{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T22:47:14Z","timestamp":1777330034403,"version":"3.51.4"},"posted":{"date-parts":[[2026,4,27]]},"group-title":"Psychiatry and Clinical Psychology","reference-count":0,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,4,27]]},"abstract":"<jats:p>Background. Studies applying machine learning to obsessive-compulsive disorder (OCD) typically report accuracy in homogeneous samples but rarely assess model reliability, generalizability, and interpretability needed for clinical use.\n\nMethods. We applied a transformer-based deep learning model, the Multi-Band Brain Net, to the ENIGMA-OCD cohort - the largest available resting-state functional magnetic resonance imaging (rs-fMRI) dataset in OCD with 1,706 participants (869 cases with OCD, 837 controls) across 23 sites worldwide. We evaluated model reliability by calculating calibration - the model's ability to \"know what it doesn't know\". We assessed generalizability using leave-one-site-out validation to test performance on unseen sites with different scanners, acquisition protocols, and patient populations. Finally, we examined interpretability by analyzing model attention weights to identify the neural connectivity patterns that influence model predictions.\n\nResults. The model achieved modest but competitive classification performance (AUROC = .653, SD = .039). Crucially, while large-scale pretraining on the UK Biobank (N = 40,783) did not boost accuracy, it significantly enhanced model calibration by reducing overconfident predictions. Leave-one-site-out validation showed a generalization gap across sites (AUROC = .427-.819). Pretraining did not close this gap but removed scanner manufacturer bias. Finally, attention-based mapping identified biologically plausible patterns of widespread hypoconnectivity in OCD relative to healthy controls, particularly in low-frequency bands involving the default mode, salience, and somatomotor networks. These findings aligned with known OCD neurobiology.\n\nConclusions. This study provides a framework for developing more reliable and trustworthy clinical artificial intelligence for OCD.<\/jats:p>","DOI":"10.64898\/2026.04.24.26351711","type":"posted-content","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T22:15:49Z","timestamp":1777328149000},"source":"Crossref","is-referenced-by-count":0,"title":["Toward trustworthy clinical AI for obsessive-compulsive disorder: reliability, generalizability, and interpretability of a transformer model across the ENIGMA-OCD consortium"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-4153-6470","authenticated-orcid":false,"given":"Maria","family":"Pak","sequence":"first","affiliation":[{"name":"Department of Psychology, Seoul National University, Republic of Korea;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Youngchan","family":"Ryu","sequence":"additional","affiliation":[{"name":"Department of Electrical and Computer Engineering, Seoul National University, Republic of Korea;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0411-5692","authenticated-orcid":false,"given":"Sangyoon","family":"Bae","sequence":"additional","affiliation":[{"name":"Graduate School of Artificial Intelligence, Seoul National University, Republic of Korea;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan","family":"Anticevic","sequence":"additional","affiliation":[{"name":"Johnson & Johnson, Neuroscience Therapeutic Area;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0281-4254","authenticated-orcid":false,"given":"Ana Daniela","family":"Costa","sequence":"additional","affiliation":[{"name":"Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS\/3B's, PT Government Associate Laboratory, Braga\/Guimaraes, Portugal; Clinical Academic Center - Braga, Braga, Portugal;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2836-5223","authenticated-orcid":false,"given":"Anders L.","family":"Thorsen","sequence":"additional","affiliation":[{"name":"Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway; Centre for Crisis Psychology, University of Bergen, Bergen, Norway;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2436-4899","authenticated-orcid":false,"given":"Anouk L.","family":"van der Straten","sequence":"additional","affiliation":[{"name":"Levvel, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3746-9959","authenticated-orcid":false,"given":"Beatriz","family":"Couto","sequence":"additional","affiliation":[{"name":"Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS\/3B's, PT Government Associate Laboratory, Braga\/Guimaraes, Portugal; Clinical Academic Center - Braga, Braga, Portugal;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0748-4656","authenticated-orcid":false,"given":"Benedetta","family":"Vai","sequence":"additional","affiliation":[{"name":"Psychiatry and Clinical Psychobiology, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy ; Vita-Salute San Raffaele University, Milan, Italy;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5659-1119","authenticated-orcid":false,"given":"Bjarne","family":"Hansen","sequence":"additional","affiliation":[{"name":"Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway; Centre for Crisis Psychology, University of Bergen, Bergen, Norway;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4574-6597","authenticated-orcid":false,"given":"Carles","family":"Soriano-Mas","sequence":"additional","affiliation":[{"name":"Bellvitge Biomedical Research Institute-IDIBELL, Bellvitge University Hospital, Barcelona, Spain; CIBERSAM, Barcelona, Spain; Department of Social Psychology and Quantitative Psychology, Institute of Neurosciences, University of