Gender in obsessive–compulsive disorder: clinical and genetic findings

• Published in: European neuropsychopharmacology Vol. 14; no. 2; pp. 105 - 113
• Main Authors: Lochner, Christine, Hemmings, Sian M.J., Kinnear, Craig J., Moolman-Smook, Johanna C., Corfield, Valerie A., Knowles, James A., Niehaus, Dana J.H., Stein, Dan J.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.03.2004
• Subjects: Adolescent; Adult; Age of Onset; Aged; Case-Control Studies; Comorbidity; Cysteine - genetics; Female; Gender; Gene Frequency; Genetic Predisposition to Disease; Genetic Variation; Genetics; Genotype; Glycine - genetics; Humans; Interviews as Topic; Male; Middle Aged; Monoamine Oxidase - genetics; Obsessive-Compulsive Disorder - genetics; Obsessive-Compulsive Disorder - physiopathology; Obsessive–compulsive disorder; Phenomenology; Polymorphism, Genetic; Pregnancy; Psychiatric Status Rating Scales; Quality of Life; Receptor, Serotonin, 5-HT1D - genetics; Serotonin - genetics; Sex Characteristics; South Africa - epidemiology; South Africa; Phenomenology; Obsessive–compulsive disorder; Genetics; Gender
• ISSN: 0924-977X; 1873-7862
• DOI: 10.1016/S0924-977X(03)00063-4

Background: There is increasing recognition that obsessive–compulsive disorder (OCD) is not a homogeneous entity. It has been suggested that gender may contribute to the clinical and biological heterogeneity of OCD. Methods: Two hundred and twenty patients ( n=220; 107 male, 113 female) with DSM-IV OCD (age: 36.40±13.46) underwent structured interviews. A subset of Caucasian subjects ( n=178), including subjects from the genetically homogeneous Afrikaner population ( n=81), and of matched control subjects ( n=161), was genotyped for polymorphisms in genes involved in monoamine function. Clinical and genetic data were statistically analyzed across gender. Results: Compared with females, males with OCD (1) had an earlier age of onset, and a trend toward having more tics and worse outcome, (2) had somewhat differing patterns of OCD symptomatology and axis I comorbidity, and (3) in the Caucasian group, were more likely to have the high activity T allele of the EcoRV variant of the monoamine oxidase A ( MAO-A) gene compared to controls, and (4) in the Afrikaner subgroup, were more frequently homozygous for the C allele at the G861 C variant of the 5HT 1Dβ gene than controls. Females with OCD (1) reported more sexual abuse during childhood than males, (2) often noted changes in obsessive–compulsive symptoms in the premenstrual/menstrual period as well as during/shortly after pregnancy, and with menopause, and (3) in the Caucasian subgroup, were more frequently homozygous for the low activity C allele of the EcoRV variant of the MAO-A gene compared to controls, with this allele also more frequent in female patients than controls. Conclusion: This study supports the hypothesis that gender contributes to the clinical and biological heterogeneity of OCD. A sexually dimorphic pattern of genetic susceptibility to OCD may be present. Further work is, however, needed to delineate the mechanisms that are responsible for mediating the effects of gender.