Obsessive-Compulsive Disorder in Women

  • Albina R. Torres
  • Ricardo C. Torresan
  • Maria Alice de Mathis
  • Roseli G. Shavitt


Obsessive-compulsive disorder (OCD) is a chronic, debilitating, and heterogeneous condition that affects 2–3% of the general population. Previous studies have suggested that sex plays a role in OCD phenotypic expression. This chapter aims to review the literature regarding OCD in women, exploring sex differences in (1) the prevalence of OCD/subclinical OCD in nonclinical populations; (2) age of onset, clinical course, and severity and impact of OCD symptoms; (3) onset or aggravation of OCD symptoms among women according to the time point in the reproductive cycle; (4) OCD symptom contents; (5) psychiatric comorbidity; and (6) treatment-seeking behavior and treatment response. Studies report either a slight female predominance or a similar prevalence of OCD in adults from the general population. Women are more likely than men to be married, to present later onset, and to report preceding stressful life events. Onset or worsening of OCD symptoms during pregnancy and postpartum are frequently described. Women are more likely to present contamination obsessions and/or cleaning rituals and comorbid eating and impulse-control disorders. Several interacting mechanisms are probably responsible for mediating the effects of sex/gender in the biological and psychosocial risk factors for OCD. Sex is a relevant factor that should be taken into account when evaluating OCD patients, but more studies are necessary to determine whether or not it defines a valid OCD subtype.


Obsessive-compulsive disorder Gender Sex Sex differences Phenomenology Phenotype Clinical characteristics 


  1. 1.
    Torres AR, Lima MCP. Epidemiology of obsessive-compulsive disorder: a review. Rev Bras Psiquiatr Sao Paulo Braz 1999. 2005;27(3):237–42.Google Scholar
  2. 2.
    Fontenelle LF, Mendlowicz MV, Versiani M. The descriptive epidemiology of obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2006;30(3):327–37.PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Robins LN, Helzer JE, Weissman MM, Orvaschel H, Gruenberg E, Burke JD, et al. Lifetime prevalence of specific psychiatric disorders in three sites. Arch Gen Psychiatry. 1984;41(10):949–58.PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    Kolada JL, Bland RC, Newman SC. Epidemiology of psychiatric disorders in Edmonton. Obsessive-compulsive disorder. Acta Psychiatr Scand Suppl. 1994;376:24–35.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Douglass HM, Moffitt TE, Dar R, McGEE R, Silva P. Obsessive-compulsive disorder in a birth cohort of 18-year-olds: prevalence and predictors. J Am Acad Child Adolesc Psychiatry. 1995;34(11):1424–31.PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Karno M, Golding JM, Sorenson SB, Burnam MA. The epidemiology of obsessive-compulsive disorder in five US communities. Arch Gen Psychiatry. 1988;45(12):1094–9.PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Weissman MM, Bland RC, Canino GJ, Greenwald S, Hwu HG, Lee CK, et al. The cross national epidemiology of obsessive compulsive disorder. The Cross National Collaborative Group. J Clin Psychiatry. 1994;55(Suppl):5–10.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Torres AR, Prince MJ, Bebbington PE, Bhugra D, Brugha TS, Farrell M, et al. Obsessive-compulsive disorder: prevalence, comorbidity, impact, and help-seeking in the British National Psychiatric Morbidity Survey of 2000. Am J Psychiatry. 2006;163(11):1978–85.PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Viana MC, Teixeira MG, Beraldi F, Bassani IDS, Andrade LH. São Paulo Megacity Mental Health Survey – a population-based epidemiological study of psychiatric morbidity in the São Paulo metropolitan area: aims, design and field implementation. Rev Bras Psiquiatr Sao Paulo Braz 1999. 2009;31(4):375–86.Google Scholar
  10. 10.
    Fineberg NA, Hengartner MP, Bergbaum CE, Gale TM, Gamma A, Ajdacic-Gross V, et al. A prospective population-based cohort study of the prevalence, incidence and impact of obsessive-compulsive symptomatology. Int J Psychiatry Clin Pract. 2013;17(3):170–8.PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    Viana MC, Andrade LH. Lifetime Prevalence, age and gender distribution and age-of-onset of psychiatric disorders in the São Paulo Metropolitan Area, Brazil: results from the São Paulo Megacity Mental Health Survey. Rev Bras Psiquiatr Sao Paulo Braz 1999. 2012;34(3):249–60.Google Scholar
  12. 12.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. Washington/Londres: American Psychiatric Association; 2013.CrossRefGoogle Scholar
  13. 13.
    Fineberg NA, Hengartner MP, Bergbaum C, Gale T, Rössler W, Angst J. Lifetime comorbidity of obsessive-compulsive disorder and sub-threshold obsessive-compulsive symptomatology in the community: impact, prevalence, socio-demographic and clinical characteristics. Int J Psychiatry Clin Pract. 2013;17(3):188–96.PubMedCrossRefPubMedCentralGoogle Scholar
  14. 14.
    Grabe HJ, Meyer C, Hapke U, Rumpf HJ, Freyberger HJ, Dilling H, et al. Prevalence, quality of life and psychosocial function in obsessive-compulsive disorder and subclinical obsessive-compulsive disorder in northern Germany. Eur Arch Psychiatry Clin Neurosci. 2000;250(5):262–8.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Jaisoorya TS, Janardhan Reddy YC, Thennarasu K, Beena KV, Beena M, Jose DC. An epidemological study of obsessive compulsive disorder in adolescents from India. Compr Psychiatry. 2015;61:106–14.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Heyman I, Fombonne EH, Simmons H, Ford TH, Meltzer HR, Goodman R. Prevalence of obsessive-compulsive disorder in the British nationwide survey of child mental health. Int Rev Psychiatry Abingdon Engl. 2003;15:178–84.CrossRefGoogle Scholar
  17. 17.
    Canals J, Hernández-Martínez C, Cosi S, Voltas N. The epidemiology of obsessive--compulsive disorder in Spanish school children. J Anxiety Disord. 2012;26(7):746–52.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Jaisoorya TS, Janardhan Reddy YC, Nair BS, Rani A, Menon PG, Revamma M, et al. Prevalence and correlates of obsessive-compulsive disorder and subthreshold obsessive-compulsive disorder among college students in Kerala, India. Indian J Psychiatry. 2017;59(1):56–62.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Politis S, Magklara K, Petrikis P, Michalis G, Simos G, Skapinakis P. Epidemiology and comorbidity of obsessive-compulsive disorder in late adolescence: a cross-sectional study in senior high schools in Greece. Int J Psychiatry Clin Pract. 2017;21(3):188–94.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Vivan ADS, Rodrigues L, Wendt G, Bicca MG, Braga DT, Cordioli AV. Obsessive-compulsive symptoms and obsessive-compulsive disorder in adolescents: a population-based study. Rev Bras Psiquiatr Sao Paulo Braz 1999. 2014;36(2):111–8.Google Scholar
  21. 21.
    Alvarenga PG, Cesar RC, Leckman JF, Moriyama TS, Torres AR, Bloch MH, et al. Obsessive-compulsive symptom dimensions in a population-based, cross-sectional sample of school-aged children. J Psychiatr Res. 2015;62:108–14.PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    Rasmussen SA, Tsuang MT. Epidemiologic and clinical findings of significance to the design of neuropharmacologic studies of obsessive-compulsive disorder. Psychopharmacol Bull. 1986;22(3):723–9.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Minichiello WE, Baer L, Jenike MA, Holland A. Age of onset of major subtypes of obsessive—compulsive disorder. J Anxiety Disord. 1990;4(2):147–50.CrossRefGoogle Scholar
  24. 24.
    Castle DJ, Deale A, Marks IM. Gender differences in obsessive compulsive disorder. Aust N Z J Psychiatry. 1995;29(1):114–7.PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Lensi P, Cassano GB, Correddu G, Ravagli S, Kunovac JL, Akiskal HS. Obsessive-compulsive disorder. Familial-developmental history, symptomatology, comorbidity and course with special reference to gender-related differences. Br J Psychiatry J Ment Sci. 1996;169(1):101–7.CrossRefGoogle Scholar
  26. 26.
    Bogetto F, Venturello S, Albert U, Maina G, Ravizza L. Gender-related clinical differences in obsessive-compulsive disorder. Eur Psychiatry. 1999;14(8):434–41.PubMedCrossRefPubMedCentralGoogle Scholar
  27. 27.
    Fontenelle LF, Mendlowicz MV, de Menezes GB, Appolinário JC, Marques C, Coutinho W, et al. Comparison of symptom profiles of obese binge eaters, obese non-binge eaters, and patients with obsessive-compulsive disorder. J Nerv Ment Dis. 2002;190(9):643–6.PubMedCrossRefPubMedCentralGoogle Scholar
  28. 28.
    Lochner C, Hemmings SMJ, Kinnear CJ, Moolman-Smook JC, Corfield VA, Knowles JA, et al. Gender in obsessive-compulsive disorder: clinical and genetic findings. Eur Neuropsychopharmacol. 2004;14(2):105–13.PubMedCrossRefPubMedCentralGoogle Scholar
  29. 29.
    Tükel R, Polat A, Genç A, Bozkurt O, Atli H. Gender-related differences among Turkish patients with obsessive-compulsive disorder. Compr Psychiatry. 2004;45(5):362–6.PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    de Mathis MA, Diniz JB, Shavitt RG, Torres AR, Ferrão YA, Fossaluza V, et al. Early onset obsessive-compulsive disorder with and without tics. CNS Spectr. 2009;14(7):362–70.PubMedCrossRefGoogle Scholar
  31. 31.
    Jaisoorya TS, Reddy YCJ, Srinath S, Thennarasu K. Sex differences in Indian patients with obsessive-compulsive disorder. Compr Psychiatry. 2009;50(1):70–5.PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Torresan RC, de Abreu Ramos-Cerqueira AT, de Mathis MA, Diniz JB, Ferrão YA, Miguel EC, et al. Sex differences in the phenotypic expression of obsessive-compulsive disorder: an exploratory study from Brazil. Compr Psychiatry. 2009;50(1):63–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Ruscio AM, Stein DJ, Chiu WT, Kessler RC. The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Mol Psychiatry. 2010;15(1):53–63.CrossRefGoogle Scholar
  34. 34.
    Albert U, Aguglia A, Barbaro F, De Cori D, Maina G, Bogetto F. Differenze di genere nel disturbo ossessivo-compulsivo: uno studio clinico su 415 pazienti. Quad Ital Psichiatr. 2012;31(4):190–200.CrossRefGoogle Scholar
  35. 35.
    Cherian AV, Narayanaswamy JC, Viswanath B, Guru N, George CM, Bada Math S, et al. Gender differences in obsessive-compulsive disorder: findings from a large Indian sample. Asian J Psychiatry. 2014;9:17–21.CrossRefGoogle Scholar
  36. 36.
    Dell’Osso B, Benatti B, Rodriguez CI, Arici C, Palazzo C, Altamura AC, et al. Obsessive-compulsive disorder in the elderly: a report from the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS). Eur Psychiatry. 2017;45:36–40.PubMedCrossRefPubMedCentralGoogle Scholar
  37. 37.
    Rosso G, Albert U, Asinari GF, Bogetto F, Maina G. Stressful life events and obsessive-compulsive disorder: clinical features and symptom dimensions. Psychiatry Res. 2012;197(3):259–64.PubMedCrossRefGoogle Scholar
  38. 38.
    Goldberg X, Soriano-Mas C, Alonso P, Segalàs C, Real E, López-Solà C, et al. Predictive value of familiality, stressful life events and gender on the course of obsessive-compulsive disorder. J Affect Disord. 2015;185:129–34.PubMedCrossRefPubMedCentralGoogle Scholar
  39. 39.
    Real E, Subirà M, Alonso P, Segalàs C, Labad J, Orfila C, et al. Brain structural correlates of obsessive–compulsive disorder with and without preceding stressful life events. World J Biol Psychiatry. 2016;17(5):366–77.PubMedCrossRefGoogle Scholar
  40. 40.
    Mataix-Cols D, Boman M, Monzani B, Rück C, Serlachius E, Långström N, et al. Population-based, multigenerational family clustering study of obsessive-compulsive disorder. JAMA Psychiatry. 2013;70(7):709–17.PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Miller ML, Brock RL. The effect of trauma on the severity of obsessive-compulsive spectrum symptoms: a meta-analysis. J Anxiety Disord. 2017;47:29–44.CrossRefGoogle Scholar
  42. 42.
    Chen D, Bienvenu OJ, Krasnow J, Wang Y, Grados MA, Cullen B, et al. Parental bonding and hoarding in obsessive-compulsive disorder. Compr Psychiatry. 2017;73:43–52.PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Sobin C, Blundell M, Weiller F, Gavigan C, Haiman C, Karayiorgou M. Phenotypic characteristics of obsessive-compulsive disorder ascertained in adulthood. J Psychiatr Res. 1999;33(3):265–73.PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    Noshirvani HF, Kasvikis Y, Marks IM, Tsakiris F, Monteiro WO. Gender-divergent aetiological factors in obsessive-compulsive disorder. Br J Psychiatry. 1991;158:260–3.PubMedCrossRefPubMedCentralGoogle Scholar
  45. 45.
    Matsunaga H, Kiriike N, Matsui T, Miyata A, Iwasaki Y, Fujimoto K, et al. Gender differences in social and interpersonal features and personality disorders among Japanese patients with obsessive-compulsive disorder. Compr Psychiatry. 2000;41(4):266–72.PubMedCrossRefPubMedCentralGoogle Scholar
  46. 46.
    Torresan RC, Ramos-Cerqueira ATA, Shavitt RG, do Rosário MC, de Mathis MA, Miguel EC, et al. Symptom dimensions, clinical course and comorbidity in men and women with obsessive-compulsive disorder. Psychiatry Res. 2013;209(2):186–95.PubMedCrossRefPubMedCentralGoogle Scholar
  47. 47.
    Coluccia A, Fagiolini A, Ferretti F, Pozza A, Costoloni G, Bolognesi S, et al. Adult obsessive–compulsive disorder and quality of life outcomes: a systematic review and meta-analysis. Asian J Psychiatry. 2016;22:41–52.CrossRefGoogle Scholar
  48. 48.
    Lochner C, Stein DJ. Gender in obsessive-compulsive disorder and obsessive-compulsive spectrum disorders. Arch Womens Ment Health. 2001;4(1):19–26.CrossRefGoogle Scholar
  49. 49.
    Neziroglu F, Anemone R, Yaryura-Tobias JA. Onset of obsessive-compulsive disorder in pregnancy. Am J Psychiatry. 1992;149(7):947–50.PubMedCrossRefPubMedCentralGoogle Scholar
  50. 50.
    Brandes M, Soares CN, Cohen LS. Postpartum onset obsessive-compulsive disorder: diagnosis and management. Arch Womens Ment Health. 2004;7(2):99–110.PubMedCrossRefPubMedCentralGoogle Scholar
  51. 51.
    Abramowitz JS, Schwartz SA, Moore KM, Luenzmann KR. Obsessive-compulsive symptoms in pregnancy and the puerperium: a review of the literature. J Anxiety Disord. 2003;17(4):461–78.PubMedCrossRefPubMedCentralGoogle Scholar
  52. 52.
    Speisman BB, Storch EA, Abramowitz JS. Postpartum obsessive-compulsive disorder. J Obstet Gynecol Neonatal Nurs. 2011;40(6):680–90.PubMedCrossRefPubMedCentralGoogle Scholar
  53. 53.
    Lord C, Hall G, Soares CN, Steiner M. Physiological stress response in postpartum women with obsessive-compulsive disorder: a pilot study. Psychoneuroendocrinology. 2011;36(1):133–8.PubMedCrossRefPubMedCentralGoogle Scholar
  54. 54.
    JNP-2332-3469-04-0024.pdf [Internet]. [citado 27 de setembro de 2017]. Disponível em:
  55. 55.
    McEwen B. Estrogen actions throughout the brain. Recent Prog Horm Res. 2002;57(1):357–84.PubMedCrossRefPubMedCentralGoogle Scholar
  56. 56.
    Vulink NCC, Denys D, Bus L, Westenberg HGM. Female hormones affect symptom severity in obsessive-compulsive disorder. Int Clin Psychopharmacol. 2006;21(3):171–5.PubMedCrossRefPubMedCentralGoogle Scholar
  57. 57.
    Steiner M. Hormones and mood: from menarche to menopause and beyond. J Affect Disord. 2003;74(1):67–83.PubMedCrossRefPubMedCentralGoogle Scholar
  58. 58.
    Zohar J, Kennedy JL, Hollander E, Koran LM. Serotonin-1D hypothesis of obsessive-compulsive disorder: an update. J Clin Psychiatry. 2004;65(Suppl 14):18–21.PubMedPubMedCentralGoogle Scholar
  59. 59.
    Guglielmi V, Vulink NCC, Denys D, Wang Y, Samuels JF, Nestadt G. Obsessive-compulsive disorder and female reproductive cycle events: results from the OCD and reproduction collaborative study. Depress Anxiety. 2014;31(12):979–87.PubMedCrossRefPubMedCentralGoogle Scholar
  60. 60.
    Labad J, Menchón JM, Alonso P, Segalàs C, Jiménez S, Vallejo J. Female reproductive cycle and obsessive-compulsive disorder. J Clin Psychiatry. 2005;66(4):428–35; quiz 546.PubMedCrossRefPubMedCentralGoogle Scholar
  61. 61.
    Labad J, Alonso P, Segalas C, Real E, Jimenez S, Bueno B, et al. Distinct correlates of hoarding and cleaning symptom dimensions in relation to onset of obsessive-compulsive disorder at menarche or the perinatal period. Arch Womens Ment Health. 2010;13(1):75–81.PubMedCrossRefPubMedCentralGoogle Scholar
  62. 62.