Barcelona, Barcelona, Spai;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9393-1212","authenticated-orcid":false,"given":"Chiang-shan R.","family":"Li","sequence":"additional","affiliation":[{"name":"Departments of Psychiatry and of Neuroscience, Yale University, New Haven, CT;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3111-1304","authenticated-orcid":false,"given":"Chris","family":"Vriend","sequence":"additional","affiliation":[{"name":"Amsterdam UMC, Vrije Universiteit Amsterdam, Department of  Psychiatry, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Anatomy & Neurosciences, De Boelelaan 1117, Amsterdam, the Netherlands; Amste;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4766-3704","authenticated-orcid":false,"given":"Christine","family":"Lochner","sequence":"additional","affiliation":[{"name":"SAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2117-9321","authenticated-orcid":false,"given":"Christopher","family":"Pittenger","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Neuroscience, Psychology, and Yale Child Study Center, Yale University, New Haven, CT; Center for Brain and Mind Health, Yale University School of Medicine, New Haven, CT; Wu-Tsai Institute, Yale University, New Haven, CT;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6217-731X","authenticated-orcid":false,"given":"Clara A.","family":"Moreau","sequence":"additional","affiliation":[{"name":"Sainte Justine Hospital Azrieli Research Center, Department of Psychiatry and Addictology, University of Montreal, Canada;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6867-0727","authenticated-orcid":false,"given":"Daniela","family":"Rodriguez-Manrique","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, TUM University Hospital, School of Medicine and Health, Technical University of Munich (TUM), Munich, Germany; School of Medicine and Health, TUM-NIC Neuroimaging Center, Technical University of Munich, Munich, Germany; Gradu;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8428-7376","authenticated-orcid":false,"given":"Daniela","family":"Vecchio","sequence":"additional","affiliation":[{"name":"Laboratory of Neuropsychiatry, Department of Clinical Neuroscience and Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6741-9338","authenticated-orcid":false,"given":"Eiji","family":"Shimizu","sequence":"additional","affiliation":[{"name":"Research Center for Child Mental Development, Chiba University, Chiba, Japan; United Graduate School of Child Development, The University of Osaka, Suita, Japan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7805-594X","authenticated-orcid":false,"given":"Emily R.","family":"Stern","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, New York University School of Medicine, New York, NY; Neuroscience Institute, New York University School of Medicine, New York, NY; Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2104-7265","authenticated-orcid":false,"given":"Emma","family":"Munoz-Moreno","sequence":"additional","affiliation":[{"name":"MRI Core Facility, IDIBAPS, Barcelona, Spain;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4893-8957","authenticated-orcid":false,"given":"Erika L.","family":"Nurmi","sequence":"additional","affiliation":[{"name":"Division of Child and Adolescent Psychiatry, Jane & Terry Semel Institute For Neurosciences, University of California, Los Angeles, CA, USA;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3566-5494","authenticated-orcid":false,"given":"Fabrizio","family":"Piras","sequence":"additional","affiliation":[{"name":"Laboratory of Neuropsychiatry, Department of Clinical Neuroscience and Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5853-9912","authenticated-orcid":false,"given":"Federica","family":"Colombo","sequence":"additional","affiliation":[{"name":"Psychiatry and Clinical Psychobiology, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9546-7038","authenticated-orcid":false,"given":"Federica","family":"Piras","sequence":"additional","affiliation":[{"name":"Laboratory of Neuropsychiatry, Department of Clinical Neuroscience and Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5107-4945","authenticated-orcid":false,"given":"Fern","family":"Jaspers-Fayer","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of British Columbia, Vancouver, Canada;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4949-856X","authenticated-orcid":false,"given":"Francesco","family":"Benedetti","sequence":"additional","affiliation":[{"name":"Psychiatry and Clinical Psychobiology, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy ; Vita-Salute San Raffaele University, Milan, Italy;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0949-898X","authenticated-orcid":false,"given":"Ganesan","family":"Venkatasubramanian","sequence":"additional","affiliation":[{"name":"OCD clinic, Department of Psychiatry, National Institute of Mental Health And Neurosciences (NIMHANS), Bangalore, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7189-2868","authenticated-orcid":false,"given":"Goi Khia","family":"Eng","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, New York University School of Medicine, New York, NY; Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9332-2839","authenticated-orcid":false,"given":"H. Blair","family":"Simpson","sequence":"additional","affiliation":[{"name":"Columbia University Irving Medical College, Columbia University, New York, NY, U.S.A.; New York State Psychiatric Institute, New York, NY, U.S.A.;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0165-719X","authenticated-orcid":false,"given":"Hanyang","family":"Ruan","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, TUM