depressive disorder but preserved disorder-specific features. Neuromodulation targets showed differential correspondence with these networks: the dorsolateral prefrontal cortex and supplementary motor area aligned with the executive network, whereas the orbitofrontal cortex exhibited an opposing connectivity pattern. These findings provide a network-level framework for understanding OCD and may inform the optimization of targeted interventions.