Introduction: Deep brain stimulation (DBS) is an effective treatment for treatment-refractory obsessive-compulsive disorder (trOCD), though some mechanisms contributing to variability in outcomes remain unclear. Contamination OCD (C-OCD) affects 55-65% of OCD patients and includes fear-driven (e.g., fear of future harm) and disgust-driven (e.g., visceral disgust) subtypes. In OCD, disgust exhibits distinct neurophysiology and greater resistance to extinction during exposure therapy compared to fear. However, disgust’s impact on DBS outcomes for OCD is unknown. Here, we compare post-DBS clinical outcomes between fear- and disgust-predominant C-OCD patients.
Methods: We retrospectively examined clinical outcomes in OCD patients undergoing DBS targeting the region of the ventral capsule/ventral striatum (VC/VS) at our institution between 2019 and 2024. Of 22 total OCD patients, we included 14 with C-OCD (10 fear-predominant, 4 disgust-predominant). We recorded demographic information and evaluated OCD symptom severity with Yale-Brown Obsessive Compulsive Scale-Second Edition (YBOCS-II) scores collected preoperatively and at most recent post-DBS follow-up. All statistical comparisons were conducted with the Mann-Whitney U test.
Results: Fear- and disgust-predominant C-OCD groups displayed no significant differences in disease duration (fear: 18.3 ± 9.2 years, disgust: 19.8 ± 3.1 years, p=0.61), age at DBS intervention (fear: 36.7 ± 15.0 years, disgust: 32.8 ± 8.3 years, p=0.86), baseline Y-BOCS-II (fear: 39.8 ± 3.7, disgust: 41.5 ± 6.6, p=0.39), and time to most recent follow-up (fear: 23.6 ± 14.9 months, disgust: 21.0 ± 23.4 months, p=0.52). At most recent follow-up, the fear cohort attained significantly lower YBOCS-II scores (11.2 ± 9.2) than the disgust cohort (30.5 ± 5.7, p=0.004).
Conclusion : Disgust-predominant C-OCD patients demonstrate a less favorable response to DBS compared to fear-predominant C-OCD patients. These findings are consistent with previous behavioral studies demonstrating disgust’s heightened resistance to extinction and could inform DBS candidacy and therapeutic strategies.
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