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Gerald Nestadt, MD, MPH; Jack Samuels, PhD; Mark Riddle, MD; O. Joseph Bienvenu III, MD; Kung-Yee Liang, PhD; Michele LaBuda, PhD; John Walkup, MD; Marco Grados, MD; Rudolf Hoehn-Saric, MD

Arch Gen Psychiatry. 2000;57:358-363.

Background  The causes of obsessive-compulsive disorder (OCD) are as yet unknown. Evidence of familial aggregation is one approach for investigating the role of genetics in the etiology of this condition. The current study was conducted to determine if OCD is familial and to investigate possible familial subtypes.

Methods  Eighty case probands were identified in 5 specialty OCD clinics and 73 community control probands were identified by random-digit dialing. These probands and their first-degree relatives (343 case and 300 control relatives) were blinded to group and evaluated by psychiatrists and doctoral-level clinical psychologists using semistructured instruments. Final diagnoses were assigned by a blinded-consensus procedure. The results were analyzed using logistic regression by the method of generalized estimating equations.

Results  The lifetime prevalence of OCD was significantly higher in case compared with control relatives (11.7% vs 2.7%) (P<.001). Case relatives had higher rates of both obsessions and compulsions; however, this finding is more robust for obsessions. Age at onset of obsessive-compulsive symptoms in the case proband was strongly related to familiality (odds ratio, 0.92; confidence interval, 0.85-0.99) (P=.05); no case of OCD symptoms was detected in the relatives of probands whose age at onset of symptoms was 18 years or older. Probands with tics or obsessive-compulsive personality disorder were not more likely to have relatives with OCD than those without these features.

Conclusions  Obsessive-compulsive disorder is a familial disorder. Obsessions are more specific to the phenotype than are compulsions. Age at onset of OCD is valuable in characterizing a familial subtype.

From the Departments of Psychiatry and Behavioral Sciences, School of Medicine (Drs Nestadt, Samuels, Riddle, Bienvenu, LaBuda, Walkup, Grados, and Hoehn-Saric) and Biostatistics, School of Hygiene and Public Health (Dr Liang), Johns Hopkins University, Baltimore, Md.

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