Obsessive-compulsive disorder (OCD) is part of a cluster of diagnoses called the obsessive-compulsive and related disorders. Obsessive-compulsive and related disorders are a group of psychiatric conditions that include:
These disorders are characterized by the occurrence of repetitive behaviors, often called compulsions. Children with obsessive-compulsive disorder might engage in compulsive behaviors such as excessive washing, checking, arranging, or counting. Children with body dysmorphic disorder might engage in frequent checking of their appearance in the mirror, or excessive grooming-related behaviors. Children with hoarding disorder may engage in excessive acquiring of objects, combined with a strong need to save items. Children with trichotillomania engage in excessive hair pulling, and children with excoriation disorder engage in excessive skin picking.
In some cases, the obsessive-compulsive and related disorders are also characterized by intrusive, unwanted, or distressing thoughts, called obsessions, which come to mind again and again. Children with obsessive-compulsive disorder might have obsessive thoughts about dirt or germs, fears of something terrible happening, thoughts of harming others, fears of making mistakes, or distress about things being out of order. Children with body dysmorphic disorder have repetitive, negative thoughts about their own appearance. However, children with certain other obsessive-compulsive and related disorders (such as trichotillomania or excoriation disorder) often do not experience obsessive thoughts.
OCD is a psychiatric disorder that affects approximately 1 - 3% of children and adolescents. OCD is characterized by two main symptoms:
There are many different kinds of obsessions and compulsions. Some of the more common ones in children are:
OCD severity can range from mild to debilitating. In severe cases, OCD can lead to inability to attend school or engage in family or recreational activities. Many children and adolescents with OCD also have other psychiatric conditions, most commonly anxiety disorders. A younger age of onset of OCD is associated with an increased likelihood of certain comorbid conditions, including anxiety and attention deficit-hyperactivity disorder.
OCD is characterized by abnormalities of brain function which are thought to contribute to symptoms. In particular, evidence points to a hyperactive loop extending from the frontal cortex to the basal ganglia, which affects inhibition of thoughts and behaviors, modulation of emotion, and other aspects of the disorder. In addition, compulsive behavior and avoidance of feared situations are thought to contribute to the persistence of obsessive fears. OCD disorder has a genetic component, although having a genetic predisposition to OCD does not necessarily mean that someone will develop OCD.
In a small number of pediatric OCD cases, OCD symptoms may result from exposure to a subtype of streptococcal infection. In these cases, OCD onset is abrupt and accompanied by other symptoms, including a clear decline in handwriting and mathematical ability.
OCD is treatable. Published treatment guidelines for children and adolescents with OCD include those from the American Academy of Child and Adolescent Psychiatry and the National Institute for Clinical Excellence.
First Line Treatments
Other Effective Treatments
In cases of nonresponse to first-line treatment, alternative treatments with reasonable evidence of efficacy include:
In addition, research suggests that the following treatments are promising:
First Line Treatments
Other Effective Treatments
In cases of nonresponse to first-line treatment, alternative treatments with reasonable evidence of efficacy include:
In addition, research suggests that the following treatments are promising: