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Neurological soft signs in obsessive-compulsive disorder: two empirical studies and meta-analysis

  • N. Jaafari (a1) (a2), L. Fernández de la Cruz (a1), M. Grau (a1) (a3), E. Knowles (a1), J. Radua (a1) (a4), S. Wooderson (a5), C. Segalas (a6), P. Alonso (a6), M. L. Phillips (a7), J. M. Menchón (a6) and D. Mataix-Cols (a1)...

Neurological soft signs (NSS) have been inconsistently reported in obsessive-compulsive disorder (OCD) but may make an impact on treatment response.


The current study examined the presence of NSS in two independent European samples of OCD patients (combined 85 patients and 88 matched healthy controls) using a standardized instrument and conducted a meta-analysis of all published studies identified in the literature with the aim to provide a more definitive answer to the question of whether OCD patients are characterized by increased NSS.


Both empirical studies found elevated NSS scores in patients compared with matched controls. The results of the meta-analysis, which included 15 studies (combined 498 patients and 520 controls) showed large effect sizes (Hedges' g=1.27, 95% confidence interval 0.80–1.75), indicating that OCD patients have significantly higher rates of NSS than matched controls on both sides of the body and in multiple domains (motor coordination, sensory integration and primitive reflexes). The results were robust and remained largely unchanged in our reliability analyses, which controlled for possible outliers. Meta-regression was employed to examine the role of potential variables of interest including sociodemographic variables, symptom severity, medication effects and the use of different instruments, but none of these variables was clearly associated with NSS.


As a group, OCD patients are characterized by increased rates of NSS, compared with healthy controls. However, their origins and potential clinical importance remain to be clarified. Future directions for research are discussed.

Corresponding author
*Address for correspondence: D. Mataix-Cols, Ph.D., PO Box 69, King's College London, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. (Email:
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