Gender-related clinical differences in obsessive-compulsive disorder

Abstract

The purpose of the present study was to investigate the gender-related differences of clinical features in a sample of obsessive-compulsive (OCD) patients. One hundred and sixty outpatients with a principal diagnosis of obsessive-compulsive disorder (DSM-IV, Y-BOCS = 16) were admitted. Patients were evaluated with a semi-structured interview covering the following areas: socio-demographic data, Axis I diagnoses (DSM-IV), OCD clinical features (age at onset of OC symptoms and disorder, type of onset, life events and type of course). For statistical analysis the sample was subdivided in two groups according to gender. We found an earlier age at onset of OC symptoms and disorder in males; an insidious onset and a chronic course of illness were also observed in that group of patients. Females more frequently showed an acute onset of OCD and an episodic course of illness; they also reported more frequently a stressful event in the year preceding OCD onset. A history of anxiety disorders with onset preceding OCD and hypomanic episodes occurring after OCD onset was significantly more common among males, while females showed more frequently a history of eating disorders. We found three gender-related features of OCD: males show an earlier age at onset with a lower impact of precipitant events in triggering the disorder; OCD seems to occur in a relative high proportion of males who already have phobias and/or tic disorders; and a surfeit of chronic course of the illness in males in comparison with females.

Gender differences in obsessive-compulsive disorder: a literature review

“…6,23,33 On the other hand, several studies found no gender differences regarding major depression comorbidity, which is the most common Axis I disorder in both genders. 21,22,24,25,37,47 In an Italian study, 19 men presented more social phobia, tic disorders, and hypomania episodes. In Brazil, Torresan et al 25 found more posttraumatic stress disorder and tic disorders among men, whereas women presented more simple phobias, eating disorders (anorexia nervosa), as well as more impulse control disorders in general, particularly skin picking and "compulsive" shopping.…”

“…29 An Italian study found a higher frequency of insidious onset and chronic course among male sufferers and more episodic course among females. 19 According to Noshirvani et al, 17 similarly to schizophrenia, OCD cases with an early onset are usually more severe, reflecting the influence of cerebral lesions or constitutional aspects to which men are more vulnerable than women. Likewise, Bogetto et al 19 consider that early OCD onset is not strongly related to the impact of stressful life events but, conversely, could indicate a higher influence of biological lesions to which men are more predisposed.…”

“…19 According to Noshirvani et al, 17 similarly to schizophrenia, OCD cases with an early onset are usually more severe, reflecting the influence of cerebral lesions or constitutional aspects to which men are more vulnerable than women. Likewise, Bogetto et al 19 consider that early OCD onset is not strongly related to the impact of stressful life events but, conversely, could indicate a higher influence of biological lesions to which men are more predisposed. Biological theories propose that damage occurring during pregnancy is more global than that occurring after birth, and that the rapid growing organs are more vulnerable.…”

“…Women are more prone to contamination obsessions, 22 usually associated with cleaning rituals; 6,19,23,24 whereas sexual obsessions are more common among men. 19,22,23,35 Several studies combine rates of sexual and religious symptoms, which are more frequent in males. 6,24,36 Results are inconclusive regarding aggressive obsessions, with studies showing varying predominance between genders.…”

“…6,24,36 Results are inconclusive regarding aggressive obsessions, with studies showing varying predominance between genders. 22,36,37 In male, symmetry obsessions would be more common, 23,24,38 as well as ordering, 36,38 repeating, 19 checking, 23 and hoarding compulsions. 39,40,41 Torresan et al 25 found among Brazilian men more sexual, religious, and symmetry obsessions, as well as more mental rituals.…”