Symptom dimensions of pediatric obsessive-compulsive Disorder: Exploratory examination of associations with clinical features and response to cognitive-behavioral therapy

Several overarching symptom dimensions have been identified within pediatric obsessive-compulsive disorder (OCD), including doubting, obsessing, washing, ordering, neutralizing, and hoarding. These unique symptom presentations may have important clinical implications, especially in terms of potentially distinct associations with age, functional impairment, insight, family accommodation, and symptoms of anxiety and depression. Such symptom dimensions may also differ in their responsiveness to cognitive-behavioral therapy (CBT). Existing literature on the features associated with, and the clinical impact of, OCD dimensions has primarily focused on adults and has often employed measures that make standardized categorization of OCD dimensions across studies more challenging. In the present exploratory study, we examined the clinical features and treatment outcomes associated with different OCD symptom dimensions measured by the Obsessive-Compulsive Inventory-Children's Version (OCI-CV) using data from a previously completed clinical trial. A secondary analysis of data collected from 161 primarily White/non-Hispanic youth (M_age = 12.19) enrolled in a randomized control trial of d-cycloserine-augmented CBT with exposure and response prevention revealed differential relations between clinical features and OCD symptom dimensions at baseline, particularly related to doubting symptoms which were associated with all measured clinical features except insight. However, the rate of improvement in OCD symptom severity during CBT did not differ as a function of OCD symptom dimension. The present study provides evidence that youth can benefit from CBT despite differences in clinical features associated with OCD symptom dimensions. Findings suggest that mental health providers can deliver idiographically tailored gold standard CBT flexibly to youth regardless of OCD symptom dimensionality.