Is Obsessive-Compulsive Disorder (OCD) Hereditary and Other Facts

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When I was little but old enough to remember, when we were going shopping, I recall my mother opening the front door again and checking the oven to make sure it was off. Sometimes, she would open the front door and go into the kitchen, three times, to check the oven’s status.

And I remember her, opening the closet and looking at the shoes I wore to school repeatedly just to make sure they were there, washing her hands when she washed a minute ago, or opening the refrigerator, multiple times in a row, and me thinking that was weird but giving it no thought a few seconds after.

But now, I know. She suffered from a condition which is now known as Obsessive Compulsive Disorder (OCD) and I have it, too, noticeable in my adolescence which got worse as I aged. The first time I detected OCD, not knowing OCD’s name yet, was with my brother embarrassing me when I was 13-years-old. No details please. Ever.

OCD’s history is an interesting one.

Ancient and religious observations:

Early religious texts describe people tormented by unwanted thoughts and compelled to repeat rituals out of fear of committing a sin. This form of obsessive religiosity was called “scrupulosity” that included, among other things, intrusive thoughts that challenge one’s religious beliefs or actions.
Writers and clerics documented cases of “religious melancholy,” with symptoms that included obsessive doubt and intrusive “blasphemous thoughts.”
Written in the 17th century, William Shakespeare’s character Lady Macbeth, is often cited as an early fictional portrayal of OCD-like behavior, with her obsessive hand-washing ritual to cleanse herself of guilt.

The 19th-century medical framework:

In the 1800s, psychiatrists began to classify these symptoms within a medical structure.

In 1838, French psychiatrist Jean Esquirol described obsessions as a form of “monomania,” or partial insanity.
The French psychiatrist Henri Legrand du Saulle published a book in 1875 describing la folie du doute (“the madness of doubt”), which involved intrusive questioning and checking, similar to the modern OCD.
German psychiatrist Karl Westphal introduced the term Zwangsvorstellung in 1877 (meaning “compulsive idea”), which captured both the cognitive and behavioral aspects of the condition. This German term ultimately led to the English terms “obsession” and “compulsion.”

Modern psychiatric recognition:

In the late 19th and early 20th centuries, Sigmund Freud wrote about “obsessional neurosis,” framing compulsive behaviors as a result of unconscious conflicts. His psychoanalytic theories heavily influenced how the condition was understood for decades.
OCD was officially recognized as a distinct mental health condition in the Diagnostic and Statistical Manual of Mental Disorders and was initially categorized as an anxety disorder.
In 2013, the Diagnostic and Statistical Manual of Mental Disorders moved OCD to its own category, “Obsessive-Compulsive and Related Disorders,” reflecting a more modern, neurologically based understanding of the condition.

Why OCD Happens

Familial Risk:

The risk of developing OCD is significantly higher for first-degree relatives (parents, siblings, or children) of an affected individual compared to the general population.
If one parent has OCD, the chance of a child developing the condition is estimated to be around 10% to 20.
Identical twins (who share 100% of genes) show a rate of about 45-65% for OCD.
Fraternal twins (who share 50% of genes) have an OCD rate of about 15-30%.
This difference strongly suggests genetic factors, but the fact that identical twins don’t have 100% shows environment also matters.
Unlike some genetic diseases caused by one faulty gene, OCD is influenced by hundreds to thousands of genes, each contributing only a small amount to the overall risk. Researchers have identified multiple genetic locations associated with an increased risk of OCD.
The genetic influence appears to be stronger in cases where OCD begins in childhood or adolescence compared to when it begins in adulthood.

Key non-genetic risk factors include:

In some children, a sudden onset of OCD or tic symptoms can follow a streptococcal infection. This is referred to as Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) or the broader Pediatric Acute-onset Neuropsychiatric Syndrome (PANS).
Experiencing significant stress or trauma can sometimes trigger the onset or worsening of OCD symptoms in genetically vulnerable individuals.
OCD is associated with differences in the structure and function of certain brain circuits, particularly those involving chemical messengers like serotonin and dopamine.

Complex Inheritance:

OCD isn’t caused by a single gene (like eye color).
It involves multiple genes, each contributing a small effect.
No specific “OCD gene” has been definitively identified.
Likely involves genes related to brain development.

Biological Factors:

Brain structure and function as in the differences in circuits connecting the frontal cortex, basal ganglia, and thalamus (the thalamus acts as a critical hub in the frontal cortex-basal ganglia-thalamic circuit, linking the basal ganglia to the frontal cortex)
Neurotransmitter imbalances, particularly serotonin, dopamine, and glutamate
Complications during pregnancy or birth
PANDAS/PANS, described above, in some children, infections like strep throat may trigger sudden OCD symptoms

Environmental Triggers:

Traumatic events chronic stress
Major changes or losses
Observation and reinforcement patterns in learned behavior
Strict upbringing through childhood experiences
Infections (like streptococcal infections in children, like PANDAS/PANS)
Brain injury (damage to the frontal and basal ganglia areas)
Chemical imbalances, especially serotonin and dopamine

If a Family Member Has OCD:

You have a moderately increased risk, but it’s still more likely you won’t develop it.
Being informed about symptoms can help with early detection.
Family therapy and education can be beneficial.

Knowing OCD has biological and genetic components helps people understand it’s a real medical condition, not a character flaw or weakness. Genetics increase likelihood but don’t determine destiny. Many people with genetic risk never develop OCD, and many with OCD have no family history.

Treatment Works:

Regardless of the cause, OCD is highly treatable with:

- Cognitive Behavioral Therapy (CBT), especially Exposure and Response Prevention (ERP)
- Medications, typically Selective Serotonin Reuptake Inhibitor (SSRIs)
- Combination of CBT and SSRI though check with your doctor

Scientists are working to develop more targeted treatments based on genetic profiles. They are also studying how genes interact with environmental factor and understand the neurobiological mechanisms causing OCD.

Brain scans show that people with OCD often have:

Overactivity in the orbitofrontal cortex (the “worry” area of the brain)
Imbalance in neurotransmitter pathways (like serotonin and dopamine, known through MRI–stands for Magnetic Resonance Imaging)
Trouble in the feedback loops that tell your brain when a task or thought is “done”

In her book, Little Do We Know, Tamara Ireland Stone writes, “Telling someone with OCD to stop obsessing about something is like telling someone who’s having an asthma attack to just breathe normally.”

You’ll know what I’m talking about in this detestable and loathsome OCD club. If you don’t have OCD, you’ll have the education to share my blog with others.