Skip to main content Accessibility help

Cognitive functioning in obsessive-compulsive disorder: a meta-analysis

  • N. Y. Shin (a1), T. Y. Lee (a2), E. Kim (a2) and J. S. Kwon (a1) (a2) (a3)



Substantial empirical evidence has indicated impairment in the cognitive functioning of patients with obsessive-compulsive disorder (OCD) despite inconsistencies. Although several confounding factors have been investigated to explain the conflicting results, the findings remain mixed. This study aimed to investigate cognitive dysfunction in patients with OCD using a meta-analytic approach.


The PubMed database was searched between 1980 and October 2012, and reference lists of review papers were examined. A total of 221 studies were identified, of which 88 studies met inclusion criteria. Neuropsychological performance and demographic and clinical variables were extracted from each study.


Patients with OCD were significantly impaired in tasks that measured visuospatial memory, executive function, verbal memory and verbal fluency, whereas auditory attention was preserved in these individuals. The largest effect size was found in the ability to recall complex visual stimuli. Overall effect estimates were in the small to medium ranges for executive function, verbal memory and verbal fluency. The effects of potentially confounding factors including educational level, symptom severity, medication status and co-morbid disorders were not significant.


Patients with OCD appear to have wide-ranging cognitive deficits, although their impairment is not so large in general. The different test forms and methods of testing may have influenced the performance of patients with OCD, indicating the need to select carefully the test forms and methods of testing used in future research. The effects of various confounding variables on cognitive functioning need to be investigated further and to be controlled before a definite conclusion can be made.


Corresponding author

* Address for correspondence: J. S. Kwon, M.D., Ph.D., Department of Psychiatry, Seoul National University College of Medicine, 28 Yeongon-dong, Chongno-gu, Seoul, South Korea 110-744. (Email:


