Psychotic vulnerability in pediatric OCD: associations with neurocognitive functioning

Although psychotic vulnerability features may accompany obsessive-compulsive disorder (OCD) in children and adolescents, the neurocognitive characteristics of this clinical presentation remain insufficiently understood. This study examined whether psychotic vulnerability is associated with neurocognitive functioning in pediatric OCD. The sample comprised 112 children and adolescents with DSM-5 OCD and 30 healthy controls. Based on positive symptom ratings on the Structured Interview for Psychosis-Risk Syndromes, the OCD group was divided into a subgroup with psychotic vulnerability (Psy+; n = 52) and a subgroup without psychotic vulnerability (Psy-; n = 60). Participants were assessed using standardized measures of psychopathology, neurocognition, global functioning, and premorbid adjustment. Group differences were examined using ANOVA, and multiple linear regression analyses were conducted to evaluate associations between symptom dimensions and neurocognitive outcomes. Compared with Psy- cases, Psy+ cases showed poorer global functioning, worse premorbid adjustment, and greater psychosis-spectrum symptom burden. In categorical analyses, both OCD subgroups performed worse than healthy controls on verbal learning and memory measures, with the lowest performance observed in the Psy+ group. Differences between Psy+ and Psy- cases were also most evident in verbal learning and memory. In dimensional analyses, OCD symptom severity was not significantly associated with neurocognitive outcomes, whereas negative symptoms were associated with poorer neurocognitive performance. These findings suggest that psychotic vulnerability may represent a clinically meaningful feature in pediatric OCD, associated with poorer functioning and selective neurocognitive differences.