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Structure and clinical correlates of obsessive–compulsive symptoms in a large sample of children and adolescents: a factor analytic study across five nations

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Abstract

The underlying structure of obsessive–compulsive disorder (OCD) remains to be confirmed in child and adolescent populations. In this paper we report the first factor analytic study of individual OCD items from Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS). OCD symptoms were assessed using the CY-BOCS symptom checklist in a sample of 854 patients with OCD (7–18 years of age) recruited from clinics in five countries. Pooled data were subjected to exploratory and confirmatory factor analysis (CFA) to identify the optimal factor structure. Various models were tested for age and gender subgroups. Also, the invariance of the solution across age and gender was tested and associations with demographic and clinical factors were explored. A three-factor model provided the best-fit solution. It consisted of the following factors: (1) harm/sexual, (2) symmetry/hoarding, (3) contamination/cleaning. The factor structure was invariant for age and gender across subgroups. Factor one was significantly correlated with anxiety, and factor two with depression and anxiety. Factor three was negatively correlated with tic disorder and attention-deficit/hyperactivity disorder (ADHD). Females had higher scores on factor two than males. The OCD symptom structure in children and adolescents is consistent across age and gender and similar to results from recent child and adolescents although hoarding may not be a separate factor. Our three-factor structure is almost identical to that seen in early studies on adults. Common mental disorders had specific patterns of associations with the different factors.

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References

  1. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Publishing, Arlington

    Book  Google Scholar 

  2. Thomsen PH (1993) Obsessive–compulsive disorder in children and adolescents. Self-reported obsessive–compulsive behaviour in pupils in Denmark. Acta Psychiatr Scand 88:212–217. doi:10.1111/j.1600-0447.1993.tb03441.x

    Article  CAS  PubMed  Google Scholar 

  3. Heyman I, Fombonne E, Simmons H et al (2001) Prevalence of pervasive developmental disorders in the British nationwide survey of child mental health. J Am Acad Child Adolesc Psychiatry 40:820–827. doi:10.1097/00004583-200107000-00017

    Article  Google Scholar 

  4. Eisen JL, Mancebo MA, Pinto A et al (2006) Impact of obsessive–compulsive disorder on quality of life. Compr Psychiatry 47:270–275. doi:10.1016/j.comppsych.2005.11.006

    Article  PubMed  PubMed Central  Google Scholar 

  5. Sørensen CB, Kirkeby L, Thomsen PH (2004) Quality of life with OCD. A self-reported survey among members of the Danish OCD Association. Nord J Psychiatry 58:231–236. doi:10.1080/08039480410006287

    Article  PubMed  Google Scholar 

  6. Torp NC, Dahl K, Skarphedinsson G et al (2015) Effectiveness of cognitive behavior treatment for pediatric obsessive–compulsive disorder: acute outcomes from the Nordic long-term OCD Treatment Study (NordLOTS). Behav Res Ther 64:15–23. doi:10.1016/j.brat.2014.11.005

    Article  PubMed  Google Scholar 

  7. Freeman J, Garcia A, Frank H et al (2013) Evidence base update for psychosocial treatments for pediatric obsessive–compulsive disorder. J Clin Child Adolesc Psychol 43:7–26. doi:10.1080/15374416.2013.804386

    Article  PubMed  Google Scholar 

  8. Geller DA, March J (2012) Practice parameter for the assessment and treatment of children and adolescents with obsessive–compulsive disorder. J Am Acad Child Adolesc Psychiatry 51:98–113. doi:10.1016/j.jaac.2011.09.019

    Article  Google Scholar 

  9. Mataix-Cols D, do Rosario-Campos MC, Leckman JF (2005) A multidimensional model of obsessive–compulsive disorder. Am J Psychiatry 162:228–238. doi:10.1176/appi.ajp.162.2.228

    Article  PubMed  Google Scholar 

  10. Leckman JF, Grice DE, Boardman J et al (1997) Symptoms of obsessive–compulsive disorder. Am J Psychiatry 154:911–917

    Article  CAS  PubMed  Google Scholar 

  11. Scahill L, Riddle MA, McSwiggin-Hardin M et al (1997) Children’s Yale-Brown obsessive compulsive scale: reliability and validity. J Am Acad Child Adolesc Psychiatry 36:844–852. doi:10.1097/00004583-199706000-00023

    Article  CAS  PubMed  Google Scholar 

  12. Bloch MH, Landeros-Weisenberger A, Rosario MC et al (2008) Meta-analysis of the symptom structure of obsessive–compulsive disorder. Am J Psychiatry 165:1532–1542. doi:10.1176/appi.ajp.2008.08020320

    Article  PubMed  PubMed Central  Google Scholar 

  13. Farrell L, Barrett P (2006) Obsessive–compulsive disorder across developmental trajectory: cognitive processing of threat in children, adolescents and adults. Br J Psychol 97:95–114. doi:10.1348/000712605X58592

    Article  PubMed  Google Scholar 

  14. Geller DA, Biederman J, Faraone S et al (2001) Developmental aspects of obsessive compulsive disorder: findings in children, adolescents, and adults. J Nerv Ment Dis 189:471–477

    Article  CAS  PubMed  Google Scholar 

  15. Delorme R, Bille A, Betancur C et al (2006) Exploratory analysis of obsessive compulsive symptom dimensions in children and adolescents: a prospective follow-up study. BMC Psychiatry 6:1. doi:10.1186/1471-244X-6-1

    Article  PubMed  PubMed Central  Google Scholar 

  16. McKay D, Piacentini J, Greisberg S et al (2006) The structure of childhood obsessions and compulsions: dimensions in an outpatient sample. Behav Res Ther 44:137–146. doi:10.1016/j.brat.2005.02.001

    Article  PubMed  Google Scholar 

  17. Mataix-Cols D, Nakatani E, Micali N, Heyman I (2008) Structure of obsessive–compulsive symptoms in pediatric OCD. J Am Acad Child Adolesc Psychiatry 47:773–778. doi:10.1097/CHI.0b013e31816b73c0

    Article  PubMed  Google Scholar 

  18. Stewart SE, Rosario MC, Brown TA et al (2007) Principal components analysis of obsessive–compulsive disorder symptoms in children and adolescents. Biol Psychiatry 61:285–291. doi:10.1016/j.biopsych.2006.08.040

    Article  PubMed  Google Scholar 

  19. Stewart SE, Rosario MC, Baer L et al (2008) Four-factor structure of obsessive–compulsive disorder symptoms in children, adolescents, and adults. J Am Acad Child Adolesc Psychiatry 47:763–772. doi:10.1097/CHI.0b013e318172ef1e

    Article  PubMed  Google Scholar 

  20. Torres AR, Fontenelle LF, Ferrão YA et al (2012) Clinical features of obsessive–compulsive disorder with hoarding symptoms: a multicenter study. J Psychiatr Res 46:724–732. doi:10.1016/j.jpsychires.2012.03.005

    Article  PubMed  Google Scholar 

  21. Ivarsson T, Melin K, Wallin L (2008) Categorical and dimensional aspects of co-morbidity in obsessive–compulsive disorder (OCD). Eur Child Adolesc Psychiatry 17:20–31. doi:10.1007/s00787-007-0626-z

    Article  PubMed  Google Scholar 

  22. Grados MA, Riddle MA, Samuels JF et al (2001) The familial phenotype of obsessive–compulsive disorder in relation to tic disorders: the Hopkins OCD family study. Biol Psychiatry 50:559–565. doi:10.1016/S0006-3223(01)01074-5

    Article  CAS  PubMed  Google Scholar 

  23. Lebowitz ER, Motlagh MG, Katsovich L et al (2012) Tourette syndrome in youth with and without obsessive compulsive disorder and attention deficit hyperactivity disorder. Eur Child Adolesc Psychiatry 21:451–457. doi:10.1007/s00787-012-0278-5

