Network Analysis of Sensory Phenomena and Obsessive-Compulsive Symptoms in OCD: A Multicenter Study

Sensory phenomena (SP) affect 60%-80% of obsessive-compulsive (OC) disorder (OCD) patients, demonstrate dimension-specific symptom associations, yet their mechanistic role in OCD's network architecture remains unexamined.

In this cross-sectional study, 1350 clinician-diagnosed OCD patients from the China OCD Cohort (COCC) underwent standardized assessments using the University of São Paulo SP Scale (USP-SPS), Yale-Brown OC Scale (Y-BOCS), OC Inventory-Revised (OCI-R), and Beck Depression Inventory-II/Beck Anxiety Inventory (BDI-II/BAI). Network analysis was utilized to identify core/bridge symptoms and test network differences across early/late-onset and SP-severity subgroups.

SP-positive OCD patients (n = 850) demonstrated earlier disease onset (p  < 0.001), more severe compulsions (p = 0.010), and greater depression than SP-negative patients (n = 500). Network analysis in the SP-positive cohort identified SP symptoms as central network drivers, though with considerable heterogeneity across subtypes: muscle-joint/bone sensation (strength = 3.41) and sound "just-right" (strength = 2.73) exhibited the highest centrality, while other SP subtypes showed more modest or selective connectivity. Anxiety was the primary bridge symptom (bridge strength = 1.60), with the strongest cross-domain link between "look 'just-right'" and "ordering." The network architecture remained stable across subgroups, though elevated SP severity significantly increased global connectivity (S = 5.343, p = 0.002) without altering topology.

SP may represent a clinically meaningful dimension of OCD psychopathology, within which SP subtypes operate as a heterogeneous set of experiences rather than a uniform construct, differentially shaping symptom connectivity. Anxiety serves as a critical bridge between SP and OC symptoms, while SP severity functions as a symptom network intensifier rather than a structural reorganizer. Future studies should explore whether precision interventions targeting anxiety and sensory-channel-specific pathways may improve treatment outcomes for refractory OCD with SP. Trial Registration: Chinese Clinical Trial Registry: ChiCTR2100051536.