University Hospital, School of Medicine and Health, Technical University of Munich (TUM), Munich, Germany; School of Medicine and Health, TUM-NIC Neuroimaging Center, Technical University of Munich, Munich, Germany;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hao","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R.China;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3543-4135","authenticated-orcid":false,"given":"Hein J.F.","family":"van Marle","sequence":"additional","affiliation":[{"name":"Amsterdam UMC, Vrije Universiteit Amsterdam, Dept. Psychiatry, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam, The Netherlands;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8389-0541","authenticated-orcid":false,"given":"Hirofumi","family":"Tomiyama","sequence":"additional","affiliation":[{"name":"Graduate School of Medical Sciences, Kyushu University, Fukuoka-shi, Japan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4036-0284","authenticated-orcid":false,"given":"Ignacio","family":"Martinez-Zalacain","sequence":"additional","affiliation":[{"name":"Bellvitge Biomedical Research Institute-IDIBELL, Bellvitge University Hospital, Barcelona, Spain; Department of Radiology, Bellvitge University Hospital, Barcelona, Spain;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0391-345X","authenticated-orcid":false,"given":"Jamie","family":"Feusner","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Division of Neurosciences and Clinical Translation, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Women's and Children's Health, Karolinska Institutet, Stoc;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janardhanan C.","family":"Narayanaswamy","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, School of Clinical Sciences, Monash University, Melbourne, Australia; Monash Health, Melbourne, Australia; OCD clinic, Department of Psychiatry, National Institute of Mental Health And Neurosciences (NIMHANS), Bangalore, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5531-2410","authenticated-orcid":false,"given":"Je-Yeon","family":"Yun","sequence":"additional","affiliation":[{"name":"Seoul National University Hospital, Seoul, Republic of Korea; Yeongeon Student Support Center, Seoul National University College of Medicine;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7503-9781","authenticated-orcid":false,"given":"Joao R.","family":"Sato","sequence":"additional","affiliation":[{"name":"Center of Mathematics, Computing and Cognition, Universidade Federal do ABC, Santo Andre, Brazil;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1272-0032","authenticated-orcid":false,"given":"Jonathan","family":"Ipser","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Mental Health and Neuroscience Institute, University of Cape Town, Cape Town, South Africa;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7358-7602","authenticated-orcid":false,"given":"Jose C.","family":"Pariente","sequence":"additional","affiliation":[{"name":"MRI Core Facility, IDIBAPS, Barcelona, Spain;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6231-6524","authenticated-orcid":false,"given":"Jose M.","family":"Menchon","sequence":"additional","affiliation":[{"name":"Bellvitge Biomedical Research Institute-IDIBELL, Bellvitge University Hospital, Barcelona, Spain; CIBERSAM, Barcelona, Spain; Department of Clinical Sciences, University of Barcelona, Barcelona, Spain;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2216-3903","authenticated-orcid":false,"given":"Joseph","family":"O'Neill","sequence":"additional","affiliation":[{"name":"Division of Child and Adolescent Psychiatry, Jane & Terry Semel Institute For Neurosciences, University of California, Los Angeles, CA, USA;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1060-1462","authenticated-orcid":false,"given":"Jun Soo","family":"Kwon","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Hanyang University College of Medicine, Seoul, Republic of Korea; Department of Psychiatry, Hanyang University Hospital, Seoul, Republic of Korea; Institute of Human Behavioral Medicine, SNU-MRC, Seoul, Republic of Korea;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4664-8016","authenticated-orcid":false,"given":"Kathrin","family":"Koch","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, TUM University Hospital, School of Medicine and Health, Technical University of Munich (TUM), Munich, Germany; School of Medicine and Health, TUM-NIC Neuroimaging Center, Technical University of Munich, Munich, Germany;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4286-1277","authenticated-orcid":false,"given":"Kristen","family":"Hagen","sequence":"additional","affiliation":[{"name":"Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway; Psychiatric Department, More og Romsdal Hospital Trust, Molde, Norway; Department of Mental Health, NTNU, Trondheim, Norway;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6482-1316","authenticated-orcid":false,"given":"Lea","family":"Backhausen","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry, Faculty of Medicine of the Technische Universitat Dresden, Dresden, Germany;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3239-6957","authenticated-orcid":false,"given":"Lea","family":"Waller","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Neurosciences CCM, Charite Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin, Berlin, Germany; German Center for Mental Health (DZPG), partner site Berlin-Potsdam, Berl;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8425-5750","authenticated-orcid":false,"given":"Luisa","family":"Lazaro","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic, IDIBAPS, Barcelona, Spain; Department