    Moreira L, Bins H, Toressan R, Ferro C, Harttmann T, Petribú K, et al. An exploratory dimensional approach to premenstrual manifestation of obsessive-compulsive disorder symptoms: a multicentre study. J Psychosom Res. 2013;74(4):313–9.PubMedCrossRefPubMedCentralGoogle Scholar
  63. 63.
    Forray A, Focseneanu M, Pittman B, McDougle CJ, Epperson CN. Onset and exacerbation of obsessive-compulsive disorder in pregnancy and the postpartum period. J Clin Psychiatry. 2010;71(8):1061–8.PubMedPubMedCentralCrossRefGoogle Scholar
  64. 64.
    Uguz F, Sahingoz M, Gezginc K, Karatayli R. Obsessive-compulsive disorder in postmenopausal women: prevalence, clinical features, and comorbidity. Aust N Z J Psychiatry. 2010;44(2):183–7.PubMedCrossRefPubMedCentralGoogle Scholar
  65. 65.
    Belloch A, Del Valle G, Morillo C, Carrió C, Cabedo E. To seek advice or not to seek advice about the problem: the help-seeking dilemma for obsessive-compulsive disorder. Soc Psychiatry Psychiatr Epidemiol. 2009;44(4):257–64.PubMedCrossRefPubMedCentralGoogle Scholar
  66. 66.
    McGuinness M, Blissett J, Jones C. OCD in the perinatal period: is postpartum OCD (ppOCD) a distinct subtype? A review of the literature. Behav Cogn Psychother. 2011;39(3):285–310.PubMedCrossRefPubMedCentralGoogle Scholar
  67. 67.
    Uguz F, Gezginc K, Zeytinci IE, Karatayli S, Askin R, Guler O, et al. Obsessive-compulsive disorder in pregnant women during the third trimester of pregnancy. Compr Psychiatry. 2007;48(5):441–5.PubMedCrossRefPubMedCentralGoogle Scholar
  68. 68.
    Uguz F, Kaya V, Gezginc K, Kayhan F, Cicek E. Clinical correlates of worsening in obsessive-compulsive symptoms during pregnancy. Gen Hosp Psychiatry. 2011;33(2):197–9.PubMedCrossRefPubMedCentralGoogle Scholar
  69. 69.
    Zambaldi CF, Cantilino A, Montenegro AC, Paes JA, de Albuquerque TLC, Sougey EB. Postpartum obsessive-compulsive disorder: prevalence and clinical characteristics. Compr Psychiatry. 2009;50(6):503–9.PubMedCrossRefPubMedCentralGoogle Scholar
  70. 70.
    Fairbrother N, Janssen P, Antony MM, Tucker E, Young AH. Perinatal anxiety disorder prevalence and incidence. J Affect Disord. 2016;200:148–55.PubMedCrossRefPubMedCentralGoogle Scholar
  71. 71.
    Leung B, Letourneau N, Bright K, Giesbrecht GF, Ntanda H, Gagnon L, et al. Appraisal of the Psychiatric Diagnostic Screening Questionnaire in a perinatal cohort: the APrON study. Scand J Public Health. 2017;45(6):658–65.PubMedCrossRefPubMedCentralGoogle Scholar
  72. 72.
    Russell EJ, Fawcett JM, Mazmanian D. Risk of obsessive-compulsive disorder in pregnant and postpartum women: a meta-analysis. J Clin Psychiatry. 2013;74(4):377–85.PubMedCrossRefPubMedCentralGoogle Scholar
  73. 73.
    Kim P, Mayes L, Feldman R, Leckman JF, Swain JE. Early postpartum parental preoccupation and positive parenting thoughts: relationship with parent-infant interaction: parental preoccupation. Infant Ment Health J. 2013;34(2):104–16.PubMedCrossRefPubMedCentralGoogle Scholar
  74. 74.
    Maina G, Albert U, Bogetto F, Vaschetto P, Ravizza L. Recent life events and obsessive-compulsive disorder (OCD): the role of pregnancy/delivery. Psychiatry Res. 1999;89(1):49–58.PubMedCrossRefPubMedCentralGoogle Scholar
  75. 75.
    Sichel DA, Cohen LS, Dimmock JA, Rosenbaum JF. Postpartum obsessive compulsive disorder: a case series. J Clin Psychiatry. 1993;54(4):156–9.PubMedPubMedCentralGoogle Scholar
  76. 76.
    Arnold LM. A case series of women with postpartum-onset obsessive-compulsive disorder. Prim Care Companion J Clin Psychiatry. 1999;1(4):103–8.PubMedPubMedCentralCrossRefGoogle Scholar
  77. 77.
    Leckman JF, Mayes LC. Preoccupations and behaviors associated with romantic and parental love. Perspectives on the origin of obsessive-compulsive disorder. Child Adolesc Psychiatr Clin N Am. 1999;8(3):635–65.PubMedCrossRefPubMedCentralGoogle Scholar
  78. 78.
    Miller ES, Hoxha D, Wisner KL, Gossett DR. Obsessions and compulsions in postpartum women without obsessive compulsive disorder. J Womens Health 2002. 2015;24(10):825–30.CrossRefGoogle Scholar
  79. 79.
    Ross LE, McLean LM. Anxiety disorders during pregnancy and the postpartum period: a systematic review. J Clin Psychiatry. 2006;67(8):1285–98.PubMedCrossRefPubMedCentralGoogle Scholar
  80. 80.
    Shear MK, Mammen O. Anxiety disorders in pregnant and postpartum women. Psychopharmacol Bull. 1995;31(4):693–703.PubMedPubMedCentralGoogle Scholar
  81. 81.
    Marchesi C, Ossola P, Amerio A, Daniel BD, Tonna M, De Panfilis C. Clinical management of perinatal anxiety disorders: a systematic review. J Affect Disord. 2016;190:543–50.PubMedCrossRefPubMedCentralGoogle Scholar
  82. 82.
    Challacombe FL, Salkovskis PM. Intensive cognitive-behavioural treatment for women with postnatal obsessive-compulsive disorder: a consecutive case series. Behav Res Ther. 2011;49(6–7):422–6.PubMedCrossRefPubMedCentralGoogle Scholar
  83. 83.
    Challacombe FL, Salkovskis PM, Woolgar M, Wilkinson EL, Read J, Acheson R. A pilot randomized controlled trial of time-intensive cognitive-behaviour therapy for postpartum obsessive-compulsive disorder: effects on maternal symptoms, mother-infant interactions and attachment. Psychol Med. 2017;47(8):1478–88.PubMedCrossRefPubMedCentralGoogle Scholar
  84. 84.
    House SJ, Tripathi SP, Knight BT, Morris N, Newport DJ, Stowe ZN. Obsessive-compulsive disorder in pregnancy and the postpartum period: course of illness and obstetrical outcome. Arch Womens Ment Health. 2016;19(1):3–10.PubMedCrossRefPubMedCentralGoogle Scholar
  85. 85.
    Ratnasuriya RH, Marks IM, Forshaw DM, Hymas NF. Obsessive slowness revisited. Br J Psychiatry. 1991;159:273–4.PubMedCrossRefPubMedCentralGoogle Scholar
  86. 86.
    Denys D, de Geus F, van Megen HJGM, Westenberg HGM. Symptom dimensions in obsessive-compulsive disorder: factor analysis on a clinician-rated scale and a self-report measure. Psychopathology. 2004;37(4):181–9.PubMedCrossRefPubMedCentralGoogle Scholar
  87. 87.
    Lochner C, Hemmings SMJ, Kinnear CJ, Moolman-Smook JC, Corfield VA, Knowles JA, et al. Corrigendum to “gender in obsessive-compulsive disorder: clinical and genetic findings” [Eur. Neuropsychopharmacol. 14 (2004) 105–113]. Eur Neuropsychopharmacol J Eur Coll Neuropsychopharmacol. 2004;14(5):437–45.CrossRefGoogle Scholar
  88. 88.
    Karadaĝ F, Oguzhanoglu NK, Ozdel O, Ateşci FC, Amuk T. OCD symptoms in a sample of Turkish patients: a phenomenological picture. Depress Anxiety. 2006;23(3):145–52.PubMedCrossRefPubMedCentralGoogle Scholar
  89. 89.
    Stein DJ, Andersen EW, Overo KF. Response of symptom dimensions in obsessive-compulsive disorder to treatment with citalopram or placebo. Rev Bras Psiquiatr Sao Paulo Braz 1999. 2007;29(4):303–7.Google Scholar
  90. 90.
    Labad J, Menchon JM, Alonso P, Segalas C, Jimenez S, Jaurrieta N, et al. Gender differences in obsessive-compulsive symptom dimensions. Depress Anxiety. 2008;25(10):832–8.PubMedCrossRefPubMedCentralGoogle Scholar
  91. 91.
    Li Y, Marques L, Hinton DE, Wang Y, Xiao Z-P. Symptom dimensions in Chinese patients with obsessive-compulsive disorder. CNS Neurosci Ther. 2009;15(3):276–82.PubMedPubMedCentralCrossRefGoogle Scholar
  92. 92.
    Hantouche EG, Lancrenon S. Modern typology of symptoms and obsessive-compulsive syndromes: results of a large French study of 615 patients. L’Encephale. 1996;22(1):9–21.PubMedPubMedCentralGoogle Scholar
  93. 93.
    Leckman JF, Grice DE, Boardman J, Zhang H, Vitale A, Bondi C, et al. Symptoms of obsessive-compulsive disorder. Am J Psychiatry. 1997;154(7):911–7.PubMedCrossRefPubMedCentralGoogle Scholar
  94. 94.
    Mataix-Cols D, Wooderson S, Lawrence N, Brammer MJ, Speckens A, Phillips ML. Distinct neural correlates of washing, checking, and hoarding symptom dimensions in obsessive-compulsive disorder. Arch Gen Psychiatry. 2004;61(6):564–76.PubMedCrossRefPubMedCentralGoogle Scholar
  95. 95.
    Goldstein JM, Seidman LJ, Horton NJ, Makris N, Kennedy DN, Caviness VS, et al. Normal sexual dimorphism of the adult human brain assessed by in vivo magnetic resonance imaging. Cereb Cortex. 2001;11(6):490–7.PubMedCrossRefPubMedCentralGoogle Scholar
  96. 96.
    Alonso P, Gratacòs M, Segalàs C, Escaramís G, Real E, Bayés M, et al. Variants in estrogen receptor alpha gene are associated with phenotypical expression of obsessive-compulsive disorder. Psychoneuroendocrinology. 2011;36(4):473–83.PubMedCrossRefPubMedCentralGoogle Scholar
  97. 97.
    de Mathis MA, de Alvarenga P, Funaro G, Torresan RC, Moraes I, Torres AR, et al. Gender differences in obsessive-compulsive disorder: a literature review. Rev Bras Psiquiatr São Paulo Braz 1999. 2011;33(4):390–9.Google Scholar
  98. 98.
    Kalra SK, Swedo SE. Children with obsessive-compulsive disorder: are they just “little adults”? J Clin Invest. 2009;119(4):737–46.PubMedPubMedCentralCrossRefGoogle Scholar
  99. 99.
    Wheaton M, Timpano KR, Lasalle-Ricci VH, Murphy D. Characterizing the hoarding phenotype in individuals with OCD: associations with comorbidity, severity and gender. J Anxiety Disord. 2008;22(2):243–52.PubMedCrossRefPubMedCentralGoogle Scholar
  100. 100.
    Fischer DJ, Himle JA, Hanna GL. Age and gender effects on obsessive-compulsive symptoms in children and adults. Depress Anxiety. 1997 de 1996;4(5):237–9.PubMedCrossRefPubMedCentralGoogle Scholar
  101. 101.
    Samuels J, Bienvenu OJ, Riddle MA, Cullen BA, Grados MA, Liang KY, et al. Hoarding in obsessive compulsive disorder: results from a case-control study. Behav Res Ther. 2002;40(5):517–28.PubMedCrossRefPubMedCentralGoogle Scholar
  102. 102.
    de Mathis MA, Diniz JB, Hounie AG, Shavitt RG, Fossaluza V, Ferrão Y, et al. Trajectory in obsessive-compulsive disorder comorbidities. Eur Neuropsychopharmacol. 2013;23(7):594–601.PubMedCrossRefPubMedCentralGoogle Scholar
  103. 103.
    The National Comorbidity Survey of the United States. Int Rev Psychiatry;6(4) [Internet]. [citado 27 de setembro de 2017]. Disponível em:
  104. 104.
    McLean CP, Asnaani A, Litz BT, Hofmann SG. Gender differences in anxiety disorders: prevalence, course of illness, comorbidity and burden of illness. J Psychiatr Res. 2011;45(8):1027–35.PubMedPubMedCentralCrossRefGoogle Scholar
  105. 105.
    Gentil AF, de Mathis MA, Torresan RC, Diniz JB, Alvarenga P, do Rosário MC, et al. Alcohol use disorders in patients with obsessive-compulsive disorder: the importance of appropriate dual-diagnosis. Drug Alcohol Depend. 2009;100(1–2):173–7.PubMedCrossRefPubMedCentralGoogle Scholar
  106. 106.
    de Mathis MA, de Alvarenga P, Funaro G, Torresan RC, Moraes I, Torres AR, et al. Gender differences in obsessive-compulsive disorder: a literature review. Rev Bras Psiquiatr Sao Paulo Braz 1999. 2011;33(4):390–9.Google Scholar
  107. 107.
