“Brain not right” and “lonely in a crowd”: unveiling the central architecture of psychopathology in obsessive-compulsive disorder

Background The co-occurrence of obsessive-compulsive disorder (OCD) and psychotic-like symptoms suggests the existence of the “obsessive-schizophrenic spectrum”, and this study uses network analysis to explore their interaction mechanism. Methods A total of 528 patients with obsessive-compulsive disorder (OCD) were included. A symptom network was constructed based on the Yale-Brown ObsessiveCompulsive Scale (Y-BOCS), Symptom Checklist-90 (SCL-90), Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS). Core nodes were identified through centrality indicators. Results “Brain not right” (SCL90) has the highest betweenness centrality and serves as a crucial metacognitive mediator connecting symptom clusters. Lonely in crowd (SCL77) has the highest strength, maintaining network activation. unusual thoughts (SCL68) and Somatic concern (SCL87) emerged as a bridge node linking obsessivecompulsive symptoms to subjective experiential and thought-perceptual disturbances associated with the psychosis spectrum. Malignant loops such as “obsessive interference – collapse of metacognitive evaluation” have been identified. Conclusions The catastrophe of brain functions and the sense of loneliness are the central hubs which drive the complexity of OCD symptoms. In addition to traditional treatments, correcting metacognitive beliefs and improving social isolation are crucial for preventing the deterioration of disease.