    Article  PubMed  PubMed Central  Google Scholar 

  24. Nikolajsen KH, Nissen JB, Thomsen PH (2011) Obsessive–compulsive disorder in children and adolescents: symptom dimensions in a naturalistic setting. Nord J Psychiatry 65:244–250. doi:10.3109/08039488.2010.533386

    Article  PubMed  Google Scholar 

  25. Mataix-Cols D, Rauch SL, Manzo PA et al (1999) Use of factor-analyzed symptom dimensions to predict outcome with serotonin reuptake inhibitors and placebo in the treatment of obsessive–compulsive disorder. Am J Psychiatry 156:1409–1416

    CAS  PubMed  Google Scholar 

  26. Robertson MM (2000) Tourette syndrome, associated conditions and the complexities of treatment. Brain 123(Pt 3):425–462. doi:10.1093/brain/123.3.425

    Article  PubMed  Google Scholar 

  27. Cath DC, Spinhoven P, Hoogduin CA et al (2001) Repetitive behaviors in Tourette’s syndrome and OCD with and without tics: what are the differences? Psychiatry Res 101:171–185. doi:10.1016/S0165-1781(01)00219-0

    Article  CAS  PubMed  Google Scholar 

  28. Nestadt G, Di CZ, Riddle MA et al (2009) Obsessive–compulsive disorder: subclassification based on co-morbidity. Psychol Med 39:1491. doi:10.1017/S0033291708004753

    Article  CAS  PubMed  Google Scholar 

  29. Cherian AV, Narayanaswamy JC, Viswanath B et al (2014) Gender differences in obsessive–compulsive disorder: findings from a large Indian sample. Asian J Psychiatr 9:17–21. doi:10.1016/j.ajp.2013.12.012

    Article  PubMed  Google Scholar 

  30. De Mathis MA, De Alvarenga P, Funaro G et al (2011) Gender differences in OCD: a literature review. Rev Bras Psiquiatr 33:390–399

    Article  Google Scholar 

  31. Williams MT, Farris SG, Turkheimer EN et al (2014) The impact of symptom dimensions on outcome for exposure and ritual prevention therapy in obsessive–compulsive disorder. J Anxiety Disord 28:553–558

    Article  PubMed  PubMed Central  Google Scholar 

  32. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edn (text revision), American Psychiatric Association, Washington, DC. doi:10.1002/jps.3080051129

  33. Lewin AB, Piacentini J, De Nadai AS et al (2014) Defining clinical severity in pediatric obsessive–compulsive disorder. Psychol Assess 26:679–684. doi:10.1037/a0035174

    Article  PubMed  Google Scholar 

  34. Murphy TK, Storch EA, Lewin AB et al (2012) Clinical factors associated with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. J Pediatr 160:314–319. doi:10.1016/j.jpeds.2011.07.012

    Article  PubMed  Google Scholar 

  35. Pols R (2014) Towards improving treatment for childhood ocd: analysing mediating mechanisms and non-response. Kind Adolesc Prakt 13:93. doi:10.1007/s12454-014-0026-8

    Article  Google Scholar 

  36. Storch EA, Caporino NE, Morgan JR et al (2011) Preliminary investigation of web-camera delivered cognitive-behavioral therapy for youth with obsessive–compulsive disorder. Psychiatry Res 189:407–412. doi:10.1016/j.psychres.2011.05.047

    Article  PubMed  Google Scholar 

  37. Storch EA, De Nadai AS, Jacob ML et al (2014) Phenomenology and correlates of insight in pediatric obsessive–compulsive disorder. Compr Psychiatry 55:613–620. doi:10.1016/j.comppsych.2013.09.014

    Article  PubMed  Google Scholar 

  38. Holmgren Melin K, Skärsäter I, Mowatt Haugland BS, Ivarsson T (2015) Treatment and 12-month outcome of children and adolescents with obsessive–compulsive disorder: a naturalistic study. J Obsessive Compuls Relat Disord 6:1–6. doi:10.1016/j.jocrd.2015.04.002

    Article  Google Scholar 

  39. Wolters LH (2013) Towards improving treatment for childhood OCD: analyzing mediating mechanisms and non-response. University of Amsterdam, Amsterdam

    Google Scholar 

  40. Storch EA, Murphy TK, Geffken GR et al (2004) Psychometric evaluation of the children’s Yale-Brown obsessive–compulsive scale. Psychiatry Res 129:91–98. doi:10.1016/j.psychres.2004.06.009

    Article  PubMed  Google Scholar 

  41. Kaufman J, Birmaher B, Brent D et al (1997) Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 36:980–988. doi:10.1097/00004583-199707000-00021

    Article  CAS  PubMed  Google Scholar 

  42. Silverman WK, Saavedra LM, Pina AA (2001) Test-retest reliability of anxiety symptoms and diagnoses with the Anxiety Disorders Interview Schedule for DSM-IV: child and parent versions. J Am Acad Child Adolesc Psychiatry 40:937–944. doi:10.1097/00004583-200108000-00016

    Article  CAS  PubMed  Google Scholar 

  43. Cronbach LJ (1951) Coefficient alpha and the internal structure of tests. Psychometrika 16:297–334

    Article  Google Scholar 

  44. Katerberg H, Delucchi KL, Stewart SE et al (2010) Symptom dimensions in OCD: item-level factor analysis and heritability estimates. Behav Genet 40:505–517. doi:10.1007/s10519-010-9339-z

    Article  PubMed  PubMed Central  Google Scholar 

  45. Fabrigar LR, Wegener DT, MacCallum RC, Strahan EJ (1999) Evaluating the use of exploratory factor analysis in psychological research. Psychol Methods 4:272–299. doi:10.1037//1082-989X.4.3.272

    Article  Google Scholar 

  46. Kubinger KD (2003) On artificial results due to using factor analysis for dichotomous variables. Psychology 45:106–110

    Google Scholar 

  47. StataCorp (2013) Stata statistical software: release 13. StataCorp LP, College Station, TX

  48. Muthén LK, Muthén BO (1998-2015) Mplus user’s guide, 7th edn. Muthén and Muthén, Los Angeles, CA

  49. Bentler PM, Bonett DG (1980) Significance tests and goodness of fit in the analysis of covariance structures. Psychol Bull 88:588–606. doi:10.1037/0033-2909.88.3.588

    Article  Google Scholar 

  50. Cabrera HN, Cuda G, López M, Costa JA (1984) Basal cell epithelioma of the vulva in chronic endemic regional arsenic poisoning. Med Cutan Ibero Lat Am 12:81–85. doi:10.1207/s15327906mbr2502_4

    CAS  PubMed  Google Scholar 

  51. Yu C (2002) Evaluating cutoff criteria of model fit indices for latent variable models with binary and continuous outcomes. University of California, Oakland

    Google Scholar 

  52. Geller DA, Hoog SL, Heiligenstein JH et al (2001) Fluoxetine treatment for obsessive–compulsive disorder in children and adolescents: a placebo-controlled clinical trial. J Am Acad Child Adolesc Psychiatry 40:773–779

    Article  CAS  PubMed  Google Scholar 

  53. Abramowitz JS, Franklin ME, Street GP et al (2000) Effects of comorbid depression on response to treatment for obsessive–compulsive disorder. Behav Ther 31:517–528. doi:10.1016/S0005-7894(00)80028-3

    Article  Google Scholar 

  54. Floyd FJ, Widaman KF (1995) Factor analysis in the development and refinement of clinical assessment instruments. Psychol Assess 7:286–299. doi:10.1037/1040-3590.7.3.286

    Article  Google Scholar 

  55. Baer L (1994) Factor analysis of symptom subtypes of obsessive compulsive disorder and their relation to personality and tic disorders. J Clin Psychiatry 55(Suppl):18–23

    PubMed  Google Scholar 

  56. Hantouche EG, Lancrenon S (1996) Modern typology of symptoms and obsessive–compulsive syndromes: results of a large French study of 615 patients. Encephale 22(Spec No):9–21

    PubMed  Google Scholar 

  57. Stein DJ, Carey PD, Lochner C et al (2008) Escitalopram in obsessive–compulsive disorder: response of symptom dimensions to pharmacotherapy. CNS Spectr 13:492–498

    Article  PubMed  Google Scholar 

  58. Girishchandra BG, Khanna S (2001) Phenomenology of obsessive compulsive disorder: a factor analytic approach. Indian J Psychiatry 43:306–316

    CAS  PubMed  PubMed Central  Google Scholar 

  59. Denys D, De Geus F, Van Megen HJGM, Westenberg HGM (2004) Symptom dimensions in obsessive–compulsive disorder: factor analysis on a clinician-rated scale and a self-report measure. Psychopathology 37:181–189. doi:10.1159/000079509

    Article  PubMed  Google Scholar 

  60. Stein DJ, Andersen EW, Overo KF (2007) Response of symptom dimensions in obsessive–compulsive disorder to treatment with citalopram or placebo. Rev Bras Psiquiatr (São Paulo, Brazil 1999) 29:303–307. doi:10.1590/S1516-44462007000400003

    Article  Google Scholar 

  61. Storch EA, Lack CW, Merlo LJ et al (2007) Clinical features of children and adolescents with obsessive–compulsive disorder and hoarding symptoms. Compr Psychiatry 48:313–318. doi:10.1016/j.comppsych.2007.03.001

    Article  PubMed  Google Scholar 

  62. Fineberg NA, Chamberlain SR, Goudriaan AE et al (2014) New developments in human neurocognition: clinical, genetic, and brain imaging correlates of impulsivity and compulsivity. CNS Spectr 19:69–89. doi:10.1017/S1092852913000801

    Article  PubMed  PubMed Central  Google Scholar 

  63. Hasler G, LaSalle-Ricci VH, Ronquillo JG et al (2005) Obsessive–compulsive disorder symptom dimensions show specific relationships to psychiatric comorbidity. Psychiatry Res 135:121–132. doi:10.1016/j.psychres.2005.03.003

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank TrygFonden, Lundbeck Foundation and Central Region Denmark’s Research Fund for supporting the research presented in this article through project grants. They would also like to thank the participants and staff from the contributing clinics.

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Authors and Affiliations

  1. Center for Child and Adolescent Psychiatry, Aarhus University Hospital Risskov, Risskov, Denmark

    D. R. M. A. Højgaard, K. Hybel, J. B. Nissen & P. H. Thomsen

  2. Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark

    E. L. Mortensen

  3. The Center for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Oslo, Norway

    T. Ivarsson, G. Skarphedinsson, K. Dahl & N. C. Torp

  4. Regional Centre for Child and Youth Mental Health and Child Welfare, Central Norway, Trondheim, Norway

    R. Valderhaug & B. Weidle

  5. Department of Child and Adolescent Psychiatry, Hospital of Aalesund, Aalesund, Norway

    R. Valderhaug

  6. Department of Child and Adolescent Psychiatry, St. Olavs Hospital, Trondheim, Norway

    B. Weidle

  7. John Hopkins Children’s Center, Baltimore, USA

    M. Grados

  8. Department of Pediatrics, University of South Florida College of Medicine, Tampa, FL, USA

    A. B. Lewin, E. A. Storch & T. K. Murphy

  9. Department of Child and Adolescent Psychiatry, Queen Silvia’s Children’s Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden

    K. H. Melin

  10. Department of Child and Adolescent Psychiatry, Academic Medical Center, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands

    L. H. Wolters

  11. Department of Psychology, University of Southampton, Southampton, UK

    E. J. S. Sonuga-Barke

  12. Department of Child and Adolescent Psychiatry, Division of Mental Health and Addiction, Vestre Viken Hospital, Drammen, Norway