Hide All
Abbruzzese, M, Bellodi, L, Ferri, S, Scarone, S (1995). Frontal lobe dysfunction in schizophrenia and obsessive–compulsive disorder: a neuropsychological study. Brain and Cognition 27, 202212.
Abbruzzese, M, Ferri, S, Scarone, S (1997). The selective breakdown of frontal functions in patients with obsessive–compulsive disorder and in patients with schizophrenia: a double dissociation experimental finding. Neuropsychologia 35, 907912.
Abramovitch, A, Dar, R, Schweiger, A, Hermesh, H (2011). Neuropsychological impairments and their association with obsessive–compulsive symptom severity in obsessive–compulsive disorder. Archives of Clinical Neuropsychology 26, 364376.
Aigner, M, Sachs, G, Bruckmuller, E, Winklbaur, B, Zitterl, W, Kryspin-Exner, I, Gur, R, Katschnig, H (2007). Cognitive and emotion recognition deficits in obsessive-compulsive disorder. Psychiatry Research 149, 121128.
Aycicegi, A, Dinn, WM, Harris, CL, Erkmen, H (2003). Neuropsychological function in obsessive–compulsive disorder: effects of comorbid conditions on task performance. European Psychiatry 18, 241248.
Bohne, A, Savage, CR, Deckersbach, T, Keuthen, NJ, Jenike, MA, Tuschen-Caffier, B, Wilhelm, S (2005). Visuospatial abilities, memory, and executive functioning in trichotillomania and obsessive-compulsive disorder. Journal of Clinical and Experimental Neuropsychology 27, 385399.
Boone, KB, Ananth, J, Philpott, L, Kaur, A (1991). Neuropsychological characteristics of nondepressed adults with obsessive–compulsive disorder. Neuropsychiatry, Neuropsychology and Behavioral Neurology 4, 96109.
Borges, MC, Braga, DT, Iego, S, D'Alcante, CC, Sidrim, I, Machado, MC, Pinto, PS, Cordioli, AV, do Rosario, MC, Petribu, K, Mendlowicz, MV, Mari, JJ, Miguel, EC, Fontenelle, LF (2011). Cognitive dysfunction in post-traumatic obsessive–compulsive disorder. Australian and New Zealand Journal of Psychiatry 45, 7685.
Bucci, P, Galderisi, S, Catapano, F, Di Benedetto, R, Piegari, G, Mucci, A, Maj, M (2007). Neurocognitive indices of executive hypercontrol in obsessive-compulsive disorder. Acta Psychiatry Scandinavica 115, 380387.
Cavallaro, R, Cavedini, P, Mistretta, P, Bassi, T, Angelone, SM, Ubbiali, A, Bellodi, L (2003). Basal-corticofrontal circuits in schizophrenia and obsessive–compulsive disorder: a controlled, double dissociation study. Biological Psychiatry 54, 437443.
Cavedini, P, Cisima, M, Riboldi, G, D'Annucci, A, Bellodi, L (2001). A neuropsychological study of dissociation in cortical and subcortical functioning in obsessive–compulsive disorder by Tower of Hanoi task. Brain and Cognition 46, 357363.
Cavedini, P, Gorini, A, Bellodi, L (2006). Understanding obsessive–compulsive disorder: focus on decision making. Neuropsychology Review 16, 315.
Cavedini, P, Zorzi, C, Piccinni, M, Cavallini, MC, Bellodi, L (2010). Executive dysfunctions in obsessive–compulsive patients and unaffected relatives: searching for a new intermediate phenotype. Biological Psychiatry 67, 11781184.
Ceschi, G, Van der Linden, M, Dunker, D, Perroud, A, Bredart, S (2003). Further exploration memory bias in compulsive washers. Behaviour Research and Therapy 41, 737748.
Cha, KR, Koo, MS, Kim, CH, Kim, JW, Oh, WJ, Suh, HS, Lee, HS (2008). Nonverbal memory dysfunction in obsessive–compulsive disorder patients with checking compulsions. Depression and Anxiety 25, E115E120.
Chamberlain, SR, Blackwell, AD, Fineberg, NA, Robbins, TW, Sahakian, BJ (2005). The neuropsychology of obsessive compulsive disorder: the importance of failures in cognitive and behavioural inhibition as candidate endophenotypic markers. Neuroscience and Biobehavioral Reviews 29, 399419.
Chamberlain, SR, Fineberg, NA, Blackwell, AD, Clark, L, Robbins, TW, Sahakian, BJ (2007). A neuropsychological comparison of obsessive–compulsive disorder and trichotillomania. Neuropsychologia 45, 654662.
Choi, JS, Kang, DH, Kim, JJ, Ha, TH, Lee, JM, Youn, T, Kim, IY, Kim, SI, Kwon, JS (2004). Left anterior subregion of orbitofrontal cortex volume reduction and impaired organizational strategies in obsessive-compulsive disorder. Journal of Psychiatry Research 38, 193199.
Cohen, J (1988). Statistical Power Analysis for the Behavioral Sciences, 2nd edn. Lawrence Earlbaum: Hillsdale, NJ.
Cohen, Y, Lachenmeyer, JR, Springer, C (2003). Anxiety and selective attention in obsessive–compulsive disorder. Behaviour Research and Therapy 41, 13111323.
Deckersbach, T, Savage, CR, Reilly-Harrington, N, Clark, L, Sachs, G, Rauch, SL (2004). Episodic memory impairment in bipolar disorder and obsessive–compulsive disorder: the role of memory strategies. Bipolar Disorders 6, 233244.
