Just because you’re born with a genetic predisposition or meet specific risk factors does not mean you’ll definitely develop OCD.

Obsessive-compulsive disorder (OCD) is a mental health disorder affecting approximately 1.2% of adults in the United States annually. For more than half of people living with OCD, the condition is a source of major impairment.

OCD features experiences of obsessions, persistent thoughts and urges, as well as compulsions and mental and physical ritualistic behaviors.

Obsessions are often intrusive and distressing and come with an array of emotions, from intense guilt and anxiety to fear. In OCD, compulsions are a way to neutralize the negative feelings that accompany an obsession.

Why someone develops OCD isn’t well understood. Genetics may be involved, and other factors like structural brain changes, trauma, and significant stress might also be underlying influences.

There is a link between OCD and your genes, though no specific genetic variant has been identified as the one responsible for OCD.

According to a review from 2021, multiple genes — possibly hundreds — may be involved in determining your overall genetic risk for this condition. According to the researchers, it’s likely that each genetic variant only contributes a small amount to your genetic predisposition for OCD.

The more of these variants you have, the higher your risk of developing OCD.

Dr. Ryan Sultan, a board certified psychiatrist and professor at Colombia University in New York City, explains experts have concluded genetics plays a role because of study results between family members.

“Studies have shown that individuals with a first-degree relative like a parent or sibling who has OCD are at a higher risk of developing the disorder themselves,” Sultan explains. He added that genetics do not guarantee the onset of OCD, nor is it correct to say someone is “born with” OCD.

“It’s not accurate to say people are born with OCD in the same way one might be born with blue eyes or a certain hair color,” says Sultan. “However, some people may have a genetic predisposition or specific brain structures that make them more susceptible to developing the disorder.”

Many studies have investigated specific genetic variants and their role in OCD. In 2017, for example, one study found four genes potentially associated with OCD:

  • NRXN1
  • HTR2A
  • CTTNBP2
  • REEP3

According to a 2019 review, other genes potentially influential in OCD development include:

  • SLC1A1
  • DLGAP1
  • PTPRD

People who develop OCD as children may have a larger number of hereditary factors compared to those who develop it as adults, according to a 2018 study.

What are the chances of inheriting OCD?

A 2023 review on the genetic epidemiology of OCD suggests that OCD is 7.2 times more frequent among families with an OCD history than families without.

Another review from 2021 notes family members of people living with OCD may have as high as a 20-fold risk for OCD compared to people without OCD in their families.

Genetics alone can’t yet explain why one person develops OCD while another doesn’t. For many people, environmental factors may be just as influential.

Sultan says situations that cause significant stress, traumatic events, or major life changes can lead to the onset of OCD symptoms or make them more severe.

“For instance, someone who is predisposed to OCD might experience their first major episode after a traumatic event or significant life stressor,” he indicates.

Is OCD a chemical imbalance?

People living with OCD might have differences in brain structure or the balance of certain chemicals like neurotransmitters.

How this influences OCD development isn’t well understood. “It’s not a simple chemical imbalance but rather a complex interplay of factors,” says Sultan.

Puberty, for example, with its rush of hormones and changes in brain structure, can be a time when mental health conditions, including OCD, first manifest or intensify, he adds.

This doesn’t mean puberty causes OCD, but that puberty may be a time of opportunity when conditions are more favorable for OCD to emerge.

Can OCD be learned?

The core symptoms of OCD are not learned, but it is possible to learn progressive behaviors and rituals.

“For example, if a person feels relief from their anxiety after checking the stove multiple times, they might continue to check it more frequently in the future, reinforcing the behavior, says Sultan. “Over time, this can lead to a pattern where the compulsion is deeply ingrained.”

Sometimes, children may mimic the behaviors of parents living with OCD, but this doesn’t mean the child is living with OCD.

Genetics, environmental factors, and brain alterations are the main risk factors for OCD.

They’re referred to as risk factors because they’ve been shown to have an influence on the development of OCD, but they haven’t been established as definitive causes.

A cause is something directly responsible for an outcome, and at this time, the causes of OCD remain unknown.

Research supports a strong link between OCD and genetics. Certain genetic variants may make you more likely to develop OCD, and having a first-degree relative with OCD can also increase your risk.

This doesn’t mean OCD is solely genetic, however. Like changes to the brain’s structure and function or environmental factors, genetics is considered a risk factor for OCD rather than a cause.