Podcast Summary: "Is OCD Genetic? Here's What The Science Says"

Podcast: Get to know OCD
Host: Dr. Patrick McGrath (NOCD)
Guest: Dr. Evelyn Stewart
Date: September 4, 2025

Main Theme/Purpose

In this episode, Dr. Patrick McGrath sits down with renowned psychiatrist and OCD researcher Dr. Evelyn Stewart to explore the question: Is OCD genetic? They discuss the latest scientific findings on the heritability of OCD, particularly in childhood onset cases, debunk common misconceptions about parenting and the origins of OCD, and share hopeful insights for treatment and family support. The conversation also highlights practical challenges families face, the importance of early intervention, advances in genetics and epigenetics, and the value of multidisciplinary collaboration in the OCD community.

Key Discussion Points & Insights

1. Dr. Evelyn Stewart’s Background and Entry into OCD Research

• [03:30] Dr. Stewart initially wanted to be a pediatrician but became fascinated by psychiatry during medical school’s “decade of the brain.”
• [03:55] Inspired by Judith Rappaport’s book The Boy Who Couldn't Stop Washing – “It seemed like a psychiatric condition... Clearly, it's impairing... but it was treatable.” – Dr. Stewart
• [06:18] Mentored by the late Dr. Mike Jenike: “Patients come first, families come first... If you're torn between different tasks, let's think about the people who are living with OCD.”

2. Understanding Childhood Onset OCD and Developmental Trajectories

• [08:55] Epidemiological studies show OCD is not just an adult disorder:
  • Three general peaks: ages 8-10, teenage years, and early adulthood
  • Onset patterns differ by gender
• [09:20] Signs of distinct features in childhood OCD and consideration of factors like inflammation

3. Role of Genetics in OCD

• [11:54] Childhood onset OCD appears more genetically driven than adult onset
• [12:30] Twin studies and family research confirm heritability
• [13:12] Debunking parental blame: “While OCD runs in families, it seems to be inherited, not caused by parenting techniques.” – Dr. Stewart
  • Recent study (Kendler, lead author) reinforces this finding
• [39:10] “Even if you wanted to cause OCD in your child... that's not in your power. It's just... outside of your control.” – Dr. Stewart

4. Treatment – Barriers and Family Dynamics

• [14:49] Delays in diagnosis and treatment are common
  • Many families take 7-8 steps before seeing a specialist
• [15:45] Awareness and destigmatization are improving, but access to evidence-based treatment lags
  • “Exposure, response, prevention is the cornerstone... Medications enable the child to be brave enough to start the CBT journey.” – Dr. Stewart
• [16:53] Motivating families:
  • Parents sometimes more motivated than children
  • Key is “learning about the way that OCD is bossing them around or getting in the way of things they might want to do.”
  • Addressing stigma, building trust, and education are essential

5. The Impact of OCD on Families

• [19:34] OCD’s effects go well beyond the individual, deeply impacting family structure and daily routines
  • “A half of moms and a third of dads reported daily impact on their jobs due to their child’s OCD.”
• [22:01] Coaching parents to tolerate their child's distress rather than accommodate OCD or react emotionally
  • “Neither of those [over-accommodating or reacting angrily] will help OCD go away. What those do is enable family accommodation.”
  • “Fake it till you make it” – Stay even-keeled during OCD upsets

6. Family Accommodation and Turning Points

• [24:46] Family disagreement on approach can lead to chaos, even divorce
  • “OCD, it loves causing a stink, it creates a distraction. OCD wins.”
• [25:08] Early intervention is key: “If you’re able to address OCD sooner in childhood... your outcome as an adult is going to be significantly better.”