    N. C. Torp

  13. Academic Center for Child and Adolescent Psychiatry, de Bascule, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands

    L. H. Wolters

  14. Department of Psychiatry and Behavioral Neurosciences, University of South Florida, St. Petersburg, FL, USA

    A. B. Lewin, E. A. Storch & T. K. Murphy

  15. Department of Psychology, University of South Florida, St. Petersburg, FL, USA

    E. A. Storch

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  1. D. R. M. A. Højgaard
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  2. E. L. Mortensen
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  3. T. Ivarsson
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  4. K. Hybel
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  5. G. Skarphedinsson
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  6. J. B. Nissen
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  7. R. Valderhaug
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  11. M. Grados
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  14. E. A. Storch
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  17. E. J. S. Sonuga-Barke
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  18. P. H. Thomsen
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Correspondence to D. R. M. A. Højgaard.

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Conflict of interest

Edmund Sonuga-Barke: Speaker fees, consultancy, research funding and conference support from Shire Pharma. Speaker fees from Janssen Cilag, Consultancy from Neurotech solutions, Aarhus University, University of Copenhagen and Berhanderling, Skolerne, Copenhagen, KU Leuven. Book royalties from OUP and Jessica Kingsley. Grants awarded from MRC, ESRC, Wellcome Trust, Solent NHS Trust, European Union, Child Health Research Foundation New Zealand, NIHR, Nuffield Foundation, Fonds Wetenschappelijk Onderzoek-Vlaanderen (FWO), MQ—Transforming Mental Health. Eric A. Storch: Research Funding: National Institutes of Health, All Children’s Hospital Research Foundation Agency for Healthcare Research and Quality. Book Royalties: Wiley, Springer, American Psychological Association, Lawrence Erlbaum. Consultant: Prophase, INC, Rogers Memorial Hospital. Tord Ivarsson: Speakers bureau of Shire. Per Hove Thomsen: Speakers bureau of Shire and MEDICE. Tanya Murphy has received research funding from the Florida Agency for Healthcare Administration, AstraZeneca Research &Development, Brain and Behavior Research Foundation, the Centers for Disease Control and Prevention (CDCP), F. Hoffmann-La Roche Ltd., Indevus Pharmaceuticals, IOCDF, NIMH, Otsuka Pharmaceuticals, Pfizer, Inc., Psyadon Pharmaceuticals, Inc, and Shire Pharmaceuticals. She is on the Scientific and Clinical Advisory Board for the IOCDF. She has received travel support from the TSA and honoraria from grand rounds/CME lectures. Adam Lewin has received research funding from All Children’s Hospital, Florida Agency for Healthcare Administration, the International OCD Foundation (IOCDF), and the Centers for Disease Control and Prevention (CDC). He is on the Scientific and Clinical Advisory Board for the IOCDF and is on the Board of Directors for the Society for Clinical Child and Adolescent Psychology (SCCAP) and the American Board of Clinical Child and Adolescent Psychology (ABCCAP). He has received honorarium and/or travel support from the Tourette Association of America (TAA), American Psychological Association, Springer, Oxford Press, University of Central Oklahoma, Rogers Memorial Hospital, and James Cook University. He is on the speaker’s bureau for IOCDF and TAA. Consultant for Prophase, LLC and Bracket. Remaining authors: No conflict of interest.

Ethics

National committees for Medical and Health Research in Denmark, Norway, Sweden, USA and the Netherlands approved the data collection. Informed consent was obtained from the participants and/or their parent(s) or legal guardian(s).

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Højgaard, D.R.M.A., Mortensen, E.L., Ivarsson, T. et al. Structure and clinical correlates of obsessive–compulsive symptoms in a large sample of children and adolescents: a factor analytic study across five nations. Eur Child Adolesc Psychiatry 26, 281–291 (2017). https://doi.org/10.1007/s00787-016-0887-5

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