Obsessive-Compulsive Disorder

in Childhood and Adolescence

Prepared by:
Chino M. dela Cruz

Characterized by
Recurrent

intrusive thoughts
associated with anxiety or fear
and/or repetitive purposeful
mental or behavioral actions
aimed at reducing fears and
tensions caused by obsessions.

Epidemiology
OCD

is common among children

and adolescents
Point prevalence of 0.5%
Lifetime prevalence of 2-4%
Among young children with OCD,
there is a slight male
predominance that decreases
with age

Etiology
GENETICS
Rate of OCD among 1st degree
relatives of children and
adolescents with OCD is ten
times greater than the general
population.
OCD has been recognized to run
in families

Susceptibility

loci on
chromosomes 1q, 3q, 6q, 7p, 9p,
10p and 15q
Sapap 3 gene promising
candidate gene for OCD

Neuroimmunology
Hypothesized

to be related to an
inflammatory process in the
BASAL GANGLIA a/w an
autoimmune response to an
infection that may trigger OCD
and tics.
Prototype of this hypothesis: OCD
in small group of children and
adolescents following
documented exposure to or
infection with GABHS

Termed

as PANDAS (Pediatric
Autoimmune Neuropsychiatric
Disorders Associated with
Streptococcus)

Neurochemistry
Evidence

suggest that multiple

neurotransmitter systems play a
role in OCD
Serotonin and Dopamine
Clinical obsessions and
compulsions may be exacerbated
during treatment of ADHD
SSRIs diminish symptoms of OCD
Can be augmented by dopamine
antagonists

Neuroimaging
Children

and adults with OCD

have:
Smaller volumes of basal ganglia
segments
Smaller gray matter density in
parietofrontal cortical regions and
anterior prefrontal cortex
Hypermetabolism of frontal corticalstriatal-thalamocortical networks
(adult studies)

DIAGNOSIS AND CLINICAL

FEATURES
Most

common reported
obsessions in children:
Extreme fears of contamination
Worries related to harm befalling
themselves, family members
Fear of harming others due to losing
control over aggressive impulses

Typical

compulsive rituals in
children and adolescents:

Cleaning
Checking
Counting
Repeating behaviors
Arranging items

Associated

behaviors:

Avoidance
Indecision
Doubt
Slowness to complete tasks

DSM

5 added specifiers: good,

fair, poor and absent insight
High comorbidity with: anxiety
disorders, ADHD, tic disorders
(esp. Tourettes syndrome)

Pathology and Laboratory

Examination
No

specific labs are useful in

diagnosis of OCD

Differential Diagnosis
Children

and adolescents with

GAD, separation anxiety disorder,
and social phobia experience
intense worries that are often
expressed repeatedly but are
mundane compared to
obsessions.
Children with autism may also
display repetitive behavior

Course and Prognosis

Chronic,

waxing and waning

disorder with variability in
severity and outcome
40-50% recover with minimal
residual symptoms
If with subthreshold OCD
symptoms, high risk of
developing full OCD disorder
within 2 years

Responsive

to available
treatments, resulting in
improvements, if not complete
remission, in the majority of
cases.

Treatment
CBT
SSRIs
POTS

(Pediatric OCD Treatment

Study) revealed that combination
treatment was superior to either
treatment alone