Is obsessive–compulsive disorder an anxiety disorder, and what, if any, are spectrum conditions? A family study perspective
Open accessAbstract
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.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
ICD-11 includes Hypochondriasis in the grouping of Obsessive-Compulsive and Related Disorders based on shared phenomenological features, high rates of co-occurrence and tendency to run in families with other disorders of the grouping, and a similar response to treatments.
“It is included in the grouping of Obsessive-Compulsive and Related Disorders based on shared phenomenological features (repetitive thoughts about having an illness, and repeated and excessive behaviours driven by the preoccupation) 22 , high rates of co-occurrence and tendency to run in families with the other disorders of the grouping 23 , and a similar response to treatments 24 .”
From An organization‐ and category‐level comparison of diagnostic requirements for mental disorders in <scp>ICD</scp> ‐11 and <scp>DSM</scp> ‐5 (2021) · cites this paper as [23]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
The number needed to treat: a clinically useful measure of treatment effect
Cook, R. J., & Sackett, D. L. (1995) · BMJ · doi:10.1136/bmj.310.6977.452 · Cited by 1,885 · see citing works
Personality disorders and normal personality dimensions in obsessive-compulsive disorder
Samuels, J., Nestadt, G., Bienvenu, O. J., Costa, P. T., Riddle, M. A., Liang, K.-Y., Hoehn-Saric, R., Grados, M. A., & Cullen, B. A. M. (2000) · British Journal of Psychiatry · doi:10.1192/bjp.177.5.457 · Cited by 237 · see citing works
Self-citationA family study of obsessive-compulsive disorder
Black, D. W. (1992) · Archives of General Psychiatry · doi:10.1001/archpsyc.1992.01820050026004 · Cited by 233 · see citing works
Should OCD be classified as an anxiety disorder in DSM-V?
Stein, D. J., Fineberg, N. A., Bienvenu, O. J., Denys, D., Lochner, C., Nestadt, G., Leckman, J. F., Rauch, S. L., & Phillips, K. A. (2010) · Depression and Anxiety · doi:10.1002/da.20699 · Cited by 212 · see citing works
Self-citationWhat is the genetic relationship between anxiety and depression?
Hettema, J. M. (2008) · American Journal of Medical Genetics Part C Seminars in Medical Genetics · doi:10.1002/ajmg.c.30171 · Cited by 207 · see citing works
The Demography, Phenomenology, and Family History of 22 Persons with Compulsive Hair Pulling
Schlosser, S., Black, D., Blum, N., & Goldstein, R. (1994) · Annals of Clinical Psychiatry · doi:10.3109/10401239409148996 · Cited by 178 · see citing works
Flagged first, then by citations
Research works printed but not linked: 34
- Barsky AJ, Wyshak G, Klerman GL (1992). Psychiatric comorbidity in DSM-III-R hypochondriasis. Archives of General Psychiatry 49, 101– 108. 1550462
- 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, 191– 197. 16753222
- 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, 287– 293. 10960159
- Bienvenu OJ, Stein MB (2003). Personality and anxiety disorders: a review. Journal of Personality Disorders 17, 139– 151. 12755327
- 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, 145– 148. 8187479
- Black DW, Noyes R, 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, 1226– 1232. 8328568
- 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, 165– 174. 15643633
- 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, 193– 195. 11277358
- 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, 473– 476. 19446706
- 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, 92– 97. 15892140
- Fyer AJ, Lipsitz JD, Mannuzza S, Aronowitz B, Chapman TF (2005). A direct interview family study of obsessive-compulsive disorder: I. Psychological Medicine 35, 1611– 1621. 16219119
- 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, 383– 394. 8179462
- 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, 1986– 1992. 17074951
- 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, 559– 565. 11690590
- 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, 13– 19. 15635694
- 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, 317– 329. 18412058
- 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, 317– 323. 12923710
- 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, 1065– 1069. 9204677
- Kraemer HC, Wilson KA, Hayward C (2006). Lifetime prevalence and pseudocomorbidity in psychiatric research. Archives of General Psychiatry 63, 604– 608. 16754833
- 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, 925– 933. 1634595
- 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, 603– 610. 9672050
- 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, 317– 325. 3806426
- 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, 358– 363. 10768697
- 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, 481– 487. 11305856
- Noyes R Jr., Clarkson C, Crowe RR, Yates WR, McChesney CM (1987). A family study of generalized anxiety disorder. American Journal of Psychiatry 144, 1019– 1024. 3605423
- Noyes R Jr., Holt CS, Happel RL, Kathol RG, Yagla SJ (1997). A family study of hypochondriasis. Journal of Nervous and Mental Disease 185, 223– 232. 9114807
- Pauls DL, Alsobrook JP, Goodman W, Rasmussen S, Leckman JF (1995). A family study of obsessive-compulsive disorder. American Journal of Psychiatry 152, 76– 84. 7802125
