Obsessive-Compulsive Disorder (OCD)

BASICS

A disorder characterized by pathologic obsessions (recurrent intrusive thoughts, ideas, or images) and/or compulsions (repetitive, ritualistic behaviors, or mental acts) that are time-consuming and cause significant distress
Not to be confused with obsessive-compulsive (anankastic) personality disorder

Three subtypes: child/adolescent-onset (age <18 years), adult-onset (18 to 39 years), and late-onset (age ≥40 years).
Child/adolescent-onset in 50% of cases (usually by age 18 years) (1)
Consider pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) in acute presentation of OCD and tics in children (2).
Consider neurologic or neurodegenerative disorders in new-onset OCD.

~2% lifetime prevalence; slight female predominance when including postpartum OCD

While the exact etiology of OCD is unknown, genetic, anatomical, neurochemical, and environmental factors are believed to contribute to the disorder.
Dysregulation of serotonergic, catecholaminergic and glutamatergic pathways
Dysfunction of cortico-striatal-thalamo-cortical (CSTC) circuit, involving the orbitofrontal cortex (OFC) and anterior cingulate cortex (ACC)
Stressors, trauma, and learned behaviors may be contributing factors to development of OCD symptoms

Prevalence rates of 7–15% in first-degree relatives of children/adolescents with OCD
~45–65% of the variance of OCD is explained by genetics

Family history of OCD
Advanced paternal and maternal age
Coexisting psychiatric disorders, most commonly anxiety disorders and schizophrenia
Antipsychotics such as clozapine and olanzapine with greater serotonergic blockade may cause symptoms of OCD
Brain insult (i.e., encephalitis, pediatric streptococcal infection, or head injury)
History of childhood traumatic events, including social isolation and physical abuse

Early diagnosis and treatment can decrease distress and impairment.

Major depressive disorder
Anxiety disorders including panic disorder/phobia/social phobia/generalized anxiety disorder
Tourette syndrome/tic syndromes
Substance abuse/eating disorder/body dysmorphic disorder
Other obsessive-compulsive-spectrum disorders including body-focused repetitive behaviors (trichotillomania, excoriation disorder), body dysmorphia, and hoarding disorder

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