de Geus, F, Denys, DA, Sitskoorn, MM, Westenberg, HG (2007). Attention and cognition in patients with obsessive-compulsive disorder. Psychiatry and Clinical Neurosciences 61, 4553.
Duval, S, Tweedie, R (2000). Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56, 455463.
Egger, M, Smith, GD, Schneider, M, Minder, C (1997). Bias in meta-analysis detected by a simple, graphical test. BMJ 315, 629634.
Fenger, MM, Gade, A, Adams, KH, Hansen, ES, Bolwig, TG, Knudsen, GM (2005). Cognitive deficits in obsessive–compulsive disorder on tests of frontal lobe functions. Nordic Journal of Psychiatry 59, 3944.
Gambini, O, Abbruzzese, M, Scarone, S (1993). Smooth pursuit and saccadic eye movements and Wisconsin Card Sorting Test performance in obsessive-compulsive disorder. Psychiatry Research 48, 191200.
Goncalves, OF, Marques, TR, Lori, NF, Sampaio, A, Branco, MC (2010). Obsessive–compulsive disorder as a visual processing impairment. Medical Hypotheses 74, 107109.
Hedges, L, Holkin, I (1985). Statistical Methods for Meta-Analysis. Academic Press: New York, NY.
Henin, A, Savage, CR, Rauch, SL, Deckersbach, T, Wilhelm, S, Baer, L, Otto, MW, Jenike, MA (2001). Is age at symptom onset associated with severity of memory impairment in adults with obsessive–compulsive disorder? American Journal of Psychiatry 158, 137139.
Hur, JW, Shin, NY, Kim, SN, Jang, JH, Choi, JS, Shin, YC, Kwon, JS (2012). Do pathological gambling and obsessive-compulsive disorder overlap? A neurocognitive perspective. CNS Spectrums 17, 207213.
Hwang, SH, Kwon, JS, Shin, YW, Lee, KJ, Kim, YY, Kim, MS (2007). Neuropsychological profiles of patients with obsessive–compulsive disorder: early onset versus late onset. Journal of the International Neuropsychological Society 13, 3037.
Kitis, A, Akdede, BB, Alptekin, K, Akvardar, Y, Arkar, H, Erol, A, Kaya, N (2007). Cognitive dysfunctions in patients with obsessive-compulsive disorder compared to the patients with schizophrenia patients: relation to overvalued ideas. Progress in Neuro-Psychopharmacology and Biological Psychiatry 31, 254261.
Kuelz, AK, Hohagen, F, Voderholzer, U (2004). Neuropsychological performance in obsessive–compulsive disorder: a critical review. Biological Psychology 65, 185236.
Lacerda, AL, Dalgalarrondo, P, Caetano, D, Haas, GL, Camargo, EE, Keshavan, MS (2003). Neuropsychological performance and regional cerebral blood flow in obsessive-compulsive disorder. Progress in Neuro-Psychopharmacology and Biological Psychiatry 27, 657665.
Lawrence, NS, Wooderson, S, Mataix-Cols, D, David, R, Speckens, A, Phillips, ML (2006). Decision making and set shifting impairments are associated with distinct symptom dimensions in obsessive-compulsive disorder. Neuropsychology 20, 409419.
Lucey, JV, Burness, CE, Costa, DC, Gacinovic, S, Pilowsky, LS, Ell, PJ, Marks, IM, Kerwin, RW (1997). Wisconsin Card Sorting Task (WCST) errors and cerebral blood flow in obsessive-compulsive disorder (OCD). British Journal of Medical Psychology 70 403411.
Melloni, M, Urbistondo, C, Sedeño, L, Gelormini, C, Kichic, R, Ibanez, A (2012). The extended fronto-striatal model of obsessive compulsive disorder: convergence from event-related potentials, neuropsychology and neuroimaging. Frontiers in Human Neuroscience 6, 259.
Menzies, L, Chamberlain, SR, Laird, AR, Thelen, SM, Sahakian, BJ, Bullmore, ET (2008). Integrating evidence from neuroimaging and neuropsychological studies of obsessive–compulsive disorder: the orbitofronto-striatal model revisited. Neuroscience and Biobehavioral Reviews 32, 525549.
Muller, J, Roberts, JE (2005). Memory and attention in obsessive–compulsive disorder: a review. Journal of Anxiety Disorders 19, 128.
Murphy, R, Nutzinger, DO, Paul, T, Leplow, B (2004). Conditional-associative learning in eating disorders: a comparison with OCD. Journal of Clinical and Experimental Neuropsychology 26, 190199.
Nakao, T, Nakagawa, A, Yoshiura, T, Nakatani, E, Nabeyama, M, Yoshizato, C, Kudoh, A, Tada, K, Yoshioka, K, Kawamoto, M (2005). A functional MRI comparison of patients with obsessive-compulsive disorder and normal controls during a Chinese character Stroop task. Psychiatry Research 139, 101114.
Nakao, T, Nakagawa, A, Yoshiura, T, Nakatani, E, Nabeyama, M, Sanematsu, H, Togao, O, Yoshioka, K, Tomita, M, Kuroki, T, Kanba, S (2009). Duration effect of obsessive–compulsive disorder on cognitive function: a functional MRI study. Depression and Anxiety 26, 814823.
Nedeljkovic, M, Kyrios, M, Moulding, R, Doron, G, Wainwright, K, Pantelis, C, Purcell, R, Maruff, P (2009). Differences in neuropsychological performance between subtypes of obsessive–compulsive disorder. Australian New Zealand Journal of Psychiatry 43, 216226.
