Myth of the pure obsessional type in obsessive-compulsive disorder

Monnica T. Williams, Samantha G. Farris, Eric Turkheimer, Anthony Pinto, Krystal Ozanick, Martin E. Franklin, Michael Liebowitz, H. Blair Simpson, Edna B. Foa

Research output: Contribution to journalArticlepeer-review

62 Scopus citations


Background: Several studies have identified discrete symptom dimensions in obsessive-compulsive disorder (OCD), derived from factor analyses of the individual items or symptom categories of the Yale-Brown Obsessive-Compulsive Scale Symptom Checklist (YBOCS-SC). This study aims to extend previous work on the relationship between obsessions and compulsions by specifically including mental compulsions and reassurance-seeking. Because these compulsions have traditionally been omitted from prior factor analytic studies, their association to what have been called "pure obsessions" may have been overlooked. Method: Participants (N5201) were recruited from two multi-site randomized clinical treatment trials for OCD. The YBOCS-SC was used to assess OCD symptoms, as it includes a comprehensive list of obsessions and compulsions, arranged by content category. Each category was given a score based on whether symptoms were present and if the symptom was a primary target of clinical concern, and a factor analysis was conducted. Mental compulsions and reassurance-seeking were considered separate categories for the analysis. Results: Using an orthogonal geomin rotation of 16 YBOCS-SC categories/items, we found a five-factor solution that explained 67% of the total variance. Inspection of items that composed each factor suggests five familiar constructs, with mental compulsions and reassurance-seeking included with sexual, aggressive, and religious obsessions (unacceptable/taboo thoughts). Conclusions: This study suggests that the concept of the "pure obsessional" (e.g., patients with unacceptable/taboo thoughts yet no compulsions) may be a misnomer, as these obsessions were factorially associated with mental compulsions and reassurance-seeking in these samples. These findings may have implications for DSM-5 diagnostic criteria.

Original languageEnglish (US)
Pages (from-to)495-500
Number of pages6
JournalDepression and anxiety
Issue number6
StatePublished - Jun 2011
Externally publishedYes


  • Factor analysis
  • Obsessions
  • Obsessive-compulsive disorder
  • Symptom dimensions

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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