Claudio Sica, Corrado Caudek, Ilaria Colpizzi, Anna Malerba, Gioia Bottesi
5 min
This study investigates the classification of Obsessive-Compulsive (OC) symptoms within dimensional models of psychopathology. While OC symptoms are traditionally categorized under Negative Affect or Internalizing domains, their heterogeneous nature has led to ongoing debate. The authors explore whether 'Not Just Right Experiences' (NJREs)—a sensory-based vulnerability factor for OCD—can clarify the placement of OC symptoms within the DSM-5 Alternative Model of Personality Disorders (AMPD).
The researchers employed an exploratory-confirmatory design using two large non-clinical samples (N=978 and N=1004). In the first sample, they performed a series of principal component analyses to map a hierarchical structure of general psychopathology, incorporating the 25 lower-order traits of the PID-5 and NJRE measures. In the second sample, they utilized structural equation modeling (SEM) to validate the hierarchical placement of NJREs and their relationship with the five AMPD domains (Negative Affect, Detachment, Antagonism, Disinhibition, and Psychoticism).
The exploratory analysis revealed a hierarchical structure where NJREs consistently migrated toward the Psychoticism domain at the most granular level of the hierarchy. Furthermore, the Psychoticism domain showed a robust, unique association with all measured OC symptoms, significantly outperforming other AMPD components in predictive strength. The confirmatory SEM validated these results, showing that while both Psychoticism and Negative Affect contribute to NJREs, the link between Psychoticism and NJREs is significantly stronger. This suggests that the 'thought disorder' or 'perceptual dysregulation' aspects of the Psychoticism domain are central to the experience of OC symptoms.
These findings challenge the traditional view that OCD is primarily an anxiety-driven (Internalizing) disorder. By linking NJREs and OC symptoms to the Psychoticism domain, the study provides a potential explanation for why some patients do not respond well to standard anxiety-focused treatments. Clinically, this suggests that therapeutic approaches for OCD might benefit from addressing the sensory-perceptual dysregulation associated with Psychoticism rather than focusing solely on emotional distress or anxiety reduction.
Dimensional models provide a framework for characterizing psychopathology and personality disorders based on lower-order maladaptive traits, typically organized into five overarching domains: Negative Affect or Internalizing, Detachment, Antagonism, Disinhibition, and Psychoticism or Thought Disorder. Within the context of these dimensional models, the classification of Obsessive-Compulsive (OC) symptoms has raised questions, as they are often placed within the Negative Affect/Internalizing or Psychoticism/Thought Disorder domains. The discrepancy in their categorization may be attributed to the diversity in how these symptoms manifest. An alternative perspective involves the adoption of a measure associated with a vulnerability factor for OCD, which may transcend the specific symptoms of the disorder. In this study, our objective was to explore the association between 'Not Just Right Experiences' (NJREs) and the dimensions specified in the DSM-5 Alternative Model of Personality Disorders (AMPD). We utilized two distinct samples, one consisting of 978 participants and the other comprising 1004, all of whom were non-clinical individuals. Through a series of exploratory factor analyses conducted on the initial sample, we uncovered a hierarchical structure of general psychopathology. Within this structure, NJREs were situated within the AMPD's Psychoticism domain. Furthermore, the Psychoticism domain exhibited a strong and unique association with all OC symptoms, surpassing the influence of other AMPD components. A structural equation model applied to the second sample validated these findings, indicating that both the Psychoticism and Negative Affect played significant roles in explaining a substantial portion of the variance observed in NJRE measures. These outcomes have pertinent clinical implications, particularly in the context of Cognitive-Behavioral Therapy for individuals with OCD.
Alex: So they built the theory on one group and verified it on a different group entirely.
Sam: Exactly. And what they found was that "Not Just Right" feelings function as a stable marker—something that consistently points to the same underlying mechanism across different samples. It's like finding a specific gear inside a watch that keeps sticking. It's not the whole watch, but it explains why the hands keep jumping.
Alex: Does this change how OCD should be treated?
Sam: It could, and that's where the clinical stakes become real. The standard approach for OCD is exposure therapy—gradually confronting the thing that triggers anxiety until the fear fades. That works well when fear is the engine. But if the core issue is a perceptual mismatch, that approach may not be sufficient on its own. The paper suggests developing protocols focused on what researchers call sensory habituation: essentially teaching the brain to accept that a sensation is "good enough," even when it doesn't feel perfect.
Alex: So instead of fighting the fear, you're recalibrating the internal sensor.
Sam: Precisely. And by placing OCD within this kind of dimensional model—rather than treating it as a single, isolated category—we start to see it as a spectrum of experiences. The core vulnerability, on this view, is how someone perceives the world, not just how they react to stress.
Alex: What are the limits here? What should listeners be cautious about?
Sam: A few things worth noting. The study relied entirely on self-report questionnaires—participants answering questions about their own feelings. That can introduce bias, because people interpret questions differently. More importantly, the samples were non-clinical, meaning these weren't people in active treatment for OCD. To know whether this framework holds up where it matters most, it needs to be validated with people who are actually seeking care.
Alex: So it's a meaningful framework, but still in the early stages of being tested in real clinical settings.
Sam: That's a fair reading. The paper itself frames this as a step toward more precise, personalised care—particularly for the proportion of patients who don't get sufficient relief from standard therapy. By identifying these specific sensory-based vulnerabilities, the hope is to move away from a one-size-fits-all approach and toward treatment that addresses the specific mechanism behind a person's symptoms.
Alex: It's a useful reminder that even well-established diagnostic categories are working hypotheses. Re-examining the foundations can open up new ways to help people. Thanks for walking us through this, Sam.
Sam: It was a good one to dig into. The move toward more dimensional models of mental health is a meaningful development—and one worth watching as the clinical evidence builds.
Alex: And that's it for today's episode. Thanks for listening to ResearchPod.