The Structure of Concern Project compares many theoretical models from many disciplines to the Adizes PAEI model, arguing that they must all be reflecting the same underlying phenomenon. One concern structure model is described below.
Hasler et al. (2005) report on the results of factor- and cluster-analytic analyses of symptom categories in obsessive–compulsive disorder, associating the emergent OCD symptom dimensions with comorbid neuropsychiatric conditions. The hypothesis was that people with certain sets of OCD symptoms might be more like to have certain comorbidities than others. They interviewd people with OCD using the DSM-IV Structured Clinical Interview, assessing OCD symptoms using the Yale–Brown Obsessive–Compulsive Scale Symptom Checklist (N =169) and the Thoughts and Behaviors Inventory (N =275). These assessments were subjected to factor and cluster analyses.
Hasler et al. (2005) report that "An identical four-factor solution emerged in two different data sets from overlapping samples, in agreement with most smaller factor-analytic studies employing the YBOCS checklist alone. The cluster analysis confirmed the four-factor solution and provided additional information on the similarity among OCD symptom categories at five different levels."
The four OCD symptom factors are listed below in PAEI order:
P - Factor IV (Hoarding obsessions and compulsions) Did not dominate any category for comorbid symptoms. Hoarding can be seen as a competitive/exclusive activity, which is resource-oriented rather than social or self-presentational. Action to secure material resources is a strong P trait.
A - Factor II (Obsessions: symmetry. Compulsions: repeating, counting and ordering/arranging) associated with panic disorder, agoraphobia, tics (Nestadt et al. 2003), and bipolar disorders (Hasler et al., 2005). Using order to manage, divert or contain panic is a core feature of A concern structures.
E - Factor I: (Obsessions: aggressive, sexual, religious and somatic. Compulsions: checking) was broadly associated with comorbid anxiety disorders and depression for Hasler et. al, with a male skew to distrubtion of people experiencing these symptoms. Other studies (Perugi et al., 2002; Hantouche et al., 2003) have related bipolar disorder to this factor/cluster as well. The obssessive symptoms are self-aggrandizing or self-presentational. The compulsion relates to an unquenchable need to ascertain that the state of the world does or does not match what one wants/doesn't want it to be. Factor I combines a narcissistic self-structure with an uncertain sense of the actuality of accomplished events.
I - Factor III (Obsessions: contamination. Compulsions: washing, cleaning) associated with eating disorders, and with more females than males describing this experience. The concern is hygenic, involving caretaking functions and the social, physical and personal care of the body - coping with a poisoned nest by sealing boundaries.
Factors I and II had the strongest familial component, and were associated with early-onset OCD.
Mataix-Cols et al. (2005) review twelve factor analytic studies with information from over 2000 participants with OCD, that consistently extracted factors or clusters of the type reported by Hasler et al. Mataix-Cols et al. also review neuroimaging research, showing the following patterns of brain involvement in OCD symptom-provocation studies:
P - Factor IV (Hoarding obsessions and compulsions): Increased activity in the left precentral gyrus and right orbitofrontal cortex, reduced glucose metabolism in the posterior cingulate gyrus and the dorsolateral prefrontal (DLPFC reduction proportional to symptom severity; Mataix-Cols et al., 2003; 2004; Saxena et al., 2001).
A - Factor II (Obsessions: symmetry. Compulsions: repeating, counting and ordering/arranging): Correlated with reduced regional cerebral blood flow in the striatum (Rauch et al., 1998).
E - Factor I: (Obsessions: aggressive, sexual, religious and somatic. Compulsions: checking): Increased activation and blood flow in frontostriatal regions and the thalamus, including the putamen/globus pallidus and dorsal cortical areas in general (Rauch et al., 1998; Mataix-Cols et al., 2003; 2004).
I - Factor III (Obsessions: contamination. Compulsions: washing, cleaning): Increased ventral and medial cortical activation including bilateral anterior cingulate, ventromedial, ventrolateral, left orbitofrontal, right insular and parahippocampal cortices. (Shapira et al., 2003; Mataix-Cols et al., 2003; 2004)