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Is obsessive–compulsive disorder an anxiety disorder, and what, if any, are spectrum conditions? A family study perspective

  • O. J. Bienvenu (a1), J. F. Samuels (a1), L. A. Wuyek (a1), K.-Y. Liang (a2), Y. Wang (a1), M. A. Grados (a1), B. A. Cullen (a1), M. A. Riddle (a1), B. D. Greenberg (a3), S. A. Rasmussen (a3), A. J. Fyer (a4) (a5), A. Pinto (a4) (a5), S. L. Rauch (a6) (a7), D. L. Pauls (a6) (a7), J. T. McCracken (a8), J. Piacentini (a8), D. L. Murphy (a9), J. A. Knowles (a10) and G. Nestadt (a1)...

Abstract

Background

Experts have proposed removing obsessive–compulsive disorder (OCD) from the anxiety disorders section and grouping it with putatively related conditions in DSM-5. The current study uses co-morbidity and familiality data to inform these issues.

Method

Case family data from the OCD Collaborative Genetics Study (382 OCD-affected probands and 974 of their first-degree relatives) were compared with control family data from the Johns Hopkins OCD Family Study (73 non-OCD-affected probands and 233 of their first-degree relatives).

Results

Anxiety disorders (especially agoraphobia and generalized anxiety disorder), cluster C personality disorders (especially obsessive–compulsive and avoidant), tic disorders, somatoform disorders (hypochondriasis and body dysmorphic disorder), grooming disorders (especially trichotillomania and pathological skin picking) and mood disorders (especially unipolar depressive disorders) were more common in case than control probands; however, the prevalences of eating disorders (anorexia and bulimia nervosa), other impulse-control disorders (pathological gambling, pyromania, kleptomania) and substance dependence (alcohol or drug) did not differ between the groups. The same general pattern was evident in relatives of case versus control probands. Results in relatives did not differ markedly when adjusted for demographic variables and proband diagnosis of the same disorder, though the strength of associations was lower when adjusted for OCD in relatives. Nevertheless, several anxiety, depressive and putative OCD-related conditions remained significantly more common in case than control relatives when adjusting for all of these variables simultaneously.

Conclusions

On the basis of co-morbidity and familiality, OCD appears related both to anxiety disorders and to some conditions currently classified in other sections of DSM-IV.

Copyright

Corresponding author

*Address for correspondence: O. J. Bienvenu, M.D., Ph.D., Johns Hopkins University, Meyer 115, 600 N. Wolfe Street, Baltimore, MD 21287, USA. (Email: jbienven@jhmi.edu)

