Obsessive Compulsive Disorder at Johns Hopkins

What is OCD?

Obsessive-compulsive disorder (OCD) is a mental disorder that usually begins in adolescence or early adulthood, although it may begin in childhood. The signs and symptoms vary from person to person, but all people with OCD have either obsessions or compulsions or both.

Obsessions: These are recurrent and persistent thoughts, impulses, or images that are experienced as intrusive and inappropriate and that cause anxiety or distress. They are not simply excessive worries about real-life problems. The person attempts to ignore or suppress the thoughts, impulses, or images, or to neutralize them with some other thought or action. Common obsessions include:

• Repeated thoughts about contamination (e.g., becoming contaminated by shaking hands)
• Repeated doubts (e.g., wondering whether one has performed some act as having left a door unlocked)
• A need to have things in a particular order (e.g., distress when objects are disordered or asymmetrical)
• Aggressive or horrific impulses or images (e.g., physically hurt someone or to blurt out obscenities in public)
• Sexual imagery (e.g., recurrent images with sexual content)

Compulsions: These are repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly. The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, they are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive. Common compulsions include:

• Washing and cleaning
• Counting
• Checking
• Requesting or demanding re-assurances
• Repeating Actions
• Ordering/Arranging (e.g., dressing in a set order or arranging things symmetrically)

Recent Research Findings

A recent study, conducted by Dr. Hong and colleagues at Johns Hopkins University and the Bloomberg School of Medicine, investigated factors associated with the development of recurring major depression. Major depressive disorder is the most frequent co-morbid condition with OCD. They compared people, who were enrolled in the JHU Family Study, and had diagnoses of recurring major depression and OCD with those who had an OCD diagnosis only. The findings suggest that individuals with OCD and recurring major depression had an earlier age at first diagnosis, more severe OCD symptoms, and a family history of recurrent major depression. They were also more likely to have other diagnoses such as social phobia, separation anxiety, and Body Dysmorphic Disorders. Early age of onset of OCD diagnosis was found to increase the risk of developing depressive disorders. (Depression and Anxiety, 2004).

Genetic Replication Research

This study aimed to test the hypothesis that there is a genetic linkage on chromosome 9 for OCD. Samples from the OCD Family Study were used to replicate the genetic work by Hanna et al (2002). The JHU OCD research group genotyped DNA samples from 50 families with siblings diagnosed with OCD. A total of 179 subjects, including 105 participants with definite OCD diagnoses, and 8 with probable OCD diagnoses were used in this analysis. The results provide promising evidence for an OCD susceptibility gene in the 9p24 region, and also the feasibility to pursue further genetic testing. (Am J Hum Genet, 2004)

Other Important Research

Hanna et. al. provided important findings on differences between early-onset of OCD symptoms in those with a family history of OCD and those without (familial vs. sporadic families). By studying first and second-degree relatives of people diagnosed with OCD, these researchers found that ordering compulsions, unusual grooming behaviors (e.g., skin picking), and diagnosis of other anxiety disorders were more common in those with a family history of OCD symptoms. Clinicians should be aware of family history of psychiatric conditions in order to address other co-morbid diagnoses; these findings also are relevant for future genetic studies. (Biol Psychiatry, 2005)