- Pauls DL, Raymond CL, Stevenson JM, Leckman JF (1991). A family study of Gilles de la Tourette syndrome. American Journal of Human Genetics 48, 154– 163. 1985456 PMC1682764
- 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, 528– 555. 20533367 PMC3985410
- 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, 118– 127. 14625876
- 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, 201– 207. PMC2555990 16511842
- Storch EA, Abramowitz J, Goodman WK (2008). Where does obsessive-compulsive disorder belong in DSM-V? Depression and Anxiety 25, 336– 347. 18412060
- Torres AR, Del Porto JA (1995). Comorbidity of obsessive-compulsive disorder and personality disorders: a Brazilian controlled study. Psychopathology 28, 322– 329. 8838405
- van Grootheest DS, Cath DC, Beekman AT, Boomsma DI (2005). Twin studies on obsessive-compulsive disorder: a review. Twin Research and Human Genetics 8, 450– 458. 16212834
Cited by
Sorted by citations
Varese, F., Smeets, F., Drukker, M., Lieverse, R., Lataster, T., Viechtbauer, W., Read, J., van Os, J., & Bentall, R. P. (2012) · Schizophrenia Bulletin · doi:10.1093/schbul/sbs050 · Cited by 2,436 · see citing works
Neurocognitive endophenotypes of impulsivity and compulsivity: Towards dimensional psychiatry
Robbins, T. W., Gillan, C. M., Smith, D. G., de Wit, S., & Ersche, K. D. (2012) · Trends in Cognitive Sciences · doi:10.1016/j.tics.2011.11.009 · Cited by 1,003 · see citing works
Obsessive-compulsive disorder: An integrative genetic and neurobiological perspective
Pauls, D. L., Abramovitch, A., Rauch, S. L., & Geller, D. A. (2014) · Nature Reviews Neuroscience · doi:10.1038/nrn3746 · Cited by 793 · see citing works
Self-citationFineberg, N. A., Chamberlain, S. R., Goudriaan, A. E., Stein, D. J., Vanderschuren, L. J. M. J., Gillan, C. M., Shekar, S., Gorwood, P. A. P. M., Voon, V., Morein-Zamir, S., et al. (2014) · CNS Spectrums · doi:10.1017/s1092852913000801 · Cited by 488 · see citing works
Acceptance and Commitment Therapy as a Treatment for Anxiety and Depression
Twohig, M. P., & Levin, M. E. (2017) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2017.08.009 · Cited by 268 · see citing works
First, M. B., Gaebel, W., Maj, M., Stein, D. J., Kogan, C. S., Saunders, J. B., Poznyak, V. B., Gureje, O., Lewis‐Fernández, R., Maercker, A., et al. (2021) · World Psychiatry · doi:10.1002/wps.20825 · Cited by 236 · see citing works
Monzani, B., Rijsdijk, F., Harris, J., & Mataix-Cols, D. (2014) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2013.3524 · Cited by 208 · see citing works
The classification of obsessive-compulsive and related disorders in the ICD-11
Stein, D. J., Kogan, C. S., Atmaca, M., Fineberg, N. A., Fontenelle, L. F., Grant, J. E., Matsunaga, H., Reddy, Y. C. J., Simpson, H. B., Thomsen, P. H., et al. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.10.061 · Cited by 204 · see citing works
Specificity of performance monitoring changes in obsessive-compulsive disorder
Endrass, T., & Ullsperger, M. (2014) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2014.03.024 · Cited by 141 · see citing works
Goes, F. S., McCusker, M. G., Bienvenu, O. J., MacKinnon, D. F., Mondimore, F. M., Schweizer, B., National Institute of Mental Health Genetics Initiative Bipolar Disorder Consortium, DePaulo, J. R., & Potash, J. B. (2012) · Psychological Medicine · doi:10.1017/s0033291711002637 · Cited by 136 · see citing works
Self-citationZebhauser, A., Hofmann‐Xu, L., Baumert, J., Häfner, S., Lacruz, M. E., Emeny, R. T., Döring, A., Grill, E., Huber, D., Peters, A., et al. (2014) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.3998 · Cited by 129 · see citing works
Ahmari, S. E., & Dougherty, D. D. (2015) · Depression and Anxiety · doi:10.1002/da.22367 · Cited by 128 · see citing works
Reduced levels of vasopressin and reduced behavioral modulation of oxytocin in psychotic disorders
Rubin, L. H., Carter, C. S., Bishop, J. R., Pournajafi-Nazarloo, H., Drogos, L. L., Hill, S. K., Ruocco, A. C., Keedy, S. K., Reilly, J. L., Keshavan, M. S., et al. (2014) · Schizophrenia Bulletin · doi:10.1093/schbul/sbu027 · Cited by 127 · see citing works
DSM-5: a collection of psychiatrist views on the changes, controversies, and future directions
Nemeroff, C. B., Weinberger, D., Rutter, M., MacMillan, H. L., Bryant, R. A., Wessely, S., Stein, D. J., Pariante, C. M., Seemüller, F., Berk, M., et al. (2013) · BMC Medicine · doi:10.1186/1741-7015-11-202 · Cited by 128 · see citing works
Gillett, C. B., Bilek, E. L., Hanna, G. L., & Fitzgerald, K. D. (2018) · Clinical Psychology Review · doi:10.1016/j.cpr.2018.01.007 · Cited by 99 · see citing works
Genetics of obsessive-compulsive disorder and related disorders
Browne, H. A., Gair, S. L., Scharf, J. M., & Grice, D. E. (2014) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2014.06.002 · Cited by 92 · see citing works
Wood, J., & Ahmari, S. E. (2015) · Frontiers in Systems Neuroscience · doi:10.3389/fnsys.2015.00171 · Cited by 85 · see citing works
“How to classify OCD, and its relationship to other anxiety disorders, is a topic of ongoing debate in the field (Nutt and Malizia, 2006; Craig and Fineberg, 2008; Bienvenu et al., 2012).”