References

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Barsky, AJ, Wyshak, G, Klerman, GL (1992). Psychiatric comorbidity in DSM-III-R hypochondriasis. Archives of General Psychiatry 49, 101108.
Biederman, J, Petty, C, Faraone, SV, Henin, A, Hirshfeld-Becker, D, Pollack, MH, de Figueiredo, S, Feeley, R, Rosenbaum, JF (2006). Effects of parental anxiety disorders in children at high risk for panic disorder: a controlled study. Journal of Affective Disorders 94, 191197.
Bienvenu, OJ, Samuels, JF, Riddle, MA, Hoehn-Saric, R, Liang, KY, Cullen, BA, Grados, MA, Nestadt, G (2000). The relationship of obsessive–compulsive disorder to possible spectrum disorders: results from a family study. Biological Psychiatry 48, 287293.
Bienvenu, OJ, Stein, MB (2003). Personality and anxiety disorders: a review. Journal of Personality Disorders 17, 139151.
Black, DW, Goldstein, RB, Noyes, R, Blum, N (1994). Compulsive behaviors and obsessive–compulsive disorder (OCD): lack of a relationship between OCD, eating disorders, and gambling. Comprehensive Psychiatry 35, 145148.
Black, DW, Noyes, R Jr., Goldstein, RB, Blum, N (1992). A family study of obsessive–compulsive disorder. Archives of General Psychiatry 49, 362368.
Black, DW, Noyes, R Jr., Pfohl, B, Goldstein, RB, Blum, N (1993). Personality disorder in obsessive–compulsive volunteers, well comparison subjects, and their first-degree relatives. American Journal of Psychiatry 150, 12261232.
Carter, AS, Pollock, RA, Suvak, MK, Pauls, DL (2004). Anxiety and major depression comorbidity in a family study of obsessive–compulsive disorder. Depression and Anxiety 20, 165174.
Cook, RJ, Sackett, DL (1995). The number needed to treat: a clinically useful measure of treatment effect. British Medical Journal 310, 452454.
Cullen, BA, Samuels, JF, Bienvenu, OJ, Grados, M, Hoehn-Saric, R, Hahn, J, Liang, K, Wellen, D, Dees, M, Riddle, M, Nestadt, G (2001). The relationship of pathologic skin picking to obsessive–compulsive disorder. Journal of Nervous and Mental Disease 189, 193195.
Dimsdale, JE, Creed, FH (2009). The proposed diagnosis of somatic symptom disorders in DSM-V to replace somatoform disorders in DSM-IV – a preliminary report. Journal of Psychosomatic Research 66, 473476.
do Rosario-Campos, MC, Leckman, JF, Curi, M, Quatrano, S, Katsovitch, L, Miguel, EC, Pauls, DL (2005). A family study of early-onset obsessive–compulsive disorder. American Journal of Medical Genetics, Part B, Neuropsychiatric Genetics 136, 9297.
First, M, Gibbon, M, Spitzer, R, Williams, G (1996). Users Guide for the SCID. Biometrics Research Division, New York State Psychiatric Institute: New York, NY.
Fyer, AJ, Lipsitz, JD, Mannuzza, S, Aronowitz, B, Chapman, TF (2005). A direct interview family study of obsessive–compulsive disorder: I. Psychological Medicine 35, 16111621.
Goldstein, RB, Weissman, MM, Adams, PB, Horwath, E, Lish, JD, Charney, D, Woods, SW, Sobin, C, Wickramaratne, PJ (1994). Psychiatric disorders in relatives of probands with panic disorder and/or major depression. Archives of General Psychiatry 51, 383394.
Grabe, HJ, Ruhrmann, S, Ettelt, S, Buhtz, F, Hochrein, A, Schulze-Rauschenbach, S, Meyer, K, Kraft, S, Reck, C, Pukrop, R, Freyberger, HJ, Klosterkötter, J, Falkai, P, John, U, Maier, W, Wagner, M (2006). Familiality of obsessive–compulsive disorder in nonclinical and clinical subjects. American Journal of Psychiatry 163, 19861992.
Grados, MA, Riddle, MA, Samuels, JF, Liang, KY, Hoehn-Saric, R, Bienvenu, OJ, Walkup, JT, Song, D, Nestadt, G (2001). The familial phenotype of obsessive–compulsive disorder in relation to tic disorders: the Hopkins OCD family study. Biological Psychiatry 50, 559565.
Hanna, GL, Himle, JA, Curtis, GC, Gillespie, BW (2005). A family study of obsessive–compulsive disorder with pediatric probands. American Journal of Medical Genetics, Part B, Neuropsychiatric Genetics 134, 1319.
Hettema, JM (2008). What is the genetic relationship between anxiety and depression? American Journal of Medical Genetics, Part C, Seminars in Medical Genetics 148C, 140146.
Hollander, E, Braun, A, Simeon, D (2008). Should OCD leave the anxiety disorders in DSM-V? The case for obsessive compulsive-related disorders. Depression and Anxiety 25, 317329.
Jaisoorya, TS, Reddy, YC, Srinath, S (2003). The relationship of obsessive–compulsive disorder to putative spectrum disorders: results from an Indian study. Comprehensive Psychiatry 44, 317323.
Kaufman, J, Birmaher, B, Brent, D, Rao, U, Flynn, C, Moreci, P, Williamson, D (1997). Schedule for Affective Disorders and Schizophrenia for School-Age Children – Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry 36, 10651069.
Kraemer, HC, Wilson, KA, Hayward, C (2006). Lifetime prevalence and pseudocomorbidity in psychiatric research. Archives of General Psychiatry 63, 604608.
