Obsessive-Compulsive Disorder

Epidemiology

OCD in children and adolescents often goes unrecognized and undiagnosed due to its idiosyncratic, not always obvious nature.

• Point prevalence of pediatric OCD is 0.25% (British study 5-15 y.o., Heyman I, IntRevPsych 2003);
• Overall pediatric prevalence rate is 1-2% (USA studies, Apter A, JAACAP 1996)
• Incidence of OCD peaks during two developmental periods, pre-adolescents, and young adults (mean 20 y.o.). (Geller D, March J, Practice Parameter, JAACAP 2012)

Genetic and non-genetic factors

• OCD has a significant familial/genetic component with higher concordance rates in monozygotic twins vs. dizygotic twins.
• Environmental triggers and immunological cross-reactions, particularly to Strep infection had been implicated. Specifically, in PANDAS - Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus, is attributed to immune response to Group A Strep, which can cause cross-reactivity and inflammation of basal ganglia. This can produce (the somewhat controversial) syntrome of PANDAS, which involves tics, OCD, and hyperactivity.

Diagnosis

Presentation

Children may have compulsions without obsessions.

Common obsessions

• The most common obsessions in children and adolescents involve aggressive and catastrophic worries (e.g death of parent); these become less common in adults. (Geller DA, J Nerv Men D/o 2001)
• Sexual and religious obsessions are more common in adolescents.
• Contamination worries are common throughout the developmental spectrum.

Common compulsions

• Most common compulsions across the developmental spectrum involve checking, cleaning, and ordering rituals.
• Hoarding compulsions are more common in children in adolescents and become less common in adults. (Geller DA, J Nerv Men D/o 2001)