of Medicine, University of Barcelona, Spain; CIBERSAM, Barcelona, Spain;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1347-8241","authenticated-orcid":false,"given":"Marcelo C.","family":"Batistuzzo","sequence":"additional","affiliation":[{"name":"Departamento de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Departament of Methods and Techniques in Psychology, Pontificial Catholic University of Sao Paulo, SP, Brazil;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9302-4380","authenticated-orcid":false,"given":"Marcelo Q.","family":"Hoexter","sequence":"additional","affiliation":[{"name":"Departamento de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1573-2445","authenticated-orcid":false,"given":"Maria","family":"Pico-Perez","sequence":"additional","affiliation":[{"name":"Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; Departamento de Psicologia Basica, Clinica y Psicobiologia, Universitat Jaume I, Castellon de la Plana, Spain;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8668-0817","authenticated-orcid":false,"given":"Minah","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Human Behavioral Medicine, SNU-MRC, Seoul, Republi;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8114-1299","authenticated-orcid":false,"given":"Nadza","family":"Dzinalija","sequence":"additional","affiliation":[{"name":"Amsterdam UMC, Vrije Universiteit Amsterdam, Department of  Psychiatry, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Anatomy & Neurosciences, De Boelelaan 1117, Amsterdam, the Netherlands; Amste;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"Beyer","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry and Psychotherapy, Faculty of Medicine, Technische Universitat Dresden, Dresden; Germany;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1477-5395","authenticated-orcid":false,"given":"Nora C.","family":"Vetter","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry, Faculty of Medicine of the Technische Universitat Dresden, Dresden, Germany; Faculty of Natural Sciences, Department of Psychology, MSB Medical School Berlin, Berlin, Germany;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3685-146X","authenticated-orcid":false,"given":"Patricia","family":"Gruner","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Yale University, New Haven, CT;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3880-3258","authenticated-orcid":false,"given":"Pedro","family":"Morgado","sequence":"additional","affiliation":[{"name":"Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS\/3B's, PT Government Associate Laboratory, Braga\/Guimaraes, Portugal; Clinical Academic Center - Braga, Braga, Portugal;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6383-6142","authenticated-orcid":false,"given":"Philip R.","family":"Szeszko","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Icahn School of Medicine at Mount Sinai, New York, NY; James J. Peters VA Medical Center, Mental Illness Research, Education and Clinical Center, Bronx, NY;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5779-9111","authenticated-orcid":false,"given":"Pino","family":"Alonso","sequence":"additional","affiliation":[{"name":"Bellvitge Biomedical Research Institute-IDIBELL, Bellvitge University Hospital, Barcelona, Spain; CIBERSAM, Barcelona, Spain; Department of Clinical Sciences, University of Barcelona, Barcelona, Spain;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6253-5832","authenticated-orcid":false,"given":"Qing","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Clinical Psychology, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R.China;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2439-6305","authenticated-orcid":false,"given":"Rachel","family":"Marsh","sequence":"additional","affiliation":[{"name":"Columbia University Irving Medical College, Columbia University, New York, NY, U.S.A.; New York State Psychiatric Institute, New York, NY, U.S.A.;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0994-6383","authenticated-orcid":false,"given":"S. Evelyn","family":"Stewart","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of British Columbia, Vancouver, Canada;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1468-7862","authenticated-orcid":false,"given":"Sara","family":"Bertolin","sequence":"additional","affiliation":[{"name":"Bellvitge Biomedical Research Institute-IDIBELL, Bellvitge University Hospital, Barcelona, Spain; CIBERSAM, Barcelona, Spain; Department of Clinical Sciences, University of Barcelona, Barcelona, Spain;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8031-1305","authenticated-orcid":false,"given":"Silvia","family":"Brem","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and ETH Zurich, Switzerland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0046-4070","authenticated-orcid":false,"given":"Sophia I.","family":"Thomopoulos","sequence":"additional","affiliation":[{"name":"Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6729-6414","authenticated-orcid":false,"given":"Srinivas","family":"Balachander","sequence":"additional","affiliation":[{"name":"OCD clinic, Department of Psychiatry, National Institute of Mental Health And Neurosciences (NIMHANS), Bangalore, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8161-8683","authenticated-orcid":false,"given":"Susanne","family":"Walitza","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and ETH Zurich, Switzerland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4410-7163","authenticated-orcid":false,"given":"Tokiko","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Research