Symptom Dimensions in OCD: Item-Level Factor Analysis and Heritability Estimates

To reduce the phenotypic heterogeneity of obsessive-compulsive disorder (OCD) for genetic, clinical and translational studies, numerous factor analyses of the Yale-Brown Obsessive Compulsive Scale checklist (YBOCS-CL) have been conducted. Results of these analyses have been inconsistent, likely as a consequence of small sample sizes and variable methodologies. Furthermore, data concerning the heritability of the factors are limited. Item and category-level factor analyses of YBOCS-CL items from 1224 OCD subjects were followed by heritability analyses in 52 OCD-affected multigenerational families. Item-level analyses indicated that a five factor model: (1) taboo, (2) contamination/cleaning, (3) doubts, (4) superstitions/rituals, and (5) symmetry/hoarding provided the best fit, followed by a one-factor solution. All 5 factors as well as the one-factor solution were found to be heritable. Bivariate analyses indicated that the taboo and doubts factor, and the contamination and symmetry/hoarding factor share genetic influences. Contamination and symmetry/hoarding show shared genetic variance with symptom severity. Nearly all factors showed shared environmental variance with each other and with symptom severity. These results support the utility of both OCD diagnosis and symptom dimensions in genetic research and clinical contexts. Both shared and unique genetic influences underlie susceptibility to OCD and its symptom dimensions.Obsessive Compulsive FoundationTourette Syndrome AssociationAnxiety Disorders Association of AmericaAmerican Academy of Child and Adolescent Psychiatr

Gender differences in obsessive-compulsive disorder: a literature review

INTRODUCTION: Obsessive-compulsive disorder (OCD) is a heterogeneous condition, in which subtypes have been proposed. Previous studies suggested that gender plays a relevant role in OCD phenotypic expression. This study aimed to review the literature on gender differences in clinical, genetic or familial aspects of OCD. METHOD: A conventional review was conducted, including all papers that investigated demographic, clinical, and genetic aspects of OCD according to gender. The search was based on data available in Medline and PsycINFO databases in the last 20 years, using as keywords: obsessive-compulsive disorder; and: gender, sex, male, female, demographic characteristics, clinical features, clinical characteristics, genetic, genes, genetics gender OCD, genes OCD, genes OCD males, genes OCD females. RESULTS: Sixty three of 487 phenotypical and genetics studies were selected. Most studies indicate that male patients are more likely than females to be single, present early onset of symptoms and chronic course of the disorder, greater social impairment, more sexual-religious and aggressive symptoms, and greater comorbidity with tic and substance use disorders. Female patients present more contamination/cleaning symptoms and greater comorbidity with eating and impulse-control disorders. Genetic and family studies are inconclusive, but suggest that gender may play a role in the disease expression. CONCLUSIONS: Gender is a relevant factor that should be taken into account when evaluating OCD patients. More studies are necessary to determine whether in fact it defines a homogeneous and particular group in OCD.INTRODUÇÃO: O transtorno obsessivo-compulsivo (TOC) é um quadro heterogêneo, no qual subtipos têm sido propostos. Estudos anteriores sugerem que gênero desempenha papel relevante na expressão fenotípica. O objetivo foi realizar uma revisão convencional da literatura sobre diferenças de gênero em relação a aspectos clínicos e genéticos ou familiares do TOC. MÉTODO: Realizou-se uma revisão convencional da literatura incluindo todos os artigos que investigaram aspectos sociodemográficos, clínicos e genéticos do TOC, de acordo com o gênero. A pesquisa foi baseada em publicações disponíveis nas bases de dados Medline e PsycInfo nos últimos 20 anos, usando como palavras-chave: obsessive-compulsive disorder (OCD), e: gender, sex, male, female, demographic characteristics, clinical features, clinical characteristics, genetic, genes, genetics gender OCD, genes OCD, genes OCD males, genes OCD females. RESULTADO: Sessenta e três artigos de fenótipo e genética foram selecionados. Na maioria dos estudos, o sexo masculino associou-se mais que o feminino com: ser solteiro, apresentar início mais precoce dos sintomas, maior prejuízo social, mais sintomas sexuais, religiosos e de agressão, e mais comorbidade com transtorno de tiques e abuso de substâncias. Pacientes do sexo feminino apresentam mais sintomas de contaminação/limpeza e mais comorbidade com transtornos alimentares e do controle de impulsos. Estudos genéticos e familiares são controversos, mas indicam que o gênero pode desempenhar um papel na expressão da doença. CONCLUSÃO: Gênero é um fator relevante a ser considerado na avaliação de pacientes com TOC. São necessários mais estudos para determinar se este fator define de fato um grupo homogêneo e particular de TOC

