Mapping the Brain in OCD: Clinical Neuroimaging Insights Into Symptom Dimensions and Subtypes – A Systematic Review
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Background Obsessive–compulsive disorder (OCD) is a complex and often disabling condition that affects millions worldwide. Patients experience very different types of symptoms—from repeated handwashing to intrusive doubts or compulsive ordering—that do not always respond equally well to treatment. Understanding whether these clinical differences are reflected in the brain could open the door to more personalized care. Methods We systematically reviewed 95 neuroimaging studies published between 2000 and 2025, covering MRI, diffusion imaging, functional MRI, PET, and spectroscopy. Studies were included if they examined at least 15 patients with OCD and focused on symptom dimensions or data-driven biological subtypes. Results Across imaging methods, the same core brain network—linking the frontal cortex, striatum, thalamus, and back to the cortex—emerged as a key circuit in OCD. At the same time, different symptom profiles showed partly distinct patterns: contamination fears involved insula and ventromedial prefrontal regions; checking was linked to the dorsal anterior cingulate and dorsolateral prefrontal cortex; symmetry/ordering engaged parietal and sensorimotor regions; and hoarding involved the orbitofrontal cortex. Newer studies using multimodal data and machine learning suggest at least two reproducible neurobiological subtypes. Conclusions Neuroimaging highlights both common and unique brain signatures across OCD subtypes. These findings hold promise for tailoring treatments to patients’ needs, though larger and more collaborative studies are required before such insights can guide everyday clinical decisions.