Nielen, MM, Den Boer, JA (2003). Neuropsychological performance of OCD patients before and after treatment with fluoxetine: evidence for persistent cognitive deficits. Psychological Medicine 33, 917925.
Olley, A, Malhi, G, Sachdev, P (2007). Memory and executive functioning in obsessive–compulsive disorder: a selective review. Journal of Affective Disorders 104, 1523.
Penades, R, Catalan, R, Rubia, K, Andres, S, Salamero, M, Gasto, C (2007). Impaired response inhibition in obsessive compulsive disorder. European Psychiatry 22, 404410.
Purcell, R, Maruff, P, Kyrios, M, Pantelis, C (1998). Neuropsychological deficits in obsessive-compulsive disorder: a comparison with unipolar depression, panic disorder, and normal controls. Archives of General Psychiatry 55, 415423.
Radua, J, van den Heuvel, OA, Surguladze, S, Mataix-Cols, D (2010). Meta-analytical comparison of voxel-based morphometry studies in obsessive–compulsive disorder vs other anxiety disorders. Archives of General Psychiatry 67, 701711.
Rajender, G, Bhatia, MS, Kanwal, K, Malhotra, S, Singh, TB, Chaudhary, D (2011). Study of neurocognitive endophenotypes in drug-naive obsessive–compulsive disorder patients, their first-degree relatives and healthy controls. Acta Psychiatrica Scandinavica 124, 152161.
Rampacher, F, Lennertz, L, Vogeley, A, Schulze-Rauschenbach, S, Kathmann, N, Falkai, P, Wagner, M (2010). Evidence for specific cognitive deficits in visual information processing in patients with OCD compared to patients with unipolar depression. Progress in Neuro-psychopharmacology and Biological Psychiatry 34, 984991.
Roth, RM, Milovan, D, Baribeau, J, O'Connor, K (2005). Neuropsychological functioning in early- and late-onset obsessive–compulsive disorder. Journal of Neuropsychiatry and Clinical Neuroscience 17, 208213.
Savage, CR, Baer, L, Keuthen, NJ, Brown, HD, Rauch, SL, Jenike, MA (1999). Organizational strategies mediate nonverbal memory impairment in obsessive–compulsive disorder. Biological Psychiatry 45, 905916.
Savage, CR, Deckersbach, T, Wilhelm, S, Rauch, SL, Baer, L, Reid, T, Jenike, MA (2000). Strategic processing and episodic memory impairment in obsessive compulsive disorder. Neuropsychology 14, 141151.
Schmidtke, K, Schorb, A, Winkelmann, G, Hohagen, F (1998). Cognitive frontal lobe dysfunction in obsessive–compulsive disorder. Biological Psychiatry 43, 666673.
Segalas, C, Alonso, P, Real, E, Garcia, A, Minambres, A, Labad, J, Pertusa, A, Bueno, B, Jimenez-Murcia, S, Menchon, JM (2010). Memory and strategic processing in first-degree relatives of obsessive compulsive patients. Psychological Medicine 40, 20012011.
Shin, MS, Park, SJ, Kim, MS, Lee, YH, Ha, TH, Kwon, JS (2004). Deficits of organizational strategy and visual memory in obsessive–compulsive disorder. Neuropsychology 18, 665672.
Simpson, HB, Rosen, W, Huppert, JD, Lin, SH, Foa, EB, Liebowitz, MR (2006). Are there reliable neuropsychological deficits in obsessive-compulsive disorder? Journal of Psychiatric Research 40, 247257.
Starcke, K, Tuschen-Caffier, B, Markowitsch, HJ, Brand, M (2010). Dissociation of decisions in ambiguous and risky situations in obsessive–compulsive disorder. Psychiatry Research 175, 114120.
Trivedi, JK, Dhyani, M, Goel, D, Sharma, S, Singh, AP, Sinha, PK, Tandon, R (2008). Neurocognitive dysfunction in patients with obsessive compulsive disorder. African Journal of Psychiatry 11, 204209.
Tukel, R, Gurvit, H, Ertekin, BA, Oflaz, S, Ertekin, E, Baran, B, Kalem, SA, Kandemir, PE, Ozdemiroglu, FA, Atalay, F (2012). Neuropsychological function in obsessive–compulsive disorder. Comprehensive Psychiatry 53, 167175.
Tumkaya, S, Karadag, F, Oguzhanoglu, NK, Tekkanat, C, Varma, G, Ozdel, O, Atesci, F (2009). Schizophrenia with obsessive–compulsive disorder and obsessive–compulsive disorder with poor insight: a neuropsychological comparison. Psychiatry Research 165, 3846.
Veale, DM, Sahakian, BJ, Owen, AM, Marks, IM (1996). Specific cognitive deficits in tests sensitive to frontal lobe dysfunction in obsessive-compulsive disorder. Psychological Medicine 26, 12611269.
Wobrock, T, Gruber, O, McIntosh, AM, Kraft, S, Klinghardt, A, Scherk, H, Reith, W, Schneider-Axmann, T, Lawrie, SM, Falkai, P, Moorhead, TW (2010). Reduced prefrontal gyrification in obsessive–compulsive disorder. European Archives of Psychiatry and Clinical Neurosciences 260, 455464.


Type Description Title
Supplementary materials

Shin supplementary material
Shin supplementary material

 Word (164 KB)
164 KB


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed