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Examining Relations Between Obsessive-Compulsive Features, Substance-Use Disorders, and Antisocial Personality Disorder in the Vietnam Era Twin Cohort


Classes of obsessive-compulsive features differing both quantitatively and qualitatively have been linked to gambling disorder. This secondary data analysis sought to extend this line of investigation to examine the extent to which previously reported latent obsessive-compulsive classes may relate to externalizing conditions in a sample of 1675 twin male veterans recruited and surveyed for studies of gambling behaviors/disorder. Using latent class analysis and multivariate regression, we found that participants who reported the highest levels of obsessive-compulsive features were more likely to meet criteria for cannabis abuse and dependence and antisocial personality disorder. When adjusting for co-occurring disorders, the relationship with antisocial personality disorder remained significant whereas those for cannabis use disorders did not. These results highlight the potential utility of considering obsessive-compulsive features within a transdiagnostic framework and suggest that specific externalizing disorders have important links to obsessive-compulsive features. Future research is needed to extend these findings to other samples.

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  1. Twin studies provide a great opportunity for genetic analysis; however, due to low base rates of disorders, there was insufficient power to perform genetic analysis related to antisocial personality disorder and substance use disorders as they relate to the overlap with obsessive-compulsive features.


  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Arlington: American Psychiatric Publishing.

    Book  Google Scholar 

  • Braun, C., Léveillé, C., & Guimond, A. (2008). An orbitofrontostriatopallidal pathway for morality: evidence from postlesion antisocial and obsessive-compulsive disorder. Cognitive Neuropsychiatry, 13, 296–337.

    Article  Google Scholar 

  • Buckner, J., Bonn-Miller, M., Zvolensky, M., & Schmidt, N. (2007). Marijuana use motives and social anxiety among marijuana-using young adults. Addictive Behaviors, 32, 2238–2252.

    Article  Google Scholar 

  • Desai, R., & Potenza, M. (2008). Gender differences in the associations between past-year gambling problems and psychiatric disorders. Social Psychiatry and Psychiatric Epidemiology, 43, 173–183.

    Article  Google Scholar 

  • Douglass, H., Moffitt, T., Dar, R., McGee, R., & Silva, P. (1995). Obsessive-compulsive disorder in a birth cohort of 18-year-olds: prevalence and predictors. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 1424–1431.

    Article  CAS  Google Scholar 

  • Eisen, S., True, W., Goldberg, J., Henderson, W., & Robinette, C. D. (1987). The Vietnam Era Twin (VET) Registry: method of construction. Acta Geneticae Medicae et Gemellologiae, 36, 61–66.

    Article  CAS  Google Scholar 

  • Fineberg, N., Chamberlain, S., Goudriaan, A., Stein, D., Vanderschuren, L., Gillian, C., Shekar, S., Gorwood, P., Voon, V., Morein-Zamir, S., Denys, D., Sahakian, B., Moeller, F., Robbins, T., & Potenza, M. (2014). New developments in human neurocognition: clinical, genetic and brain imaging correlates of impulsivity and compulsivity. CNS Spectrums, 19, 69–89.

    Article  Google Scholar 

  • Fitzgerald, K., & Demakis, G. (2007). The neuropsychology of antisocial personality disorder. Disease-a-Month, 53, 177–183.

    Article  Google Scholar 

  • Goldberg, J., Curran, B., Vitek, M., Henderson, W., & Boyko, E. (2002). The Vietnam Era Twin Registry. Twin Research, 5, 476–481.

    Article  Google Scholar 

  • Gottesman, I., & Gould, T. (2003). The endophenotype concept in psychiatry: etymology and strategic intentions. The American Journal of Psychiatry, 160, 636–645.

    Article  Google Scholar 

  • Grant, J. E., Odlaug, B. L., & Chamberlain, S. R. (2017a). Gambling disorder, DSM-5 criteria and symptom severity. Comprehensive Psychiatry, 75, 1–5.

    Article  Google Scholar 

  • Grant, J. E., Potenza, M. N., Kraus, S. W., & Petrakis, I. L. (2017b). Naltrexone and disulfiram treatment response in veterans with alcohol dependence and co-occurring problem-gambling features. The Journal of Clinical Psychiatry, 78(9), e1299–e1306.

    Article  Google Scholar 

  • Insel, T., Cuthbert, B., Garvey, M., Heinssen, R., Pine, D., Quinn, K., Sanislow, C., & Wang, P. (2010). Research domain criteria (RDoC): toward a new classification framework for research on mental disorders. The American Journal of Psychiatry, 167, 748–751.

    Article  Google Scholar 

  • Kendler, K., Prescott, C., Myers, J., & Neale, M. (2003). The structure of genetic and environmental risk factors for common psychiatric and substance use disorders in men and women. Archives of General Psychiatry, 60, 929–937.

    Article  Google Scholar 

  • Krueger, R. (1999). The structure of common mental disorders. Archives of General Psychiatry, 56, 921–926.

    Article  CAS  Google Scholar 

  • Krueger, R., & Eaton, N. (2015). Transdiagnostic factors of mental disorders. World Psychiatry, 14, 27–29.

    Article  Google Scholar 

  • Lane, S., Cherek, D., Tcheremissine, O., Steinberg, J., & Sharon, J. (2007). Response perseveration and adaptation in heavy marijuana-smoking adolescents. Addictive Behaviors, 32, 977–990.

    Article  Google Scholar 

  • Medeiros, G. C., Leppink, E. W., Yaemi, A., Mariani, M., Tavares, H., & Grant, J. E. (2015). Electronic gaming machines and gambling disorder: a cross-cultural comparison between treatment-seeking subjects from Brazil and the United States. Psychiatry Research, 230(2), 430–435.

    Article  Google Scholar 

  • Moeller, F. G., Barratt, E. S., Dougherty, D. M., Schmitz, J. M., & Swann, A. C. (2001). Psychiatric aspects of impulsivity. AmJ Psychiatry., 158(11), 1783–1793.

    Article  CAS  Google Scholar 

  • National Institute on Alcohol Abuse and Alcoholism, (2005). National epidemiologic survey on alcohol and related conditions-III.

  • Robbins, T., Gillan, C., Smith, D., de Wit, S., & Ersche, K. (2012). Neurocognitive endophenotypes of impulsivity and compulsivity: towards dimensional psychiatry. Trends in Cognitive Sciences, 16, 81–91.

    Article  Google Scholar 

  • Robins, L., Helzer, J., Cottler, L., & Goldring, E. (1988). NIMH diagnostic interview schedule, version III, revised, Dept of Psychiatry,Washington University School of Medicine. St Louis.

  • RTI International, (2017). PhenX toolkit. Retrieved February 9 2017.

  • Sanz, M., Molina, V., Calcedo, A., Martin-Loeches, M., & Rubia, F. (2001). The Wisconsin Card Sorting Test and the assessment of frontal function in obsessive-compulsive patients: an event-related potential study. Cognitive Neuropsychiatry, 6, 109–129.

    Article  Google Scholar 

  • Scherrer, J., Xian, H., Slutske, W., Eisen, S., & Potenza, M. (2015). Associations between obsessive-compulsive classes and pathological gambling in a national cohort of male twins. JAMA Psychiatry, 72, 342–349.

    Article  Google Scholar 

  • Scholes, K., & Martin-Iverson, M. (2009). Cannabis use and neuropsychological performance in healthy individuals and patients with schizophrenia. Psychological Medicine, 40, 1635–1646.

    Article  Google Scholar 

  • Schumann, G., Binder, E., Holte, A., de Kloet, E., Oedegaard, K., Robbins, T., Walker-Tilley, T., Bitter, I., Brown, V., Buitelaar, J., Ciccocioppo, R., Cools, R., Escera, C., Fleischhacker, W., Flor, H., Frith, C., Heinz, A., Johnsen, E., Kirschbaum, C., Klingberg, T., Lesch, K., Lewis, S., Maier, W., Mann, K., Martinot, J., Meyer-Lindenberg, A., Müller, C., Müller, W., Nutt, D., Persico, A., Perugi, G., Pessiglione, M., Preuss, U., Roiser, J., Rossini, P., Rybakowski, J., Sandi, C., Stephan, K., Undurraga, J., Vieta, E., van der Wee, N., Wykes, T., Haro, J., & Wittchen, H. (2014). Stratified medicine for mental disorders. European Neuropsychopharmacology, 24, 5–50.

    Article  CAS  Google Scholar 

  • Shirk, S. D., Kelly, M. M., Kraus, S. W., Potenza, M. N., Pugh, K., Waltrous, C., Federman, E., Krebs, C., & Drebing, C. E. (2018). Gambling-related cognitive distortions predict level of function among US veterans seeking treatment for gambling disorders. The American Journal on Addictions, 27(2), 108–115.

    Article  Google Scholar 

  • Vermont, J. K., & Magidson, J. (2005). Latent Gold 4.0 User’sGuide. Belmont: Statistical Innovations Inc.

    Google Scholar 

  • Wallace, D., Martin, A., & Park, B. (2007). Cannabinoid hyperemesis: marijuana puts patients in hot water. Australasian Psychiatry, 15, 156–158.

    Article  Google Scholar 

  • Williams, M., & Ching, T. (2016). Transgender identity, cultural issues, and cannabis in obsessive-compulsive disorder. AACE Clinical Case Reports, 2, 276–277.

    Article  Google Scholar 

  • World Health Organization, 1992. The ICD-10 classification of mental and behavioral disorders: clinical descriptions and diagnostic guidelines. Geneva.

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The US Department of Defense, National Personnel Records Center, National Archives and Records Administration, Internal Revenue Service, National Opinion Research Center, National Research Council, National Academy of Sciences, and Institute for Survey Research provided invaluable assistance in the conduct of this study. Most importantly, the members of the VET Registry and their families provided continued cooperation and participation, without which this research would not have been possible.

Role of the Funder/Sponsor

The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.


This study was supported by grant MH60426 (Pathological Gambling: Courses, Consequences and Causes) from the Health Services Research and Development Service of the VA and National Institute of Mental Health, Yale and University of Missouri Center of Excellence in Gambling Research grants from the National Center for Responsible Gaming and by the National Center on Addiction and Substance Abuse, the Connecticut Mental Health Center, the Connecticut Department of Mental Health and Addiction Services, and the Connecticut Council on Problem Gambling. The US VA has provided financial support for the development and maintenance of the VET Registry.

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Correspondence to Marc N. Potenza.

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Conflict of Interest

The authors report no conflicts of interest. Dr. Potenza has consulted for and advised Game Day Data, the Addiction Policy Forum, AXA, and Opiant/Lakelight Therapeutics; received research support from the Mohegan Sun Casino and the National Center for Responsible Gaming (now the International Center for Responsible Gaming); participated in surveys, mailings, or telephone consultations related to drug addiction, impulse-control disorders, or other health topics; consulted for legal and gambling entities on issues related to impulse-control and addictive disorders; provided clinical care in the Connecticut Department of Mental Health and Addiction Services Problem Gambling Services Program; performed grant reviews for the National Institutes of Health and other agencies; edited journals and journal sections; given academic lectures in grand rounds, CME events, and other clinical/scientific venues; and generated books or chapters for publishers of mental health texts. The other authors report no disclosures. The views presented in this manuscript represent those of the authors and not necessarily those of the funding agencies.

Ethical Approval

The original and current study was approved by the institutional review boards of the St Louis Veterans Affairs Medical Center and the Washington University School of Medicine. All participants provided verbal informed consent.

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Williams, M., Baskin-Sommers, A.R., Xian, H. et al. Examining Relations Between Obsessive-Compulsive Features, Substance-Use Disorders, and Antisocial Personality Disorder in the Vietnam Era Twin Cohort. Int J Ment Health Addiction 19, 2045–2055 (2021).

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  • Obsessive-compulsive features
  • Impulsivity
  • Compulsivity
  • Transdiagnostic