    Moore J, Smith GW, Shevlin M, O’Neill FA. Alternative factor models and heritability of the Short Leyton Obsessional Inventory-Children’s Version. J Abnorm Child Psychol. 2010;38(7):921–34.PubMedCrossRefPubMedCentralGoogle Scholar
  108. 108.
    Miguel EC, do Rosário-Campos MC, Shavitt RG, Hounie AG, Mercadante MT. The tic-related obsessive-compulsive disorder phenotype and treatment implications. Adv Neurol. 2001;85:43–55.PubMedPubMedCentralGoogle Scholar
  109. 109.
    Mackenzie CS, Reynolds K, Cairney J, Streiner DL, Sareen J. Disorder-specific mental health service use for mood and anxiety disorders: associations with age, sex, and psychiatric comorbidity: disorder-specific mental health. Depress Anxiety. 2012;29(3):234–42.PubMedCrossRefPubMedCentralGoogle Scholar
  110. 110.
    Steiner M, Lepage P, Dunn EJ. Serotonin and gender-specific psychiatric disorders. Int J Psychiatry Clin Pract. 1997;1(1):3–13.PubMedCrossRefPubMedCentralGoogle Scholar
  111. 111.
    Christiansen D, Elklit A. Sex differences in PTSD. Rijeka: INTECH Open Access Publisher; 2012.Google Scholar
  112. 112.
    Bekker MH, van Mens-Verhulst J. Anxiety disorders: sex differences in prevalence, degree, and background, but gender-neutral treatment. Gend Med. 2007;4(Suppl 2):S178–93.PubMedCrossRefPubMedCentralGoogle Scholar
  113. 113.
    Ackerman DL, Greenland S, Bystritsky A, Morgenstern H, Katz RJ. Predictors of treatment response in obsessive-compulsive disorder: multivariate analyses from a multicenter trial of clomipramine. J Clin Psychopharmacol. 1994;14(4):247–54.PubMedCrossRefPubMedCentralGoogle Scholar
  114. 114.
    Mundo E, Bareggi SR, Pirola R, Bellodi L. Effect of acute intravenous clomipramine and antiobsessional response to proserotonergic drugs: is gender a predictive variable? Biol Psychiatry. 1999;45(3):290–4.PubMedCrossRefPubMedCentralGoogle Scholar
  115. 115.
    Fontenelle L, Marques C, Versiani M. The effect of gender on the clinical features and therapeutic response in obsessive-compulsive disorder. Rev Bras Psiquiatr. 2002;24(1):7–11.CrossRefGoogle Scholar
  116. 116.
    Farrell L, Waters A, Milliner E, Ollendick T. Comorbidity and treatment response in pediatric obsessive-compulsive disorder: a pilot study of group cognitive-behavioral treatment. Psychiatry Res. 2012;199(2):115–23.PubMedCrossRefPubMedCentralGoogle Scholar
  117. 117.
    Wolitzky-Taylor K, Bobova L, Zinbarg RE, Mineka S, Craske MG. Longitudinal investigation of the impact of anxiety and mood disorders in adolescence on subsequent substance use disorder onset and vice versa. Addict Behav. 2012;37(8):982–5.PubMedPubMedCentralCrossRefGoogle Scholar
  118. 118.
    Stewart SE, Yen C-H, Stack DE, Jenike MA. Outcome predictors for severe obsessive-compulsive patients in intensive residential treatment. J Psychiatr Res. 2006;40(6):511–9.PubMedCrossRefPubMedCentralGoogle Scholar
  119. 119.
    Examining sex and gender differences in anxiety disorders [Internet]. InTech; 2015 [citado 28 de setembro de 2017]. Disponível em:
  120. 120.
    Assunção MC, da Conceicao Costa DL, de Mathis MA, Shavitt RG, Ferrão YA, do Rosário MC, et al. Social phobia in obsessive-compulsive disorder: prevalence and correlates. J Affect Disord. 2012;143(1–3):138–47.PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Albina R. Torres
    • 1
  • Ricardo C. Torresan
    • 1
  • Maria Alice de Mathis
    • 2
  • Roseli G. Shavitt
    • 2
  1. 1.Department of Neurology, Psychology and PsychiatryBotucatu Medical School, São Paulo State University (UNESP)BotucatuBrazil
  2. 2.Department and Institute of Psychiatry, Faculty of MedicineUniversity of São Paulo (USP)São PauloBrazil

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