Is Obsessive Compulsive Disorder Genetic?

A pediatric psychiatrist on what parents need to know about OCD in children

As OCD becomes less taboo with celebrities like Justin Timberlake, Leonardo DiCaprio and Daniel Radcliffe publicly sharing personal struggles, parenting children with the disorder remains challenging.

Many high performers have habits and routines called “adaptive obsessive-compulsive features” that can look like OCD. “When those behaviors begin to dominate someone’s life is when it crosses the line into disorder territory,” says Barbara Coffey, M.D., M.S., a psychiatrist with the University of Miami Health System, who specializes in pediatric psychiatric disorders like OCD.

To help people with OCD and their families, leading experts like Dr. Coffey are researching possible genetic causes of the disorder. Understanding how someone develops OCD can help improve diagnosis and treatment. 

What does OCD look like in children?

While you might flippantly describe someone organized and uptight as OCD, the disorder is more complex than that. OCD is a mental health condition that causes your child to have uncontrollable thoughts and compulsions that interfere with daily activities. Children who develop OCD usually have symptoms that appear around age 10. Adult onset typically occurs around age 20. Without treatment, OCD can affect school performance, social skills and family life.

Children with OCD differ from adults in that they may not have insight that their obsessions and compulsions are unrealistic. Adults usually do understand this but are unable to stop these behaviors.

If your child has OCD, you might notice behaviors like:

• Worrying about germs or getting sick
• Repeatedly checking locked doors or appliances
• Excessive cleaning or handwashing
• Intrusive thoughts
• Needing to have things “just right”
• Repeating a task or starting a task over again

The science behind OCD and genetics?

OCD is among the most common psychiatric disorders, with one to three percent of the population meeting its criteria. For many children with OCD, it’s likely genetic, says Dr. Coffey. Many mental health disorders, including OCD, are caused by multiple genetic risk factors, so you need to have a lot of them to actually produce OCD, says Dr. Coffey.

While no one knows the set of genes that cause OCD, researchers do know that some specific genes can increase your risk of developing OCD.

Dr. Coffey’s team is part of a collaborative network of health systems currently recruiting people with OCD who have two parents without the diagnosis. The goal is that by recruiting trios of children with OCD and their two birth parents, the researchers can identify a rare mutation that might cause OCD.

“We’re asking what if, instead of needing thousands of individuals to find overlapping risk genes, we can look at fewer people with a rare mutation that’s highly associated with the disorder? That can be an easier method to identify risk genes than looking for a needle in a haystack of hundreds of common mutations,” says Dr. Coffey.

Click here to learn more about the OCD study at the University of Miami Health System, which is currently recruiting participants for the OCD genomics study.

Diagnosing OCD in children

There isn’t a single test that can diagnose OCD. Doctors use the pediatric version of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) to determine the severity of OCD symptoms. For example, if your child is spending more than one hour a day on compulsions or obsessions, they may receive an OCD diagnosis. 

Perfectionism is not the same as OCD. “Most kids have about 30 to 60 minutes of homework. A child with OCD might spend two to three hours on the same assignment trying to get it just right,” says Dr. Coffey.

Environmental impacts on OCD

Environmental stressors can impact both the severity and symptoms of OCD, says Dr. Coffey. During the pandemic, many people became obsessive-compulsive about cleaning. Those with pre-existing OCD had worsening symptoms.

For others, OCD traits like tidiness might have slipped into having an OCD disorder, says Dr. Coffey. “Even though OCD is no longer classified as an anxiety disorder, anxious thoughts are still a key part of OCD, and many people with well-managed OCD are experiencing more symptoms now.”

Parents can also unknowingly reinforce OCD behaviors. For example, if a child fears contamination and only eats a certain way, parents may not want to see their child suffer and will understandably feel pressure to accommodate the preferences.

What are the best treatments for OCD in children?

The first line treatment for OCD is cognitive behavioral therapy (CBT). Exposure and response prevention (ERP), a type of CBT, can be particularly helpful. ERP exposes a person with OCD to an object or compulsion in a safe setting with a therapist in order to reduce anxiety. In practice, this can mean gradually exposing a child with a fear of germs by touching a doorknob without immediately washing hands. After gradually waiting longer lengths of time, they begin to realize their fears are unfounded.

Antidepressant medications like selective serotonin reuptake inhibitors (SSRIs) and clomipramine are also effective for children with OCD. These help about 50–60% of patients and are even more effective when combined with ERP.

A newer treatment known as neuromodulation is showing the most promise for OCD that’s resistant to other forms of treatment. Procedures like transcranial magnetic stimulation (TMS) use magnets to stimulate nerve cells in the brain to improve symptoms.

A message of hope for parents

“The most important message is that while OCD can be debilitating, it’s a very treatable condition –– especially when it’s diagnosed early,” says Dr. Coffey.

Many OCD features—like attention to detail—can be adaptive and turned into a strength when channeled and managed effectively.

In decades of treating OCD, Dr. Coffey has witnessed many children grow into incredibly successful adults. For those who go on to become parents, many ask if their children will have OCD. “We’re not yet at a place to give genetic odds, but by the time their children are grown, we’ll be closer to a cure.”

If you or a family member is living with OCD, call UHealth’s Psychiatry Program at 305-243-0214 or click here to schedule an appointment.

Written by Wendy Margolin for UHealth.

Tags: Childhood mental health disorders, Dr. Barbara Coffey, Genetic factors in OCD, OCD diagnosis methods, Pediatric OCD treatment