From transdiagnostic compulsivity to clinical applications: a computational psychiatry approach to bridge research and clinic

Compulsivity, the maladaptive persistence of behaviour despite adverse consequences, is central to obsessive-compulsive disorder (OCD) and has been increasingly conceptualised as a transdiagnostic dimension spanning multiple neuropsychiatric disorders. Research within computational psychiatry has linked dimensional compulsivity to two candidate mechanisms: impaired goal-directed control and elevated metacognitive confidence. Here, we take a clinical perspective addressing how insights from these findings can be brought into practice. We first ask how dimensional compulsivity measures should be interpreted with respect to clinical presentations and discuss conflicts between the general population findings and clinical data. We highlight several challenges facing clinical implementation: effect sizes are small, goal-directed control has not been shown to change with either pharmacotherapy or psychological therapy, and the overconfidence associated with dimensional compulsivity contrasts with the reduced confidence reported in patients with OCD. We argue these discrepancies are informative rather than disqualifying and set out a translational roadmap for mechanistically informed detection and transdiagnostic intervention. Specifically, we suggest that screening and digital monitoring of dimensional compulsivity, combined with cognitive and mechanistic phenotyping to guide psychotherapy and pharmacotherapy, may ultimately improve outcomes across diagnostic boundaries.