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Original Investigation |

The Structure of Genetic and Environmental Risk Factors for Dimensional Representations of DSM-5 Obsessive-Compulsive Spectrum Disorders

Benedetta Monzani, PhD1; Fruhling Rijsdijk, PhD2; Juliette Harris, PhD3; David Mataix-Cols, PhD1,4
[+] Author Affiliations
1Department of Psychosis Studies, King’s College London, Institute of Psychiatry, London, England
2Social, Genetic & Developmental Psychiatry Research Centre, King’s College London, Institute of Psychiatry, London, England
3Department of Twin Research and Genetic Epidemiology, King’s College London School of Medicine, London, England
4Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
JAMA Psychiatry. 2014;71(2):182-189. doi:10.1001/jamapsychiatry.2013.3524.
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Importance  The new DSM-5 “Obsessive-Compulsive and Related Disorders” chapter contains a series of conditions thought to be etiologically related to obsessive-compulsive disorder (OCD). However, the evidence to support this relatedness remains incomplete.

Objective  To estimate the degree to which genetic and environmental risk factors are shared and/or unique to dimensionally scored OCD, body dysmorphic disorder (BDD), hoarding disorder (HD), trichotillomania (hair-pulling disorder) (TTM), and excoriation (skin-picking) disorder (SPD).

Design, Setting, and Participants  Multivariate twin modeling methods involving 5409 female members of the TwinsUK adult population-based twin register.

Main Outcomes and Measures  Scores on the Obsessive-Compulsive Inventory–Revised, the Dysmorphic Concern Questionnaire, the Hoarding Rating Scale, the Massachusetts General Hospital Hairpulling Scale, and the Skin Picking Scale.

Results  A 2–latent factor common pathway model fitted the data best; the first latent factor loaded on all 5 phenotypes, particularly on OCD, BDD, and HD. A second factor loaded exclusively on TTM and SPD. Disorder-specific genetic (for OCD, BDD, and HD only) and particularly nonshared environmental risk factors were also evident. Shared environmental influences were negligible.

Conclusions and Relevance  Obsessive-compulsive and related disorders may be influenced by 2 distinct liability factors rather than a single liability factor. One of these factors was common to all disorders, and another was exclusive to TTM and SPD. Disorder-specific genetic factors unique to OCD, BDD, and HD were also apparent, whereas TTM and SPD were largely influenced by the same latent genetic factor. Environmental influences were largely disorder specific. The results help explain the apparent similarities as well as some important differences between the disorders included in the new Obsessive-Compulsive and Related Disorders chapter.

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Figure 1.
Parameter Estimates (95% CIs) for the Best-Fitting Common Pathway Model

ALF1 indicates genetic influences on the first latent factor; ALF2, genetic influences on the second latent factor; AS, disorder-specific genetic influences; BDD, body dysmorphic disorder; ELF1, unique environmental influences on the first latent factor; ELF2, unique environmental influences on the second latent factor; ES, unique environmental influences specific to each disorder; HD, hoarding disorder; OCD, obsessive-compulsive disorder; SPD, skin-picking disorder; TTM, trichotillomania.

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Figure 2.
Proportion of the Variance Accounted for by Common vs Disorder-Specific Genetic (A) and Unique Environmental (B) Factors Across the 5 Phenotypes Based on the Best-Fitting Model

AC1 indicates genetic effects in common across the 5 disorders; AC2, genetic effects common to TTM and SPD only; AS, disorder-specific genetic influences; BDD, body dysmorphic disorder; EC1, unique environmental effects in common across the 5 disorders; EC2, unique environmental effects common to TTM and SPD only; ES, unique environmental influences specific to each disorder; HD, hoarding disorder; OCD, obsessive-compulsive disorder; SPD, skin-picking disorder; TTM, trichotillomania.

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