7. Research on Genetics, Epigenetics, and Biological Markers

• [27:22] Insights from studies combining CBT with family-based support and mindfulness – parental ability to stay calm predicts better outcomes
• [28:16] Children often have more insight into OCD than commonly believed, and insight improves with CBT
  • “Even the kids who had poor insight... their insight improved after they went through cognitive behavior therapy.”
• [30:58] Cognitive markers (like poor planning) found in both affected kids and siblings with genetic risk
• [32:07] Epigenetic research:
  • “Epigenetics... it's how your environment becomes embedded in biology... on/off status of gene expression can change”
  • CBT may change biological markers; one site showed change post-CBT

8. Future Directions and Multidisciplinary Collaboration

• [35:53] Huge international collaboration (over 50,000 OCD cases, 2 million controls) identified genetic risk spread across 11,000 loci
• [37:09] Unlike disorders controlled by a few genes (e.g., Huntington's), OCD genetic risk is highly polygenic and complex
• [40:46] Dr. Stewart sees hope in “connecting the dots” between psychological and biological research
• [41:34] Value of collective action: “We have one goal in mind, which is how do we help stop the suffering that OCD causes?” – Dr. McGrath

9. Messages of Hope

• [43:00] “There is hope, so much hope... most of the kids who have OCD in childhood don't have full blown OCD as adults. It is not a life sentence.” – Dr. Stewart
• [43:30] Meds are not necessarily forever; evidence-based treatments work
• [43:50] Families and individuals with OCD are compassionate, resilient, and there's a vibrant community pushing for better outcomes

10. How to Get Involved or Find Support

• [44:31] Participate in research via the International OCD Foundation website
• [42:22] Dr. Stewart can be reached at University of British Columbia or by email

Notable Quotes & Memorable Moments

• “Even if you wanted to cause OCD in your child... that's not in your power. It's just outside of your control.”
  — Dr. Evelyn Stewart [39:10]
• “Exposure, response, prevention is the cornerstone (of treatment)... medications enable the child to be brave enough to start the CBT journey.”
  — Dr. Evelyn Stewart [15:45]
• “We know, even looking at data, looking at the evidence, most of the kids who have OCD in childhood don’t have full blown OCD as adults. It is not a life sentence.”
  — Dr. Evelyn Stewart [43:00]
• “OCD has its own best interest at heart, not anybody else’s.”
  — Dr. Patrick McGrath [19:07]
• "OCD, it loves causing a stink, it creates a distraction. OCD wins."
  — Dr. Evelyn Stewart [23:46]
• "There are many factors that are involved which... can translate into many opportunities to improve outcomes."
  — Dr. Evelyn Stewart [41:34]

Timestamps for Important Segments

• 00:00 – Introduction to the genetics of OCD and reassuring parents
• 03:30 – Dr. Stewart’s origin story in child psychiatry and OCD research
• 06:18 – Mentorship from Dr. Mike Jenike and early perspectives
• 08:55 – Developmental patterns and recognition of childhood OCD
• 11:54 – Key genetic findings and debunking parenting myths
• 14:49 – Barriers to timely OCD treatment in children
• 19:34 – Family impact and the cost of OCD for parents
• 22:01 – Training parents to support, not accommodate, OCD rituals
• 27:22 – Family-based therapy and research findings
• 32:07 – Epigenetics and therapy-induced biological change
• 35:53 – International collaboration for large-scale genetic studies
• 41:34 – The power of collective action within the OCD field
• 43:00 – Messages of hope for parents and those affected
• 44:31 – How listeners can support or participate in research

Takeaways

• OCD, especially childhood onset, has a strong genetic basis, but environmental triggers and complex multi-gene interactions matter.
• Parenting styles do not cause OCD; families should feel relief from historic blame.
• Early intervention and evidence-based treatment (particularly ERP and CBT) greatly improve outcomes.
• OCD impacts the whole family, making shared understanding and non-accommodating support essential.
• The OCD research community is large, collaborative, and committed—significant advances in genetics and epigenetics are underway.
• There is strong reason for hope: OCD is treatable, childhood onset is not always lifelong, and resources are increasingly accessible.

Resources Mentioned

• International OCD Foundation (IOCDF)
• Dr. Evelyn Stewart's work at the University of British Columbia
• NOCD (online treatment platform): nocd.com

For more information or to support ongoing research, visit the International OCD Foundation website or reach out to Dr. Stewart at the University of British Columbia.