Obsessive-compulsive disorder is associated with broad impairments in executive function: A meta-analysis

Abstract

Obsessive-compulsive disorder (OCD) is a serious and often chronically disabling condition. The current dominant model of OCD focuses on abnormalities in prefrontal-striatal circuits that support executive function (EF). While there is growing evidence for EF impairments associated with OCD, results have been inconsistent, making the nature and magnitude of these impairments controversial. The current meta-analysis uses random-effects models to synthesize 110 previous studies that compared participants with OCD to healthy control participants on at least one neuropsychological measure of EF. The results indicate that individuals with OCD are impaired on tasks measuring most aspects of EF, consistent with broad impairment in EF. EF deficits were not explained by general motor slowness or depression. Effect sizes were largely stable across variation in demographic and clinical characteristics of samples, although medication use, age, and gender moderated some effects.

Keywords: executive function; meta-analysis; obsessive-compulsive disorder.

Figure 1

Weighted mean effect sizes for all analyses. Error bars are 95% confidence intervals. Measures for which the lower error bar does not pass the vertical line are significantly greater than 0. Compared to healthy control participants, individuals with OCD are significantly impaired on most EF tasks. Executive function (EF) composite measures are indicated with diamond symbols, and individual measures within each EF component are indicated by circle symbols in the same color. Black circles indicate non-EF comparison measures. Comp. = Composite score; WCST = Wisconsin Card Sorting Test; OAT/DAT = Object alternation task/delayed alternation task; TMT–B = Trail Making Test Part B; TMT–A =Trail Making Test Part A; ID/ED = Intradimensional/Extradimensional; WM = working memory; DMTS = delayed-match-to-sample; VF = verbal fluency; TOL/TOH = Tower of London, Tower of Hanoi.