Network Analysis of Cognitive-Behavioral Symptom Connectivity in OCD Subtypes: Evaluating SSRI Treatment Response and Resistance

Abstract

Background

This study employed network analysis to predict treatment responses, focusing on obsessive beliefs and symptoms within the contamination/cleaning and danger/checking subtypes of obsessive–compulsive disorder (OCD).

Methods

The study analyzed pre-test and post-test data from a 12-week open-label phase involving 140 patients who underwent a 12-week regimen of Selective Serotonin Reuptake Inhibitors (SSRIs), followed by evaluations. Participants were categorized based on their response to therapy and OCD subtypes. Network analysis was used to assess the interconnections among obsessive beliefs, symptoms, and treatment responses before and after the intervention within the identified OCD subtypes. Additionally, the study explored the network structure among patients with treatment-responsive OCD and those with treatment-resistant OCD within each subtype.

Results

In both subtypes, the pre-test network structure of treatment-resistant OCD exhibited stronger interconnections compared to treatment-responsive OCD. Additionally, a significant difference in global strength (P < 0.05) was observed between treatment-resistant OCD and treatment responders. In the initial assessment, which included both responders and non-responders, global strength and symptom connectivity were higher in the Checking subtype compared to the Contamination/Cleaning subtype (P < 0.05). Notably, the central symptoms in contamination/cleaning treatment-resistant OCD were obsessive beliefs related to "Disgust,” "Sexual," and "Punishment." In contrast, in the check/danger treatment-resistant OCD, the most central symptoms were "Sinful,” "Accident," and "Unsafe" obsessive beliefs, along with "Throwaway" obsessive symptoms.

Conclusions

Obsessive symptoms and beliefs can serve as predictors of treatment responses across different OCD subtypes.