Obsessive-Compulsive Disorder (OCD)
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- An anxiety disorder characterized by pathologic obsessions (recurrent intrusive thoughts, ideas, or images) and compulsions (repetitive, ritualistic behaviors or mental acts) causing significant distress
- Not to be confused with obsessive-compulsive personality disorder
- Predominant age: mean age of onset 22 to 36 years
- Male = female (males present at younger age)
- Child/adolescent onset in 33% of cases 1/3 of cases present by age 15 years
- 85% of cases present at <35 years of age
- Diagnosis rarely made at >50 years of age
- Predominant gender: female > males but males more commonly affected in childhood
Insidious onset; consider brain insult in acute presentation of childhood OCD.
Consider neurologic disorders in new-onset OCD.
- 2.3% lifetime in adults
- 1–2.3% prevalence in children/adolescents (1)
Etiology and Pathophysiology
- Exact pathophysiology/etiology unknown
- Dysregulation of serotonergic pathways
- Dysregulation of corticostriatal-thalamic-cortico (CSTC) path
- Genetic and environmental factors
- Pediatric autoimmune disorder associated with streptococcal infections
- Greater concordance in monozygotic twins
- Positive family history: prevalence rates of 7–15% in first-degree relatives of children/adolescents with OCD
- Exact cause of OCD is not fully elucidated.
- Combination of biologic and environmental factors likely involved the following:
- Link between low serotonin levels and development of OCD
- Link between brain insult and development of OCD (i.e., encephalitis, pediatric streptococcal infection, or head injury)
- OCD cannot be prevented.
- Early diagnosis and treatment can decrease patient’s distress and impairment.
Commonly Associated Conditions
- Major depressive disorder
- Panic disorder
- Phobia/social phobia
- Tourette syndrome/tic syndromes
- Substance abuse
- Eating disorder/body dysmorphic disorder