BackgroundPersonality disorders are important risk factors for disability pensioning
Østby, K. A., Czajkowski, N., Knudsen, G. P., Ystrom, E., Gjerde, L. C., Kendler, K. S., Ørstavik, R. E., & Reichborn-Kjennerud, T. (2014) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-014-0878-0 · Cited by 72 · see citing works
Riesel, A., Goldhahn, S., & Kathmann, N. (2017) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2016.12.029 · Cited by 49 · see citing works
Maneeton, N., Maneeton, B., Srisurapanont, M., & Martin, S. D. (2012) · BMC Psychiatry · doi:10.1186/1471-244x-12-160 · Cited by 51 · see citing works
A family study of trichotillomania and chronic hair pulling
Keuthen, N. J., Altenburger, E. M., & Pauls, D. (2014) · American Journal of Medical Genetics Part B: Neuropsychiatric Genetics · doi:10.1002/ajmg.b.32218 · Cited by 48 · see citing works
Self-citationThe Role of Stress in Obsessive-Compulsive Disorder: A Narrative Review
Raposo-Lima, C., & Morgado, P. (2020) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000274 · Cited by 37 · see citing works
Hong, R. Y., & Tan, Y. L. (2021) · Personality and Individual Differences · doi:10.1016/j.paid.2020.110041 · Cited by 27 · see citing works
Obsessive-Compulsive Spectrum Disorders: Diagnosis, Theory, and Treatment
Clark, D. A., & Simos, G. (2013) · CBT for Anxiety Disorders · doi:10.1002/9781118330043.ch2 · Cited by 3 · see citing works
- Authors
- Bienvenu, O. J., Samuels, J. F., Wuyek, L. A., Liang, K.-Y., Wang, Y., Grados, M. A., Cullen, B. A., Riddle, M. A., Greenberg, B. D., Rasmussen, S. A., Fyer, A. J., Pinto, A., Rauch, S. L., Pauls, D. L., McCracken, J. T., Piacentini, J., Murphy, D. L., Knowles, J. A., & Nestadt, G.
- Affiliations
- Johns Hopkins University (US)
- Brown University (US)
- New York State Psychiatric Institute (US)
- Harvard University (US)
- University of California, Los Angeles (US)
- National Institute of Mental Health (US)
- University of Southern California (US)
- Corresponding author
- Bienvenu, O. J.
- ORCID
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2011-05-13
- Volume
- 42
- Issue
- 1
- Pages
- 1-13
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- PMC
- PMC10885736
- OpenAlex
- W2171090546
- Cited by
- 286
- References
- 6
- Citations by year
- 2026: 2 · 2025: 10 · 2024: 11 · 2023: 6 · 2022: 6 · 2021: 14 · 2020: 52 · 2019: 9 · 2018: 8 · 2017: 16 · 2016: 18 · 2015: 43 · 2014: 28 · 2013: 36 · 2012: 22
- FWCI
- 31.43
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Brown University
- Johns Hopkins University
- Ontario Council on Graduate Studies, Council of Ontario Universities
- National Institutes of Health (5k23mh066284-03, MH50125, MH64543, MH66284, RR-00052)
- National Institute of Mental Health (MH64543, R01MH050214, MH80221, K23MH064543, MH66284, K23MH080221, K23-MH066284, MH50125)
- National Institute of Neurological Disorders and Stroke (R01NS042609, NS42609)
- National Center for Research Resources (RR 000 52, M01RR000052)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- obsessive-compulsive disorder, anxiety disorders, DSM-5 classification, comorbidities, familiality, agoraphobia, generalized anxiety disorder, cluster C personality disorders, tic disorders, somatoform disorders, body dysmorphic disorder, trichotillomania, mood disorders, first-degree relatives
- MeSH terms
- Adolescent, Adult, Anxiety Disorders, Mental Disorders, Child, Child, Preschool, Epidemiologic Methods, Family, Female, Humans, Interview, Psychological, Male, Middle Aged, Obsessive-Compulsive Disorder, Phenotype, Socioeconomic Factors, Comorbidity, Genetic Predisposition to Disease, Diagnostic and Statistical Manual of Mental Disorders, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