Lenane, MC, Swedo, SE, Rapoport, JL, Leonard, H, Sceery, W, Guroff, JJ (1992). Rates of obsessive compulsive disorder in first degree relatives of patients with trichotillomania: a research note. Journal of Child Psychology and Psychiatry 33, 925933.
Lilenfeld, LR, Kaye, WH, Greeno, CG, Merikangas, KR, Plotnicov, K, Pollice, C, Rao, R, Strober, M, Bulik, CM, Nagy, L (1998). A controlled family study of anorexia nervosa and bulimia nervosa: psychiatric disorders in first-degree relatives and effects of proband comorbidity. Archives of General Psychiatry 55, 603610.
Mannuzza, S, Fyer, AJ, Endicott, J, Klein, DF (1985). Family Informant Schedule and Criteria. Anxiety Family Study Unit, New York State Psychiatric Institute: New York.
Mannuzza, S, Fyer, AJ, Klein, DF, Endicott, J (1986). Schedule for Affective Disorders and Schizophrenia – Lifetime version modified for the study of Anxiety disorders (SADS-LA): rationale and conceptual development. Journal of Psychiatric Research 20, 317325.
Nestadt, G, Samuels, J, Riddle, M, Bienvenu, OJ, Liang, KY, LaBuda, M, Walkup, J, Grados, M, Hoehn-Saric, R (2000). A family study of obsessive–compulsive disorder. Archives of General Psychiatry 57, 358363.
Nestadt, G, Samuels, J, Riddle, MA, Liang, KY, Bienvenu, OJ, Hoehn-Saric, R, Grados, M, Cullen, B (2001). The relationship between obsessive–compulsive disorder and anxiety and affective disorders: results from the Johns Hopkins OCD Family Study. Psychological Medicine 31, 481487.
Noyes, R Jr., Clarkson, C, Crowe, RR, Yates, WR, McChesney, CM (1987). A family study of generalized anxiety disorder. American Journal of Psychiatry 144, 10191024.
Noyes, R Jr., Holt, CS, Happel, RL, Kathol, RG, Yagla, SJ (1997). A family study of hypochondriasis. Journal of Nervous and Mental Disease 185, 223232.
Pauls, DL, Alsobrook, JP, Goodman, W, Rasmussen, S, Leckman, JF (1995). A family study of obsessive–compulsive disorder. American Journal of Psychiatry 152, 7684.
Pauls, DL, Raymond, CL, Stevenson, JM, Leckman, JF (1991). A family study of Gilles de la Tourette syndrome. American Journal of Human Genetics 48, 154163.
Pfohl, B, Blum, N, Zimmerman, M, Stangl, D (1989). Structured Interview for DSM-IIIR Personality – SIDP-R. University of Iowa College of Medicine: Iowa City, IA.
Phillips, KA, Stein, DJ, Rauch, S, Hollander, E, Fallon, B, Barsky, A, Fineberg, N, Mataix-Cols, D, Ferrão, YA, Saxena, S, Wilhelm, S, Kelly, MM, Clark, LA, Pinto, A, Bienvenu, OJ, Farrow, J, Leckman, J (2010). Should an obsessive–compulsive spectrum grouping of disorders be included in DSM-V? Depression and Anxiety 27, 528555.
Richter, MA, Summerfeldt, LJ, Antony, MM, Swinson, RP (2003). Obsessive–compulsive spectrum conditions in obsessive–compulsive disorder and other anxiety disorders. Depression and Anxiety 18, 118127.
Samuels, J, Nestadt, G, Bienvenu, OJ, Costa, PT, Riddle, MA, Liang, KY, Hoehn-Saric, R, Grados, MA, Cullen, BA (2000). Personality disorders and normal personality dimensions in obsessive–compulsive disorder. British Journal of Psychiatry 177, 457462.
Samuels, JF, Riddle, MA, Greenberg, BD, Fyer, AJ, McCracken, JT, Rauch, SL, Murphy, DL, Grados, MA, Pinto, A, Knowles, JA, Piacentini, J, Cannistraro, PA, Cullen, B, Bienvenu, OJ, Rasmussen, SA, Pauls, DL, Willour, VL, Shugart, YY, Liang, KY, Hoehn-Saric, R, Nestadt, G (2006). The OCD Collaborative Genetics Study: Methods and sample description. American Journal of Medical Genetics, Part B, Neuropsychiatric Genetics 141, 201207.
Schlosser, S, Black, DW, Blum, N, Goldstein, RB (1994). The demography, phenomenology, and family history of 22 persons with compulsive hair pulling. Annals of Clinical Psychiatry 6, 147152.
Stein, DJ, Fineberg, NA, Bienvenu, OJ, Denys, D, Lochner, C, Nestadt, G, Leckman, JF, Rauch, SL, Phillips, KA (2010). Should OCD be classified as an anxiety disorder in DSM-V? Depression and Anxiety 27, 495506.
Storch, EA, Abramowitz, J, Goodman, WK (2008). Where does obsessive–compulsive disorder belong in DSM-V? Depression and Anxiety 25, 336347.
Torres, AR, Del Porto, JA (1995). Comorbidity of obsessive–compulsive disorder and personality disorders: a Brazilian controlled study. Psychopathology 28, 322329.
van Grootheest, DS, Cath, DC, Beekman, AT, Boomsma, DI (2005). Twin studies on obsessive–compulsive disorder: a review. Twin Research and Human Genetics 8, 450458.

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Is obsessive–compulsive disorder an anxiety disorder, and what, if any, are spectrum conditions? A family study perspective

  • O. J. Bienvenu (a1), J. F. Samuels (a1), L. A. Wuyek (a1), K.-Y. Liang (a2), Y. Wang (a1), M. A. Grados (a1), B. A. Cullen (a1), M. A. Riddle (a1), B. D. Greenberg (a3), S. A. Rasmussen (a3), A. J. Fyer (a4) (a5), A. Pinto (a4) (a5), S. L. Rauch (a6) (a7), D. L. Pauls (a6) (a7), J. T. McCracken (a8), J. Piacentini (a8), D. L. Murphy (a9), J. A. Knowles (a10) and G. Nestadt (a1)...

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