Obsessive-Compulsive Disorder in Women

Obsessive-compulsive disorder (OCD) is a chronic, debilitating, and heterogeneous condition that affects 2-3% of the general population. Previous studies have suggested that sex plays a role in OCD phenotypic expression. This chapter aims to review the literature regarding OCD in women, exploring sex differences in (1) the prevalence of OCD/subclinical OCD in nonclinical populations; (2) age of onset, clinical course, and severity and impact of OCD symptoms; (3) onset or aggravation of OCD symptoms among women according to the time point in the reproductive cycle; (4) OCD symptom contents; (5) psychiatric comorbidity; and (6) treatment-seeking behavior and treatment response. Studies report either a slight female predominance or a similar prevalence of OCD in adults from the general population. Women are more likely than men to be married, to present later onset, and to report preceding stressful life events. Onset or worsening of OCD symptoms during pregnancy and postpartum are frequently described. Women are more likely to present contamination obsessions and/or cleaning rituals and comorbid eating and impulse-control disorders. Several interacting mechanisms are probably responsible for mediating the effects of sex/gender in the biological and psychosocial risk factors for OCD. Sex is a relevant factor that should be taken into account when evaluating OCD patients, but more studies are necessary to determine whether or not it defines a valid OCD subtype.Department of Neurology Psychology and Psychiatry Botucatu Medical School São Paulo State University (UNESP), SPDepartment and Institute of Psychiatry Faculty of Medicine University of São Paulo (USP), SPDepartment of Neurology Psychology and Psychiatry Botucatu Medical School São Paulo State University (UNESP), S

Psychiatric Disorders

This chapter summarizes the most significant gender influences on mental health in terms of illness incidence and prevalence, clinical presentation, course, and response to treatment. Several mental disorders including major depression, bipolar disorder, anxiety disorders, schizophrenia, and eating disorders are considered in different sections. Depression is twice more frequent in women than in men. Moreover, men and women show differences regarding presentation, course, treatment response, and outcome. Women affected by depression show higher recurrence and atypical features; they have generally an earlier onset, more severe, longer, and recurrent depressive episodes, and a lower quality of life than men do. Women are also more likely to have a comorbid anxiety, eating or somatoform disorder, and more frequently than men, they attempt suicide (although lethal suicide is more probable to happen in men). Psychopharmacological treatment of depression also might present significant gender dissimilarities; still, there is no clear consensus on whether there are gender-related differences in antidepressant efficacy. There is a significant gender difference in terms of lifetime prevalence of bipolar disorder type II, with more affected women, while both genders show a similar prevalence of bipolar disorder type I. Women usually have an older age of onset and they typically manifest a depressive polarity at the onset and a predominance of depression phases during lifetime. Women are also more likely to undergo mixed and seasonal episodes and have an increased risk of developing rapid cycling mood disturbances. Bipolar disorder in men is characterized by manic onset, recurrence of manic phases, and by lower treatment adherence. Comorbidity of psychiatric (eating and anxiety disorders) and medical (thyroid disease, migraine, obesity) conditions are more common in women, while substance use disorder is more common in men. There is no evidence that women and men suffering from bipolar disorder differ significantly in treatment response to mood stabilizers. Schizophrenia also has significant gender differences: affected males, normally younger at the onset than females, present more severe negative symptoms, worse cognitive impairment, more frequent hospitalizations, and are more likely to commit acts of severe violence. In detail, incidence rate of early onset is higher in males than females, while at older onset women predominate. Until the mid-30s, rates are estimated to be approximately 1.5\u20132 times greater in males than females. Later, rates decrease for both sexes, with a narrowing sex ratio, until the mid-40s when there is a minor secondary peak for women. Male patients are likely to have more cognitive impairment and poorer premorbid functioning, more negative symptoms, and more severe deterioration over time. Female patients experienced more severe positive symptoms (hallucinations and persecutory delusions) and commit a greater number of suicide attempts. Women also show a considerably less severe course of the illness: they show a better social functioning and have fewer hospitalizations with shorter inpatient stays. Gender differences have also been well recognized in the response to antipsychotic treatment, with women being better responders than men are. Eating disorders in the past were considered as almost exclusively female disorders (F:M = 20:1), but that is changing rapidly. One million men have been shown to suffer from eating disorders in the USA. Males accounted for roughly 10.0\u201325.0% of eating disorder patients, with the number of men struggling from bulimia nervosa being more than those who struggle with anorexia. Research and knowledge on the topic are expanding rapidly, and recent literature elucidates gender-specific issues in terms of age of onset, weight history and compensatory exercise behavior, frequency of abuse record, and substance use rates. A later age of onset, premorbid obesity, and over-exercise are more likely in men. Around 30% of subjects suffering from an eating disorder were victims of sexual abuse (1:3 in women vs. 1:7 in men) and a substance use disorder is generally more frequent in subjects with eating disorder (particularly the use of steroids and growth hormones in affected men) in comparison to the general population