Center for Child Mental Development, Chiba University, Chiba, Japan; United Graduate School of Child Development, The University of Osaka, Suita, Japan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomohiro","family":"Nakao","sequence":"additional","affiliation":[{"name":"Graduate School of Medical Sciences, Kyushu University, Fukuoka-shi, Japan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0353-8597","authenticated-orcid":false,"given":"Venkataram","family":"Shivakumar","sequence":"additional","affiliation":[{"name":"Department of Integrative Medicine, National Institute of Mental Health And Neurosciences (NIMHANS), Bangalore, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4722-0444","authenticated-orcid":false,"given":"Wieke","family":"van Leeuwen","sequence":"additional","affiliation":[{"name":"Arkin Institute for Mental Health, Department of Psychiatry, Amsterdam, The Netherlands;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9925-9631","authenticated-orcid":false,"given":"Y.C. Janardhan","family":"Reddy","sequence":"additional","affiliation":[{"name":"OCD clinic, Department of Psychiatry, National Institute of Mental Health And Neurosciences (NIMHANS), Bangalore, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8348-0801","authenticated-orcid":false,"given":"Yoshinari","family":"Abe","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine; Sugimoto Psychiatric Clinic;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3844-3061","authenticated-orcid":false,"given":"Yoshiyuki","family":"Hirano","sequence":"additional","affiliation":[{"name":"Research Center for Child Mental Development, Chiba University, Chiba, Japan; United Graduate School of Child Development, The University of Osaka, Suita, Japan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8639-3869","authenticated-orcid":false,"given":"Youngsun","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Yale University, New Haven, CT; Child Study Center, Yale University, New Haven, CT;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2370-9584","authenticated-orcid":false,"given":"Ysbrand D.","family":"van der Werf","sequence":"additional","affiliation":[{"name":"Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Anatomy & Neurosciences, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam, The Netherlands;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0276-7014","authenticated-orcid":false,"given":"Yuki","family":"Ikemizu","sequence":"additional","affiliation":[{"name":"Research Center for Child Mental Development, Chiba University, Chiba, Japan; United Graduate School of Child Development, The University of Osaka, Suita, Japan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2475-8548","authenticated-orcid":false,"given":"Yuki","family":"Sakai","sequence":"additional","affiliation":[{"name":"ATR Brain Information Communication Research Laboratory Group, Kyoto, Japan; Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine; XNef, Inc.;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4319-5314","authenticated-orcid":false,"given":"Zhen","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Clinical Psychology, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R.China;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"ENIGMA-OCD Working Group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4720-8867","authenticated-orcid":false,"given":"Paul M.","family":"Thompson","sequence":"additional","affiliation":[{"name":"Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0672-8903","authenticated-orcid":false,"given":"Willem","family":"Bruin","sequence":"additional","affiliation":[{"name":"Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Amsterdam, The Netherlands; Amsterdam Neuroscience, Amsterdam, The Netherlands; Section Forensic Family and Youth Care, Institute of Education and Child Studies, Leiden University,;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3076-5891","authenticated-orcid":false,"given":"Guido","family":"van Wingen","sequence":"additional","affiliation":[{"name":"Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Amsterdam, The Netherlands; Amsterdam Neuroscience, Amsterdam, The Netherlands;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7218-7810","authenticated-orcid":false,"given":"Dan J.","family":"Stein","sequence":"additional","affiliation":[{"name":"SAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9804-7653","authenticated-orcid":false,"given":"Odile A.","family":"van den Heuvel","sequence":"additional","affiliation":[{"name":"Amsterdam UMC, Vrije Universiteit Amsterdam, Department of  Psychiatry, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Anatomy & Neurosciences, De Boelelaan 1117, Amsterdam, the Netherlands; Amste;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5314-7992","authenticated-orcid":false,"given":"Jiook","family":"Cha","sequence":"additional","affiliation":[{"name":"Department of Psychology, Seoul National University, Republic of Korea; Graduate School of Artificial Intelligence, Seoul National University, Republic of Korea; Department of Brain and Cognitive Sciences, Seoul National University, Republic of Korea; Ins"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.64898\/2026.04.24.26351711","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T22:15:49Z","timestamp":1777328149000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.64898\/2026.04.24.26351711"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,27]]},"references-count":0,"URL":"https:\/\/doi.org\/10.64898\/2026.04.24.26351711","relation":{},"subject":[],"published":{"date-parts":[[2026,4,27]]},"subtype":"preprint"}}