Subtypes of Severe OCD and Treatment Outcome: A Latent Profile Analysis of the Yale-Brown Obsessive-Compulsive Severity Scale.

Abstract

Background: The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is the gold standard measure of OCD and the most common tool to assess OCD severity and treatment outcome. Relying on Y-BOCS total scores likely to capture overall severity well, but may obscure important qualitatively different OCD profiles. The current study aimed to identify profiles of OCD and their association to obsession/compulsion content domains (e.g., contamination), and treatment outcomes.

Methods: Participants were adults 759 (49% women) seeking partial/residential treatment for severe OCD. The sample was on average 29.81(SD=11.95) years old and predominantly White (85%). Latent profile analysis was used to identify patterns of OCD symptoms using the self-reported Y-BOCS severity scale (Y-BOCS-SS). Profiles were validated using generalized linear models to capture the association between profiles and obsession/compulsion content and changes in OCD severity, depression, and quality-of-life.

Results: Three profiles were identified: a "Severe with Lower Resistance" Profile (69% of sample) characterized by high severity with the greatest relative effort to resist symptoms, a "Moderate" profile (25%) characterized by uniform endorsement of items in the moderate range, a "Low Compulsion" (6%) profile characterized by high mean endorsement of obsession items and low endorsement of compulsion items. The profiles varied significantly in terms of endorsement of different obsession/compulsion domains but did not vary significantly in terms of treatment outcomes as measured by changes in OCD, depression, and quality-of-life.

Conclusions: Relying on Y-BOCS total score may fail to capture qualitatively different, albeit rare, presentations of OCD. However, these profiles were not predictive of treatment response.